Enuresis; It is the involuntary discharge of urine in people over the age of 5. It is defined as this behavior occurring at least twice a week for three months, causing problems with school or social life, and not being due to a medical disorder.
Urinary incontinence during sleep is caused by enuresis nocturna (nocturna). Enuresis), urinary incontinence that occurs during the day while awake, is called Enuresis diurna (diurnal enuresis), and the situation where both occur together is called Enuresis continua (continual enuresis). If enuresis has been ongoing since infancy, it is defined as primary, and if it started after at least 6 months of dryness, it is defined as secondary enuresis. Enuresis is mostly seen as night urination (noctural enuresis).
Enuresis is also classified according to the way it starts. In the vast majority of cases, approximately 85%, enuresis continues from infancy without interruption. This is called primary enuresis. In the remaining 15%, after toilet training is completed and control is achieved, bedwetting begins. This condition is called secondary enuresis.
It is estimated that there are more than 50 million children with enuresis all over the world. The incidence varies depending on the age of children. 15-20% respectively at age 5; 5% at age 10; It is 2-3% between the ages of 10-17 and 1% at the age of 17. Each year, 15% of enuretics resolve spontaneously. It is 1.5 times more common in boys than girls.
Causes of enuresis
The first possibility is that there is a problem in the urinary tract?
If the second possibility occurs, consult a psychologist or a psychologist. You should see a psychiatrist.
They are divided into biological and psychosocial reasons.
Biological Factors
Hereditary factors: Approximately 75% of enuretic children are affected. A first-degree relative has had enuresis in the past.
Hormonal factors: Some children have abnormalities in antidiuretic hormone (ADH) functions. ADH is a hormone secreted by the pituitary gland. This hormone signals the body to 'keep the fluids, don't let them go'. Thanks to the ADH hormone, a slightly more concentrated urine is produced. In cases where the ADH hormone is low, the child has a higher tendency to produce light-colored urine and wet the bed.
With Bladder Physiology � Related Situations: Lower bladder capacity may cause enuresis.
Sleep Disorder: Some parents have said that their children lose their diapers during deep sleep. However, there are no such results in studies on sleep. Although the deep sleep durations of enuretic and non-enuretic children are equal, bedwetting is seen equally in every phase of sleep
Other factors: The frequency of urinary tract infection in enuretic patients is 5%, and urinary tract history is approximately five times more common in girls. Structural, dynamic and infectious problems in the urinary structure can also lead to enuresis.
Psychosocial Factors
In the majority of enuretic children, bedwetting occurs involuntarily. and is unconscious. Do you have an organic disorder? He needs to be looked after. Is it a primary cause or a secondary condition? Do your parents have fights? Do your parents have distance separation? For example, the father goes to the officer or police station and the child may react such as wetting the bed or going to bed. In voluntary enuresis, additional diagnoses such as psychological disorder or oppositional defiant disorder are usually made. Secondary enuresis, which begins with the birth of a sibling, may be a sign of regression (protective impulse). He may be displaying a passive-aggressive expression against his overly clean and meticulous parent's education. The overprotectiveness of the family may manifest itself in the child's tendency to remain babyish. It can be seen in people who have experienced migration or similar social stress.
Treatment
Enuresis treatment is seen in 3 ways today.
1.Medication treatment: Although drug treatment is controversial, it is frequently used because it gives rapid results. In drug treatments, there is a high probability of recurrence after the treatment ends. Treatment is mostly used to reduce the amount of urine output at night based on the control of antidiuretic hormone (ADH) secretion and to tighten the bladder muscles.
2.Medication-free treatment: This method requires more frequent meetings with the child and family. Record keeping and encouraging dry nights. A schema method that the child can fill in without needing anyone else is recommended. Another method used is alarm s. prompt, the child is woken up as soon as it is noticed that he/she has started to wet the bed and is allowed to go to the toilet. Bladder training and reward-reinforcement are also used in this treatment method.
3. Other Treatment Methods:
Psychotherapy: Behavioral psychotherapies are very effective. It has an important place in treatment. Living with enuretic children is a source of stress for the family. Some families vent their anger by punishing their children. This Enuretic increases the child's stress. That's why individual psychotherapies and family therapies are effective.
Fluid restriction has not been proven to be effective, and the decrease in nighttime urine output has attracted attention in the treatment.
However, reducing fluid intake one hour before bedtime helps the treatment. .
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