Enuresis is uncontrolled urination at night in older children, when they are already able to control the process of emptying the bladder. Sleep incontinence can cause serious psychological problems for both the child and his family.
Causes of bedwetting
Enuresis is a fairly common phenomenon. It affects about one in seven children over the age of 5 and one in 20 over 10 years of age. Boys have this disorder twice as often as girls. Nocturnal urinary incontinence is still considered normal in children under 5 years of age.
There are two types of enuresis. If the child has not yet developed control over urination, and it occurs spontaneously, like in a baby, such enuresis is called primary. If the child has remained dry in bed for a sufficiently long period, and then again began to urinate in a dream, this is secondary enuresis.
The list of reasons why bedwetting occurs is quite extensive. Sometimes not one, but several factors lead to it. The most common cause is delayed neurological development. The baby's nervous system slowly processes the feeling of fullness in the bladder.
The genetic component plays an important role. Children whose one or both parents have had this problem themselves account for 44 percent and 77 percent, respectively, of those with this disorder. Genetic studies show that bedwetting is linked to genes on chromosomes 13q and 12q, and possibly 5 and 22.
Other reasons are less common. These include the consumption of drinks and foods that contain caffeine, which increases urine production by the kidneys. The problem of urinary incontinence appears in children with chronic constipation. A crowded colon puts pressure on the bladder. Children with attention deficit hyperactivity disorder are at increased risk of uncontrolled urination.
Treating the disorder
Two physical functions prevent bedwetting. The first is the body's production of a hormone that reduces urine production after sunset. This antideuric hormone is known as vasopressin. The cycle of production of this hormone is absent in newborns. In some children, it develops between the ages of two and six, in others, from six years to the end of puberty.
The second function is the ability to wake up when the bladder is full. This ability develops at the same age as the production of the hormone vasopressin. However, it is not associated with this hormonal cycle.
Doctors recommend not rushing to start treatment until at least the child is six or seven years old. In some cases, doctors may start treatment earlier to boost the child's self-esteem or help improve attitudes from family members or friends. Punishing children is ineffective and can only harm the treatment.
Simple behavioral techniques are recommended as initial therapy. Special alarms are used that emit a loud signal in response to moisture. Alarm clocks are considered effective, children are 13 times more likely to stay dry. However, relapses are possible - from 29 to 69 percent of cases. In case of relapses, treatment is usually repeated.
A good effect was shown by Desmopressin tablets - a synthetic analogue of the hormone vasopressin. Children who took them remained dry 4.5 times more often than those who took placebo.
