Nocturnal enuresis in children

To wake up in the morning and find your own child wet the bed it is the typical manifestation of what is called nocturnal enuresis: a problem that is seen more frequently in children. Let’s find out what it’s all about with Prof. Gian Antonio Manzoni, Specialist in Pediatric Urology at La Madonnina Nursing Home and Director of the Pediatric Urological Unit of the IRCCS Foundation Ospedale Maggiore Policlinico di Milano.

What is meant by nocturnal enuresis?

“The child suffers from enuresis he is unable to perceive and control the urge to urinate properly and consequently manifests one sinvoluntary loss of urine that occurs during the night’s rest, ”explains Professor Manzoni.

In fact, enuresis can be:

  • nocturnal, when the phenomenon is contextualized in the evening hours with rest;
  • daily when it affects the hours of the day;
  • mixed if it applies to both.

The classification also includes a distinction between:

  • primary enuresisif the subject has never gained control of bladder incontinence;
  • secondary enuresisif it occurs after having bladder control.

Symptoms of bedwetting

To be classified as such, enuresis disorders must occur repeatedly and continuously: 2 or more times a week and for at least 3 months.

A distinction must also be made between:

  • monosymptomatic enuresis: the form without other symptoms;
  • polysymptomatic enuresisthe form is accompanied by a symptomatology which may include: need to urinate frequently and acutely; combination with fecal incontinence or constipation (the full bowel actually reduces the capacity of the bladder).

The reasons

Professor Manzoni recalls that enuresis can be determined by various factors such as:

  • physiological;
  • neurological;
  • hormonal.

Moreoverpsychological aspect plays an important role, especially in secondary forms.

As a summary and example, the following causes of the disorder can be identified:

  • confidentiality: if one or more of your family members has suffered or is suffering from enuresis, there is often a tendency to develop the disorder;
  • emotional and / or mental problems such as anxiety, stress;
  • sleep disorders: difficulty waking up in some stages of sleep to respond to urinary stimuli; poor sleep quality, which may also include the presence of sleep apnea caused by adenoid hypertrophy (an increase in the size of the adenoids that can cause airway obstruction, red);
  • polyurea: it is an abnormal and excessive production of urine;
  • delayed development of diuresis regulatory mechanisms how endocrine disorders which can lead to a deficiency of the antidiuretic hormone vasopressin (or ADH), which usually causes the amount of urine produced to be much less during sleep than per day. day;
  • incomplete or delayed bladder development and its containment capacity;
  • anatomically-functional urinary tract dysfunctions;
  • urinary tract infections;
  • overactive bladder;
  • problems and / or pathologies of the nervous and muscular system;
  • diabetes mellitus;

When to see your doctor

Nocturnal enuresis can be considered as one usually phenomenon up to 5 years age: period during which children may not yet have complete autonomy and mastery of urinary incontinence.

In case of persistence beyond this age, a medical check-up is necessary to rule out other underlying problems and make it possible to discontinue the most appropriate treatment.

The diagnosis

In addition tophysical examinationthrough which the physician has the opportunity to evaluate the lumbo-sacral region, the child’s genital and abdominal area, simply laboratory analysis of urine and bloodable to diagnose diseases such as infections, diabetes, endocrine deficits.

It also completes the normal diagnostic process, the execution of oneultrasound of the urinary systemfor the purpose of excluding anatomical anomalies or incomplete bladder emptying.

Only when an anatomical and / or functional problem is assumed after the ultrasound, more specific examinations are performed, such as urodynamic studies (invasive or not), which can evaluate urinary function and the presence of any abnormalities (uroflowmetry, cystometry, residual bladder examination, etc.)

In addition, one diary to record the urination habits of a child suffering from enuresis, where the patient and parents go on note for a few days:

  • urination time;
  • volume of urination (using containers or diapers);
  • associated symptoms such as urinary leakage or urge to urinate;
  • the amount of fluid consumed.

The consequences

Nocturnal enuresis is a problem which in most cases is not determined in childhood by specific pathological problems and which it tends to resolve on its own in childhood: only a small percentage of patients remain enuretic even after adolescence.

As pointed out by Prof. Manzoni, “The psychological-emotional aspect of this disorder should never be overlooked, as nocturnal enuresis may have negative effects on self-esteem; trigger depression and discouragement in young patients affected and in their families “.

What are the means

Means against bed wetting vary depending on the triggering causes, whether they are mental and / or physical. If, for example, the affected child is diagnosed with diabetes, it will be necessary to act on this with appropriate therapy, just as it may happen instead that constipation is found, which will reduce the space of the bladder. , will go to request another power supply, etc.

Some measures against nocturnal enuresis that may be indicated in general are:

  • maintain adequate hydration during the day, with attention to a reduction of the evening hours, also avoid consuming exciting drinks and foods (caffeine, tea, chocolate);
  • Avoid eating foods that are particularly rich in liquids, salt and sugar for dinner: Follow a balanced diet, but limit the consumption of minestrone and vegetable soups during the evening meal, also avoid milk and derivatives due to the high calcium intake and foods that contain many sugars (eg sweets, sweets) and salt (salted meat, anchovies ) etc.)
  • sanctify you body functions (urination and evacuation) on a regular basis during the day and especially before going to sleep.

The new technologies thus provide an additional and valuable help, as some latest generation of devices (natal alarm for enuresis), equipped with special sensors, makes it possible to detect urine loss in sheets or underwear, emits an acoustic signal that awakens the subject to go to the toilet. These devices are particularly useful because they also perform a process of psychological conditioning on an unconscious level.

Medicine for bedwetting

If, on the other hand, the specialist needs to prescribe a drug treatment for enuresis, various drugs may be indicated, among which the most commonly used for children are:

  • desmopressin: the synthetic form of the antidiuretic hormone vasopressin (or ADH), which, taken orally (sublingual tablets), integrates its incomplete or lack of production of the body, causing the body to produce less urine at night;
  • anti-cholinergicsi.e. drugs that limit or inhibit the activity of the receptors for the neurotransmitter acetylicoline in the nervous system, which act on the bladder muscles, promote its ‘relaxation’ (oxybutine hydrochloride) and increase its capacity.

Password ‘understanding’

“It is essential – Professor Manzoni concludes – to implement a comprehensive behavior towards children suffering from nocturnal enuresis, as there is no voluntary gesture, especially in the primary form. A reproach to a child for having wet the bed, for example, can be associated with the event in a traumatic way, causing embarrassment and resentment that can make the psychological and emotional burden associated with bedwetting even more important. It is good to remind yourself or your children with positivity and calm that this is a well-defined pathology, and that as such there is an opportunity to trace the triggering causes and find a solution ”.

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