A guide for parents of children who wet the bed at night
What is bedwetting at night (enuresis)?
In general, it is the child aged 5 and over that should start night urine control, wetting the bed during sleep.
How often does it occur?
This situation, which is quite common, should be considered as part of the normal developmental process. While 30% of 3-year-olds wet the bed, 15% of 5-year-olds continue to wet the bed. There is an annual self-recovery rate of 15%. Bedwetting resolves spontaneously in 99% of 15-year-olds.
How many types of bedwetting are there?
In primary type bedwetting, urinary incontinence continues uninterruptedly from infancy. This accounts for about 75-80% of the problem. In secondary type bedwetting, urinary incontinence started after a period of at least six months of urinary control.
Some children have night wetting alone, with none of the symptoms of daytime incontinence. Nocturnal urinary incontinence can sometimes be a part of the frequent voiding disorder in some children. These children have a frequent and sudden need to urinate during the day. During this time, the child resorts to some urinary retention maneuvers (squatting, crossing the legs, pressing the perineum, squeezing the penis, etc.) to prevent urinary incontinence. In this way, it tries to prevent urinary incontinence by contracting the pelvic floor muscles. Constipation is also common in these children. If these inhibitions are not sufficient, daytime urinary incontinence occurs.
Why does it occur?
There are many different views and theories about the causes of this phenomenon. The three theories, which are the most classical and found to be intertwined in many cases, are increased urination at night, decreased bladder capacity and sleep factor. Usually, the amount of urine produced at night is half the amount of urine during the day. This is provided by a hormone that is secreted at night and reduces urine by helping the body retain water. If there is a problem in the rhythm of the release of this hormone, the amount of urine produced at night will exceed the bladder capacity of the child and night wetting will inevitably occur. Difficulty waking up at night when the bladder is full is also among the causes. Often night wetting occurs with the combination of these two conditions. If urine is stored, the bladder muscle should normally be relaxed and should be able to empty the bladder by contracting efficiently at the time of urination. In some children, when urine is stored during sleep, contractions occur in the bladder muscle and urine can escape.
How is it diagnosed?
A good history, voiding diary, and detailed examination are often diagnostic. Diaries provide information about the frequency and severity of the condition as well as investigate the presence of daytime symptoms and provide important information to the physician. A simple urinalysis will be helpful to investigate the urine density and the presence of infection. The urine flow curve and residual urine measurement are very useful to reveal whether a dysfunctional voiding is accompanying the event. If voiding history or urine flow curve suggests voiding dysfunction, evaluation of the upper urinary system with ultrasonography may be recommended. Very rarely, more invasive tests can be applied in treatment-resistant cases.
What is done in supportive treatment?
First, it can be helped to solve bedwetting at night with some simple precautions. Fluid restriction starting 2 hours before going to bed and emptying the bladder before sleep can be counted among these. Usually, night shifts occur within the first 2 hours of sleep. Therefore, the child should be lifted 1-2 hours after sleeping and taken to the toilet. Access to the toilet should be facilitated so that the child can go to the toilet by himself when he wakes up at night. There are some foods and drinks that make the bladder restless. These are cocoa, coffee, tea, carbonated drinks, acidic fruits such as lemons, oranges, tangerines, orange juice, lemonade and spicy foods and should keep the child away from them. In addition, the child should be educated about incontinence, urination should be recommended every two hours to reduce the feeling of urgency and urinary incontinence, daily fluid intake should be regulated (30 ml / kg / day), regular stool habits should be given to the child with diet and if necessary, physical activity should be increased in the child and long sitting should be avoided.
What is used in the treatment?
Today, there are two accepted successful treatment methods for children who continue to have night wetting after the age of 5. The first of these is the administration of analogues of the hormone (desmopressin), which reduces the amount of urine at night. This treatment method often gives results as soon as the drug is started to be used. The only disadvantage of this method, which also provides motivation for families and children, is the risk of relapse in drug discontinuation.
The second treatment method is alarm devices. The aim of alarm therapy is to develop a conditioned reflex and wake the child up at the onset of enuresis to enable him to perceive bladder fullness. This method is generally recommended for children who have difficulty waking up. Every time the alarm goes off, the family must wake the child and take him to the toilet. As can be expected, this is a method that requires patience and should be applied regularly for at least 3 months. The response to treatment begins to occur only at the end of this period and the recurrence rate is low.
A combination of these two methods can be used in some night-wetting children. In cases resistant to all these and especially with daytime symptoms, the success rate is lower even if other drugs are used.