Bed Wetting/ Nocturnal Enuresis

Bed Wetting/ Nocturnal Enuresis

 It is defined as an involuntary passage of urine after the age of 3-4 years, and failure to control the urinary bladder during sleep without any physical abnormality. Usually enuretic children are more psychologically disturbed than non-enuretic kids.

We have to diagnose this by

  1. Repeated involuntary urination by day or night
  2. At least two such events per month for 5-6 years age group, and at least one such event per month for older children
  3. The problem should not be due to any physical disorder – diabetes or seizure disorders

There are two types

  1. Nocturnal: Only it occurs at night. More common one.
  2. Diurnal: It occurs when child sleeps during day.

It is also classified as

  1. Primary: here child never achieved control of urinary bladder.
  2. Secondary/Acquired: after achieving control of urinary bladder, child lost it later days.

Cause for Bed Wetting

  1. Age: 5-16 years
  2. Sex: More common in boys than girls
  3. Genetic factors: More in the families where one or the both parents were sufferers.
  4. Immaturity or Developmental dysfunctions like timid and dependent behavior, emotional immaturity, improper development of bladder capacity
  5. Lack of toilet training or faulty habits
  6. Depth of sleep
  7. Psychiatric disorder like stress, stubbornness, delinquency, temper tantrums etc,
  8. Psychological disturbances

Treatment

  1. Toilet training
  2. High water content in early day diet and stop liquids after 6pm
  3. Make sure pass the urine before going to bed
  4. Alarm @1am to pass urine
  5. Calendar method Mark with RED ink when  bed is wet & Mark with BLUE ink when bed is dry
  6. Reward for dry nights like Golden stars for each BLUE ink mark on calendar, toys, clothes, eatables whichever healthy and affordable…
  7. Psychotherapy for child, parents and relatives. Behavior therapy works good in case of stress, tension, how to accept the reality, how to deal with certain situations, etc,. Play therapy, Art therapy, Group therapy also useful in these cases.
  8. Drugs therapy, the degree of success with most drugs was negligible. Imipramine, Amitriptyline, etc, are in use. As we said Nocturnal Enuresis is multi-sided problem, along with drug therapy we have to start other techniques to complete cure or else relapse chances will be more.

 

 


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