When is enuresis considered a problem?
Control over urination during sleep develops in children at different ages. Until the age of five, nocturnal episodes are considered normal development and do not require treatment.
After five years of age, nocturnal enuresis occurs when episodes occur regularly—usually two or more times a month. At the same time, it is important to understand that even after this age, for some children, the problem resolves on its own, but you should not wait forever: enuresis significantly affects the child’s self-esteem and the life of the family.
- Primary enuresis - the child has never had a long period of dry nights; most common option
- Secondary enuresis - incontinence appeared after a period of at least six months of dry nights; more often associated with stress, infection, endocrine causes and requires more careful examination
- Monosymptomatic enuresis - bedwetting only, no daytime symptoms
- Non-monosymptomatic - combined with daytime complaints: frequent urge, daytime leakage, difficulty urinating; more often associated with bladder dysfunction
Reasons
- Heredity is a very significant factor: if one or both parents had enuresis, the child’s likelihood is much higher
- Insufficient nighttime production of antidiuretic hormone, causing too much urine to be produced at night
- Low functional capacity of the bladder and its hyperactivity
- Features of sleep: difficulty waking up with a full bladder
- Delayed maturation of urinary control mechanisms
- Chronic constipation - a full rectum puts pressure on the bladder
- Urinary tract infections
- Psychological stress: birth of a brother or sister, starting school, family conflicts, moving
- Diabetes mellitus and diabetes insipidus - with secondary enuresis
- Obstructive sleep apnea syndrome, enlarged adenoids
- Neurological causes and abnormalities of the spine
- Anomalies of the urinary tract, ectopic ureteral orifice
Survey
- Detailed conversation: at what age, how often, have there been dry periods, are there any daytime symptoms?
- Diary of urination and volume of fluid consumed over several days
- Evaluating bowel habits is a must
- Urinalysis and culture to rule out infection
- Blood glucose and urine specific gravity to rule out diabetes
- Ultrasound of the kidneys and bladder with determination of residual urine and bladder wall thickness
- Uroflowmetry in children who can urinate on request
- Examination of the lumbar region and assessment of neurological status
- Void cystography, MRI of the spine, urodynamic study - only if organic causes are suspected
- Consultation with an ENT doctor for snoring and sleep apnea
- Consultation with a neurologist and psychologist when indicated
Treatment: where to start
The first and mandatory stage is behavioral measures and regimen. Their effect is often underestimated, but for some children this is enough.
- The main volume of fluid is in the first half of the day, limiting drinking a couple of hours before bedtime
- Avoiding carbonated drinks, strong tea, cocoa and caffeinated products in the afternoon
- Mandatory urination before bed
- Treatment of constipation - drinking regimen, fiber, medications if necessary
- A calm environment before bed, sufficient sleep duration
- Refusal from punishment, shame and discussion of the problem in front of strangers
- Calendar of dry nights with rewards for effort, not results
- Involving a child in changing clothes without reproach is part of responsibility, not punishment.
- After a certain age, it is better not to use diapers constantly - they reduce motivation, but the decision is made with a doctor
Specific treatment
- Urinary alarm clock (alarm therapy) - the device gives a signal at the first drops of urine and gradually forms a conditioned awakening reflex; one of the most effective methods with the most lasting results, but requires several weeks of patience from the whole family
- Drugs that reduce nighttime urine production - as prescribed by a doctor, with mandatory adherence to the drinking regime
- Medications that reduce bladder activity - for non-monosymptomatic enuresis with overactivity
- A combination of methods when the effect of one is insufficient
- Treatment of identified causes: infections, adenoids and sleep apnea, constipation, endocrine disorders
- Urotherapy - training in the correct mode and technique of urination
- Psychological support for the child and family
Enuresis in adults
In adults, bedwetting is much less common and almost always has a specific cause that needs to be found.
- Prostate adenoma with bladder overflow
- Overactive Bladder
- Neurogenic disorders: consequences of stroke, multiple sclerosis, spinal injuries, diabetic neuropathy
- Obstructive sleep apnea syndrome
- Diabetes mellitus and diabetes insipidus
- Taking diuretics, hypnotics and sedatives
- Alcohol abuse
- Urinary tract infections
- Enuresis that persisted from childhood is rare, but does occur
Where to get examined in Tashkent
The urological task is to exclude organic causes and evaluate the functioning of the bladder, and then select treatment together with a pediatrician or neurologist.
In Tashkent, such an examination for enuresis in children and adults is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
It’s worth coming to your appointment with a urination diary filled out several days in advance and notes on bowel habits: these simple data often determine the diagnosis and treatment faster than any research. Clinic contacts are below.
