Nocturnal enuresis (bedwetting) in kids older than 5 years

Enuresis is a disease common in kids, distinguished by involuntary urination resulted from an inability of the kid to control urination.
The causes of the disease can be different so a multifaceted approach is needed. For the diagnosis, it recommended consulting a pediatrician, urologist, nephrologist, neurologist, and psychotherapist.

Short information about nocturnal enuresis (bedwetting) in children

Description of the disease

The most common form of the disorder is bedwetting, i.e. involuntary urination during sleep. Commonly, it occurs in preschoolers and primary school children. The disease can be diagnosed if a child urinates during sleep once reaching 5 years of age. In younger children, it is not considered a deviation from normal development.

To correctly diagnose the cause of the disease it can be required to undergo examinations of different health specialists because the causes could be very different. First, you need to consult a pediatrician, then a pediatric neurologist, urologist, psychologist, and in the case of girls, sometimes a gynecologist’s consultation is needed.

Symptoms of bedwetting

The main symptom of bedwetting is involuntary urination during sleep. The episodes can occur every night or recur regularly only a few times per week or month. It should be noted that when a child involuntary urinates during sleep, they do not wake up.

Nocturnal urinary incontinence rarely exists on its own. As a rule, it is accompanied by various neurotic o autonomic disorders, for example:

- Slowing down of the pulse;
- Decrease in body temperature;
- Blue hands and feet;
- Emotional lability (frequent mood swings);
- Irritability;
- Reticence;
- Decline in school performance;
- Bruxism (teeth grinding during sleep);
- Restless sleep, etc.

In addition, children with enuresis often experience manifestations of concomitant diseases: recurrent urinary tract infections, encopresis (fecal incontinence), dermatitis, and other skin pathologies (due to frequent skin contact with urine).

Causes of bedwetting

Urination is a complex process involving many structures in the body. In children, controlled urination begins only from the moment when the brain is "included" in this process and a conditioned reflex arises. Normally, the urine accumulated in the bladder presses on its walls, provoking irritation of the receptors that signal the need for emptying. The signals reach the child's brain, and they wake up, realizing the needs to go to the toilet.

However, under the influence of a number of factors, this process can fail, and then enuresis occurs.

The causes of infantile enuresis:

- Delayed development of cerebral centers of urination. Normally, from 2 to 4 years old, the nerve centers that control urination are finally formed. However, in some children, their development is delayed, as a result of which primary enuresis occurs.
- The presence of diseases of the genitourinary system. Congenital and acquired pathologies of the excretory and reproductive systems can lead to urinary incontinence. For example, the abnormal structure of the urethra (its narrowing), the presence of infectious and inflammatory diseases (vulvovaginitis, balanoposthitis, pyelonephritis, cystitis, etc.).
- Endocrine disorders. Some diseases accompanied by hormonal disorders can provoke the development of enuresis, for example, diabetes mellitus, hypothyroidism, hyperthyroidism, etc.
- Exposure to stress. With psychological trauma suffered by the child, secondary enuresis develops. Most often the pathology is triggered by divorce of parents, moving, changing kindergarten/school, the appearance of a new family member, the death of a loved one, a tense situation in the family, conflicts with peers.
- Hereditary predisposition. The likelihood of uncontrolled urination is significantly increased if one or both parents have ever suffered from bedwetting.

It should be noted that in most cases, not one, but several factors at once (for example, heredity together with stress) lead to the occurrence of pathology.

Diagnosis of bedwetting

Several multidisciplinary specialists are involved in the diagnosis of enuresis. The problem of urinary incontinence is very delicate, requiring the establishment of psychological contact with the little patient, their parents and doctors. Only joint efforts will help to permanently cope with uncontrolled urination.

Diagnosis of children with enuresis is carried out in several directions:

- Urological and gynecological (for girls) examination. At this stage, possible pathologies of the structure and functioning of the organs of the genitourinary system are identified. Physical examination, as well as instrumental and laboratory diagnostics such as ultrasound of the kidneys and bladder, cystography, urography, uroflowmetry, as well as laboratory tests that exclude the infectious nature of the disease, are performed.
- Neurological research. To exclude neurological disorders, the child is examined by a neurologist, after which the patient is sent for neurological examinations - neurosonography, EEG, MRI, spinal cord X-ray.
- Psychological diagnostics. To identify possible psychological factors provoking enuresis, the child and their parents visit a child and family psychotherapist.

Treatment of bedwetting

The tactics of treating enuresis directly depends on the nature of the onset of the disease. The pathology is treated with the help of drug therapy, physiotherapy and psychotherapy.

Drug therapy

To cure enuresis, a child can be given different groups of drugs:

- If the pathology is a result of the immaturity of the nervous system, the patient is given nootropics. Treatment with nootropic medicines can be quite extended.
- If the disease is caused by an infection, the child needs a course of antibiotic therapy. The type of medication and dosage are chosen exclusively by the doctor.
- Since primary enuresis in commonly caused by the violation of secretion of the hormone vasopressin, the use of a synthetic analog of this hormone, Desmopressin, can be prescribed.
- If a child also suffers from sleep disturbances, irritability, anxiety, depressive conditions, the use of tranquilizers, sedatives, and antidepressants (for instance, Clomipramine) is prescribed.
- In case of violation of the tone of the bladder, it is necessary to take antispasmodics, muscle relaxants.

Physiotherapy

Physiotherapeutic procedures have proven themselves well in the treatment of uncontrolled urine discharge. The following physiotherapy methods are used:

- Reflexology;
- Magnetotherapy;
- Laser treatment;
- Electrophoresis, etc.

Psychotherapy

Classes with a psychotherapist are indicated for children with the presence of certain neurotic disorders. Not only child psychotherapy is widely used, but also family therapy. With the joint solution of the problem of bedwetting by the child and the parents, the results are achieved much faster, and relapses occur much less frequently.

Other methods

One of the modern and most effective methods of dealing with enuresis is the use of enuresis (urinary) alarms. These devices interrupt the child's sleep when the first drops of urine occur. Gradually, the child learns to wake up on his own even with the initial urge to urinate.

To prevent the act of involuntary urination, you must adhere to certain recommendations:

- Get rid of the habit of drinking before bed.
- Eliminate diuretic drinks (such as coffee) from child’s diet.
- Teach your child to always go to the bathroom before bed.
- Create trusting relationships in the family, avoid conflicts.
- Timely treat diseases of the genitourinary system.
- Do not self-medicate, select medications exclusively with your doctor.

Whichever method is chosen, it should be understood that the treatment of enuresis is a long-term process, the success of which directly depends on the participation of the parents. The child should be encouraged at the slightest success and in no case be berated for relapse of enuresis. Remember that the child does not urinate in bed on purpose, this is a physiological process that they are not yet able to control.

Post by: Kylie Richardson, General Practitioner, Rotterdam, Netherlands