What is the cause of nocturnal enuresis (bedwetting) and how to treat it?

Today, in medicine, night enuresis or bed wetting is not considered a violation, but a stage in the maturation of the nervous system, which includes control over physiological functions.

Short information about nocturnal enuresis (bedwetting) in children

Due to the variety of causes and factors that provoke urinary incontinence and nocturnal enuresis in children, pediatric doctors of various profiles are involved in the therapy of enuresis: urologist, neurologist, nephrologist, psychiatrist and others.

Until about 2-2.5 years of age, the child relieves unconsciously, since urination is reflex in nature. At a certain level of filling of the bladder, nerve impulses are sent from it to the brain about the need for emptying.

However, already at the age of 4 years, children begin to control the urge of the bladder, adequately assessing the signals about the degree of its fullness. This skill allows parents to teach the child to relieve themselves in the potty (later in the toilet) as needed or beforehand, for example, before a walk.

Control over the function of the bladder, which means the appearance/absence of nocturnal enuresis, depends on the individual characteristics of the child:

- Circadian rhythm of hormone secretion, especially vasopressin;
- Genetic properties of the nervous system (maturation rate, plasticity, etc.);
- Urological disorders (structural anomalies, diseases);
- The presence of a delay in the development of the nervous system, etc.

If urinary incontinence occurs in children after 4-4.5 years, it is necessary to consult a specialist, since enuresis can be part of the symptom complex of various disorders and diseases. According to WHO statistics, under the age of 5 years, bedwetting is typical for 10% of children, mainly boys.

The success of the treatment of enuresis is based on a timely visit to a doctor, careful observance of all their recommendations and the help of parents (we will consider the rules of parenting behavior below).

Signs indicating a mandatory visit to a pediatrician are:

- Difficulties in controlling urination in a child, both day and night;
- Relapse of enuresis after a long "dry period";
- Frequent urge to urinate;
- Frequent thirst, especially accompanied by leg swelling;
- Urinary incontinence after reaching 5 years of age.

Modern medicine offers a wide range of treatments for bedwetting, but the best results are achieved with an integrated approach. Typically, therapy for urinary incontinence is long-term, but has a favorable prognosis. According to clinical observations, only 1% of cases of enuresis recurs in adulthood.

What is bedwetting in children?

Enuresis - persistent involuntary urinary incontinence in a child over 5 years old (nocturnal, daytime, or combined). Nocturnal enuresis is incontinence of urine during sleep, at the age when the child is expected to fully develop a mechanism for controlling the function of the bladder. Daytime enuresis is urinary incontinence while awake, suggesting neurogenic bladder dysfunction.

Specialists distinguish the following main types of bedwetting:

- Primary (persistent), nocturnal urinary incontinence, which occurs due to a delay in the formation of a physiological reflex (that is, the child urinates in sleep from being an infant persistently);
- Secondary (acquired), which develops as a result of numerous factors and manifests itself at any time of the day (there is a disintegration of the formed conditioned reflex);
- Complicated, appearing as a result of serious somatic or mental illnesses (urogenital infections, diabetes mellitus, etc.);
- Uncomplicated, in which there are no deviations from the norms in health and development;
- Neurosis-like, developing as a result of nervous system infection or an intrauterine malformation of the child;
- Neurotic, characteristic of children with an unstable nervous constitution and appearing in response to a stressful situation.

Enuresis is diagnosed according to the following criteria:

- The frequency of involuntary or deliberate urination occurs at least 2 times a month in children under 7 years of age;
- Frequency of involuntary or deliberate urination at least 1 time per month in children over 7 years old;
- Duration of urinary incontinence more than 3 months;
- Lack of objective reasons for urinary incontinence (developmental anomalies, psychopathology, etc.).

What causes the child to have urinary incontinence?

Urinary incontinence can develop in a child due to physiological and neurological causes.

The main reasons for the development of enuresis are:

- Side effects of drugs;
- Urogenital infections;
- Stress;
- Endocrine dysfunction;
- Malformations of the organs of the urinary system;
- Obstruction (narrowing) of the upper airways;
- Epileptic seizures;
- Allergic reactions;
- Viral damage of the nervous system, etc.

