Voiding disorder is one of the problems frequently encountered in outpatient clinics in childhood. Your children's complaints may be only nighttime urinary incontinence, or they may be a clinical picture accompanied by various signs and symptoms that alternate between day and night urinary incontinence. Normally, children achieve nighttime urinary control at the age of 4, and daytime control is achieved earlier.
Bedwetting in children may be a simple developmental problem (maturation delay) or a congenital anatomical problem (nervous system diseases involving the brain and spinal cord). It may also be caused by congenital abnormalities of the urinary tract).
Every year, 15 percent of children between the ages of 5-19 who wet the bed only during sleep (at night) recover spontaneously.
In children, with age. Even though the bedwetting problem decreases, psychological problems arise for both parents and children during the healing process or in non-healing cases.
The fact that the bedwetting problem causes social and psychological problems in both the child and the family is the most important indicator of the need for treatment. Studies have shown that untreated children become withdrawn in social environments and fail in their classes.
Classification of bedwetting problem:
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Post-voiding dripping is the situation where the child drips urine onto his/her underwear after standing up after urinating due to urine accumulation in the lower part of the vagina. It is associated with malposition during urination. It is usually seen in obese girls. It can be prevented by sitting upright on the toilet and opening the thighs well during urination.
Day-Night bedwetting:
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Dysfunctional Voiding: It is the child's urination by contracting the sphincter and pelvic floor muscles, which are used to hold urine at the base of the bladder, during the bladder emptying phase, as a result of incorrect urination training. Children face the situation of intermittent urination and inability to fully empty the bladder after urination. Constipation also accompanies this.
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"URGE" Syndrome (OVERACTIVE BLADDER): Urge in the period when the bladder begins to fill with urine It is a condition in which urinary incontinence occurs due to contraction and the increase in pressure resulting from these contractions. Presenting complaints are daytime urinary incontinence, urgency, frequent urination of small amounts, bedwetting, constipation and urinary tract infection. Vesicoureteral reflux (VUR) is common in these children.
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Underactive bladder (LAZY BLADDER): It is urination 2-3 times a day. The child leaks urine between urinations. It is a clinical condition that manifests itself when the bladder cannot contract sufficiently to empty the urine and urine remains in the bladder after urination. The bladder has a large capacity, the feeling of fullness is reduced, and discharge occurs in the form of overflow incontinence. These children have a weak urine flow and urination cannot occur completely. It is often accompanied by constipation and cystitis. It is more complex and difficult to treat than the first two diseases.
Only bedwetting at night
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Primary enuresis nocturna: It is bedwetting only at night while sleeping, without any complaints during the day. The presence of family history, low functional bladder capacity, ADH (antidiuretic hormone) deficiency and night waking problems are the main reasons.
The importance of this classification stems from the fact that the treatments for each disease described above are different. . Bedwetting is the most important problem in every disease. Success in treatment depends on the correct diagnosis.
Therefore, for the diagnostic approach, a detailed history, physical examination, at least a two-three day urination calendar to be followed by the family (fluid intake in terms of time, amount and type of fluid and time in quantity). Examinations such as monitoring chart showing urine and even stool excretion), urine analysis and urine culture, urinary system ultrasonography and detailed pelvic ultrasound, uroflowmetry and videourodynamics in toilet trained children are required. In cases requiring more detailed examination, renal scintigraphy can be performed.
According to the diagnosis made in the treatment; Treatment of constipation, urination-related behavioral treatments, drug treatments, physical therapy, biofeedback, neuromodulation and, in necessary cases, surgical treatment options are applied alone or in combination.
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