Nocturnal enuresis or nighttime urinary in continence, commonly called bedwetting, is one of the most common childhood complaints which occurs due to the involuntary urination while asleep after the age at which bladder control usually occurs; It might happen due to genetic reasons, problems in the urinary tracts, in the nervous system, sleep disturbances, or other psychological factors.
Bedwetting is in the first place considered a family problem because it negatively influences on the child and the parents and might even make these last feel frustrated as it makes the child feels ashamed in front of the others, less important and tend to stay lonely. This problem also makes this last tend to be stubborn, vandalistic and willing to take revenge.
Day and night bedwetting which needs to be diagnosed before any treatment; this type might hide a disease that needs to be discovered and cured at an early age and might be caused by an absence of urine concentration in the kidneys or due to congenital defects.
Primary enuresis:
Children who have never been consistently dry at night. This case is the most known and spread and which represents three out of four complaints.
Secondary night involuntary urination:
it is not to control the urination suddenly after that the child was able to control the urine for a period of not less than three months, this case represents a rate that is close to one out of five.
The child must be able to control the urination during daytime at the age of 4 years old at most, and most of the children can control it from the age of three; however, most children are unable to control urination at the age of six at night, and treatment is usually not recommended before this age. This case improves automatically with maturation.
A researched published in the scientific periodic of the American academy of pediatrics found that most children can control neither urination nor defecating until after the age of two years old. As proved it by most mothers, girls can control those operations before boys. This research has specified the average age in which children can control those operations between 24 to 30 months.Â
Cases of involuntary urination differ from one child to another; however, urination often occurs when the child is punished or insulted by the parents. On the other hand, trying to understand this case, helping and encouraging the child might help in alleviating the problem.
The majority of pediatricians do not consider night urination as a problem even if it exceeds the age of 6 years old, as they think that it becomes a problem only when it causes social disquiet for the child and the family and that all children who suffered from involuntary urination have recovered without any medical intervention. They consistently stress that a bedwetting child is not a fault for situation, the psychological impacts of Bedwetting are more than the physical considerations, it's often the child's and family member' reaction to Bedwetting that determines whether it is a problem or not.
The valuation occurs by a general examination of the mental state and growth as there should be a notice of the child during urination to discover whether the child suffers from any problem in the urinary tracts.
The most important advice to any mother is not to worry if her child suffers from this problem and to treat the child with kindness and love; the readiness of the family to go through this experience is very important since it will have to clean after the child who might forget to tell his family about his desire without showing any sign of nervousness as it means the readiness of the child himself. Moreover, it is very important to provide a comfortable atmosphere for the child and to encourage him in this stage. Many pediatricians advice the mothers to stop the training for a period between one and three months if the child does not show any readiness after one week of try because this might worsen the problem.
Bedwetting counts as a disorder once a child is old enough to stay dry, but continues either to average at least two wet nights a week for 3 months and cause anxiety and social disorder or dysfunction in a 5 years old child, in the absence of any urologic, medical or neurological anomaly.
Only 1% of nocturnal enuresis can be associated with medical anomaly:
infects or disease, the most common is a urinary tract infection.
Inflammation of the spinal cord.
Diabetes and diabetes insipid us.
Pharmaceuticals side effects.
Genetics.
iInsufficient anti-diuretic hormone (ADH) production .
Stress: such as parent conflict or divorce, arrival of a new baby, or loss of a loved one can cause Bedwetting.
Genetics: In 1995 Dutch scientists found out that bedwetting is associated with the genes on chromosomes 13q. If one of the parents suffered from this problem before, the child might have suffer from it 44% and if both of them suffered from bedwetting the rate rise to 80%.
Nocturnal enuresis might be a symptom of breathing problems resulting adenoid or other problems.
There are numbers of treatments and condition management options for Bedwetting but applied for when nocturnal enuresis is not caused by a specifically identifiable medical condition such as bladder abnormality or diabetes.
The first thing to do is to reassure the child and the family, and explain that it is a common problem that disappears on its own, but until it does it is important to provide support and positive reinforcement during this stage.
The child must be reassured that Bedwetting is a normal part of growing up and that it's not going to last forever. It may comfort him to hear about other family members who also suffered from it when they were young, the child have to go to the bathroom one final time before bedtime, he has to drink more fluids during the daytime hours and less at night, parents can use a motivational system, such as stickers for dry nights with a small reward after a certain number of stickers.
Specially don't yell or punish the child when he wakes up with wet sheets; child have to help in changing the sheets and parents have to explain that this isn't punishment but it's a part of the process.
The child has to visit pediatrician to avoid the risk of urinary tract infections; attempt for a dry bed training which consist of a strict schedule of waking the child up at night, and teach him to wake up by himself.
Solution
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