Enuresis - Causes, Symptoms and Treatment

Enuresis also known as bed-wetting. Bed-wetting is fairly common. There are two kinds of enuresis: primary and secondary. Primary is nocturnal enuresis, that person has wet the bed since he or she was a baby. Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again. There might be a new psychological stress such as a divorce , a move, or a death in the family . It might be something physical: the onset of a urinary tract infection or diabetes , for example. It might be a situational change, such as altered eating, drinking, or sleeping habits. Clearly, something has changed. The first step in solving the problem is identifying any changes in your child's life.
There are three reasons why some children may still need to urinate at night. First is There is an imbalance of the bladder muscles. (For example, the muscle that contracts to squeeze the urine out is stronger, at moments, than the sphincter muscle that holds the urine in.). Second is bladders that are a little too small to hold the normal amount of urine.Third urine than their normal-size bladders can hold. Nocturnal enuresis (NE) is more common in males. Prevalence gradually declines during childhood. Of children aged 5 years, 23% have NE. During elementary school years, the problem remains common, with 20% of 7-year-old children and 4% of 10-year-old children still experiencing NE.

Persons aged 18 years and older, approximately 1-2% remain enuretic. Families of bed-wetters can experience disturbed sleep, turmoil, and a drain on energy and resources. Children have never achieved complete nighttime control. They have always wet the bed at least two times a month. Children with ADHD are 2.7 time more likely to have bedwetting issues. Difficulties waking up from sleep is cause of enuresis. Stress is controversial as a possible cause of bedwetting. Sleep issues are another controversial potential cause of bedwetting. Chronic constipation can cause bedwetting. Most bedwetting is caused by neurological-developmental problems involving multiple factors. Bedwetting cases are caused by specific medical situations. Bedwetting cases are caused by infection or disease, most common of which is a urinary tract infection. Bedwetting has a strong genetic component. Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively. Caffeine increases urine production. Tricyclic antidepressant prescription drugs with anti-muscarinic properties (i.e. Amitriptyline , Imipramine or Nortriptyline ) may be used to treat bedwetting with much success for periods up to 3 months. Diapers can reduce the embarrassment and mess of wetting incidents.

Causes of Enuresis

Common causes and risk factors of Enuresis

• Genetic factors.
• Difficulties waking up from sleep
• Slower than normal development of the central nervous system.
• Hormonal factors.
• Urinary tract infections.
• Abnormalities in the urethral valves in boys or in the ureter in girls or boys.
• Abnormalities in the spinal cord.
• Inability to hold urine for a long time because of small bladder.

Signs and Symptoms of Enuresis

Common sign and symptoms of Enuresis

• Children have never achieved complete nighttime control. They have always wet the bed at least two times a month.
• Children may suffer significant psychological stress and develop feelings of low self-esteem.
• Families of bed-wetters can experience disturbed sleep, turmoil, and a drain on energy and resources.

Treatment of Enuresis

Common Treatment of Enuresis

• Tricyclic antidepressant prescription drugs with anti-muscarinic properties (Amitriptyline , Imipramine or Nortriptyline ) may be used to treat bedwetting with much success for periods up to 3 months.
• Diapers can reduce the embarrassment and mess of wetting incidents.
• Positive attitude and motivation to be dry are important components of treatment. Children with NE benefit from a caring and patient attitude by their parents; punishment has no role.
• Alarm therapy offers the possibility of sustained improvement of NE and should be considered for every patient.
• Desmopressin acetate (DDAVP) is the preferred medication to treat children with NE. Numerous studies report total dryness in 38-55% of children treated with DDAVP.
• DDAVP tablets should be administered at bedtime. The recommended starting dose is 0.2 mg, and the drug can be titrated as necessary to a maximum of 0.6 mg.
• Anticholinergic medication may be helpful in some patients, especially those with urge syndrome, dysfunctional voiding, or neurogenic bladder. These medications reduce uninhibited detrusor contractions, increase the threshold volume at which an uninhibited detrusor contraction occurs, and enlarge the functional bladder capacity.
• Children should be instructed not to drink to excess with the evening meal and to minimize fluid intake after mealtime.