What is bedwetting at night?

What is bedwetting at night? What is the frequency?

It can be defined as involuntary urination and is called nocturnal enuresis at night and diurinal enuresis if it occurs during the day. Urinary incontinence is one of the most common problems in children. For the definition of nocturnal enuresis, urinary incontinence more than twice a month is sought despite the age of 5 years.
Most children manage to hold their urine both day and night between the ages of 2 and 4. Urine control occurs in parallel with the development of the nervous system. In infancy, urination occurs completely reflexively. Although 40% of three-year-olds wet the bed, this rate drops to 15% at the age of 5 and 10% at the age of 10. Nocturnal enuresis is 50% more common in boys than girls. 85% of children with enuresis nocturnal have normal daytime voiding habits and have no other abnormalities in their urological history, but 15% have daytime voiding problems. Enuresis has a 15’s law; 15% of 5-year-olds are wet, 1% of 15-year-olds are wet, 15% have incontinence, 15% become dry each year, 15% have daytime urinary problems , 15% have initial dry periods.

How many types of bedwetting are there and what are the causes?

There are two types of bedwetting at night. If it has not been dry at all since birth, primary (primary) type is mentioned as secondary (secondary) type bedwetting if it has started to wet the bed after being dry for at least 6 months. The vast majority of children who wet their beds are in the primary bedwetting group. Sometimes, bedwetting may be accompanied by symptoms such as frequent and urgent need to urinate. Bedwetting at night is divided into two groups, physiological and organic, according to its causes. A large group (90-95%) of children who wet the bed at night are gathered in the physiological bedwetting group, this type of bedwetting problem can also be called non-organic enuresis. It has been reported that these children have insufficient feeling of bladder fullness during sleep at night, their bladder capacity is small and their depth of sleep is high. Normally, there is approximately 50% less urine output at night than during the day. This plasma arginine occurs due to the increase in vasopressin at night. Enuretic children have similar vasopressin levels both during the day and at night, which causes them to produce more urine at night.

Importantly, bedwetting is largely based on genetic predisposition. If one of the parents has a history of bedwetting, 43% of the children have a history of bedwetting, if they both have it, 77% of the children have a bedwetting problem, and if both parents don’t have a history of bedwetting, 15% have a bedwetting problem (uncle, uncle, aunt, aunt). Cases with a family history show a similar course to their families in terms of recovery time.

Are there any problems with sleep?

The fact that wetting occurs during sleep raises the question of whether there is a sleep disorder that causes them to sleep very deeply or prevents them from waking up. However, studies have shown that there is no difference from normal children.

What diseases does it accompany?

Problems such as diabetes, kidney diseases and bladder diseases are detected in 2-3% of children who wet the bed. In 5-10% of the cases, bedwetting is accompanied by complaints such as frequent and urgent need to urinate. These are defined as “polysymptomatic bedwetting”. Urinary tract infection, bacteria in the urine, constipation and sometimes food allergy are detected in these children. In addition, in recent years, it has been emphasized that a high rate of bedwetting is observed in children with adenoid vegatation, which is known as “nasal meatus” among the people, and that their complaints after surgery are gone.

psychological problems

In general, psychological events do not cause the aforementioned primary bedwetting problem. For this reason, there is no need to look for a mental problem in the majority of children who wet the bed. In addition, it should be kept in mind that prejudices such as bad children wet the bed are invalid. If bedwetting occurs after a mental problem, it is usually a reoccurrence of physiological bedwetting. In addition to bed wetting at night, children with behavioral regression have additional symptoms such as school failure and fear, and these must be seen by child psychiatrists.

How to approach

We should immediately and strongly state that the wrong attitudes of families and society harm these children more than the bed-wetting itself. The most dangerous of these are the attempts to punish sexual areas, which are the subject of news headlines such as “She made her daughter sit on the stove”. Such attitudes leave traces on children that will last a lifetime. It should not be forgotten that children who wet the bed experience a physiological developmental delay (such as a delay in teething, speech delay) and the main task of the family is to ensure that the child’s self-esteem is overcome without damaging it. For this reason, children who wet the bed should be evaluated by a urology specialist at the age of 6 at the latest and a treatment plan should be made after the necessary examinations are made.

What kind of tests should be done in children who wet the bed?

To diagnose enuresis nocturna and distinguish it from more serious voiding disorders, it should be evaluated by a specialist urologist.

Children brought to the doctor with the complaint of bedwetting should be examined for the presence of the previously mentioned organic factors. For this reason, it should be investigated whether there are complaints such as incontinence during the day, difficult urination, constipation, difficult and urgent urination, excessive urination, head trauma, incontinence with urine, snoring and mouth breathing at night. According to the information obtained and the results of the general examination, a series of tests ranging from urine examination to bladder films should be performed. In 97% of children who wet the bed, there is no physical reason. Therefore, a detailed history often gives information about whether physiological bedwetting is present. At this point, it is important to clarify whether the child who wets the bed has a “small bladder” or not being able to wake up from sleep.

Taking a detailed disease history and making inquiries
Keeping a voiding-defecation schedule
Extended physical examination
A complete urinalysis is usually sufficient.

After these steps, if it is decided that the disease is a “pure primary night-wetting” problem, the treatment phase is started. If the urology specialist decides that the event is a more complex and comprehensive problem, more detailed examinations are performed by applying advanced diagnostic methods.

Methods used in treatment

In general, it is recommended that children who wet the bed should be treated when they reach the age of 7-8 years. At the beginning of these initiatives are programs for the child himself or his family to wake up at night. A program is implemented that allows the family to wake the child at night and go to the toilet. This program has achieved 90% success.

Alarm use and drug therapy in treatment

Alarm devices are devices that act as soon as the child starts to leak urine, thus helping the child wake up and control his bladder. With this treatment, 70-84% improvement is achieved in children. Various drugs have been used for many years in the treatment of bedwetting. There is a recurrence risk of up to 90%.

Bedwetting is a common problem in childhood and it is an issue where the wrong attitudes of families continue. First of all, children who wet the bed should be evaluated by the pediatricians who are interested in the subject and a long-term treatment approach should be tried with the participation of the family.

basic principles

Getting up at night and going to the toilet should be a goal
Access to the toilet should be made easier
Help the child take responsibility for staying dry
Avoid excessive fluid intake 2 hours before going to bed.
Drinks containing caffeine should never be given.
Going to the toilet before going to bed
Cloth should not be tied to keep it dry at night (it negatively affects the motivation to get up at night)
Child participation in morning cleaning should be ensured.
Children’s self-esteem should be supported
Guidelines that tell families how to behave should be prepared.
Which days the children stay dry should be engraved on a card
Children should be checked at least once a month.

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