What is nocturnal enuresis?
Nocturnal enuresis is the technical term given to children who urinate in bed.
What is the prevalence of nocturnal enuresis?
Around 5 to 7 million children in the United States urinate in bed. By the age of 6, around 10% of children have nocturnal enuresis, which shows that it is quite common in the pediatric population. When both parents have urinated in bed, there is a 75% chance that the children will also have this problem. When only one parent has had nocturnal enuresis, the chance is 45%. Around 30% of parents in the United States punish their children for bedwetting, which is quite reckless. Studies show that this incidence is even higher in Brazil.
What psychological effects can nocturnal enuresis have?
Nocturnal enuresis can have serious psychological effects which are aggravated by parents' inability to deal with the problem, especially when the child is punished. The child's self-esteem can be damaged. The child feels offended and embarrassed, and stops playing with classmates and participating in social activities in general. The child avoids sleeping at relatives' and friends' houses for fear of bedwetting. The child's behavior also causes frustration for the family. Nocturnal enuresis also involves the cost of washing bedding and clothes, as well as doctor's appointments and often the use of medication.
What are the causes of nocturnal enuresis?
There is no precise understanding of the causes of nocturnal enuresis in children over 5 years of age. However, there are several factors that can influence bladder function and result in bedwetting: Nocturnal enuresis is usually related to neurophysiological immaturity. In other words, as the child grows up, nocturnal enuresis tends to resolve spontaneously. Only 1% of adolescents aged 15 still have nocturnal enuresis. Enuresis can be caused by increased nocturnal diuresis or involuntary bladder contraction at night. Increased nocturnal diuresis is usually caused by reduced production of anti-diuretic hormone at night. Also, children with nocturnal enuresis usually have more difficulty waking up than those without enuresis.
When should I worry about nocturnal enuresis?
Before the age of 5, bedwetting is normal and there is no need for treatment. After the age of 7, children with nocturnal enuresis should be treated. Between the ages of 5 and 7, those children or parents who express an interest in treatment can go to a specialist to start the process.
What is the treatment for nocturnal enuresis?
Therapy should be based on the factors that contribute to nocturnal enuresis.
The program should include:
- Dietary changes that may be affecting nocturnal continence, such as avoiding acidic fruits, peppers and spicy foods before bedtime.
- Regular bowel emptying program with dietary changes and, if necessary, the use of oral laxatives or enemas.
- Behavioral modification therapy.
- Alarm: a device designed to wake children up when the device comes into contact with urine.
- Medications. The medications used for treatment consist of DDAVP, a synthetic analog of the diuretic hormone, or imipramine, a tricyclic antidepressant. These substances produce a cure rate of 40 to 80% quickly, but the rate of recurrence of symptoms is around 50% of cases. They are ideal for those situations where the child needs rapid treatment, when, for example, they know they are going to be sleeping at someone's house for the next few days. DDAVP has few side effects and is a first-line medication. Imipramine can lead to more adverse effects and a greater chance of failure, which is why it is a second-line medication. Oxybutynin is generally only of value when there are associated daytime symptoms, such as urinary urgency and daytime urinary incontinence.
- Uricontrol - we recently developed a device that represents an innovation in the treatment of enuresis. It is still in the testing phase. It consists of a humidity sensor that activates a sound circuit when activated by urine. In this sense it is the same as an alarm. What makes it different is that in uricontrol, when the sensor is activated, there is a contraction of the muscles of the perineum which means that the child doesn't lose urine at night while being treated, unlike the conventional enuresis alarm, in which the child continues to wet the bed for days or weeks. This device allows the child to go to the toilet and urinate with a full bladder when they wake up, helping with conditioning. Uricontrol was developed by us at CEDIMI and is currently being tested in various institutions around the world and in Brazil. Watch the Jornal da Band (National) report on the device at: http://www.urologiapediatrica.com.br/aparelho-impede-criancas-fazerem-xixi-na-cama/