A history of enuresis in at least one of the parents increases the child's risk of a disorder by 40%.

What doctor treats enuresis in children?

It is believed that qualified medical care is needed if urinary incontinence occurs more often than once every 21 days (in the interval between dry periods, the conditioned reflex of control does not have time to gain a foothold).

As we have already mentioned, the problem of enuresis in children is dealt with by a multidisciplinary team of doctors. However, the first step is to make an appointment with your pediatrician. This specialist, on the basis of complaints and analysis of family history, will send the child for general tests (urine and blood tests, ultrasound of the kidneys and ultrasound of the bladder with determination of residual urine) and for consultation with specialists.

Depending on the cause of enuresis, the following specialists are involved in treating the disorder:

- A pediatric urologist who is responsible for the health of the urinary system. The doctor may prescribe additional studies to clarify the nature of urinary incontinence (cystoscopy, or uroflowmetry);
- Pediatric nephrologist, since the violation can be caused by improper structure and functioning of the kidneys;
- A pediatric neurologist who detects the absence of disorders in the work of the spinal cord and brain;
- Child psychologist or psychotherapist, correcting the psychological state of the child;
- Physiotherapist or reflexologist;
- A pediatric gynecologist or andrologist, since the occurrence of enuresis is often associated with the presence of infections of the urogenital tract or anomalies in the structure of the genital organs.

How is nocturnal enuresis in children treated?

The tactics and composition of therapy for urinary incontinence in children depend on the etiology of the disorder. Therapeutic and prophylactic measures for eliminating bedwetting in children are diverse and are mainly carried out on an outpatient basis (with the exception of therapy for pathologies of the urine excretion organs).

The most popular medical treatments for urinary incontinence in children are:

- Medication course using hormonal drugs, antidepressants (for instance, Imipramine) or sedatives;
- Non-drug therapy (psycho- and physiotherapy, remedial gymnastics);
- Regimen change.

The set of treatment methods makes it possible to exclude the influence of factors provocateurs of the disorder and significantly increase the effectiveness of medical procedures.

In order to improve and consolidate the result of therapy, parents must adhere to the following rules of behavior:

- Provide comprehensive psychological support during treatment;
- Do not punish or scold the child for episodes of urinary incontinence;
- Do not discuss the problem with strangers in the presence of the child;
- Do not put on diapers at night (but use them on the road, at a party and on a walk if a child suffers from daytime incontinence);
- Observe the daily routine and put the child to bed no later than 9 pm;
- Put the child on a potty (toilet) before going to bed;
- Avoid overexcitation and fatigue before bedtime (active games, watching cartoons, etc.);
- Do not leave the child alone in a dark room;
- Avoid overcooling;
- Do not wake and take the child to the toilet during deep sleep, as this interferes with the rest of the nervous system and can aggravate the situation;
- Limit the intake of liquids and liquid meals before bedtime (about 3-4 hours before bedtime).

Also, an effective measure in eliminating enuresis is the organization of children's sleep on a hard surface with an elevation in the area under the knees (a roller of the appropriate size). During the treatment process, it is advisable to optimize the diet and not give the child products that have a diuretic effect (chocolate, watermelon, cocoa, etc.).

Can enuresis in children be cured?

A correctly selected combination of therapy methods provides a quick therapeutic effect in 30% of patients, but an incomplete course of treatment can provoke a relapse of the disorder. Often, the treatment of bedwetting is long-term, requiring the coordinated efforts of parents and doctors, but in most cases there is a complete recovery after reaching the age of 6-7 years.

Tactfulness and psychological support of parents greatly increases the speed of recovery of the child and minimizes the likelihood of re-emergence of the disorder.

It is not recommended to self-medicate and use traditional methods of therapy without the approval of a doctor. Herbal preparations contain biologically active substances that can negatively affect the functioning of the children's urinary system and aggravate the problem. Timely access to a doctor and the use of therapeutic procedures with proven effectiveness determine the success of treatment.

Post by: John Avery, General Practitioner, Manchester, United Kingdom