Nocturnal Enuresis

Summary on nocturnal enuresis – bed wetting

Nocturnal enuresis (bed wetting) is the complete emptying of the bladder that occurs involuntarily, in sleep, while the person is unconscious.
We started talking about nocturnal enuresis only in children over 5 years old (some sources, in particular American ones, start talking about nocturnal enuresis from 7 years old). Before the age of 5 or 7 years, it is estimated that this is a natural process and nocturnal enuresis is not a disease. It is noted, however, that most children sleep dry (they no longer wet the bed) between the ages of 2 and 3 years.
The exact causes of urinary incontinence are still poorly understood. Genetic and hormonal factors are believed to play an important role. An American doctor suggests that nocturnal enuresis can come from constipation.

Symptoms of nocturnal enuresis are urination during the night and unintentionally, in the wrong place (bed), note that the emptying of the bladder is usually complete. Children with this condition are often very deep sleepers.
Treatment of nocturnal enuresis is based on several strategies used separately or in combination.
One method that gives good results is the use of a device called a “pee stop”, or warning device (sometimes also called an alarm system) that will detect any drop of urine in the child and wake him up to get him used to using it. the bathroom whenever necessary.
Another therapy involves taking a drug containing a derivative of antidiuretic hormone (ADH or vasopressin). This treatment requires a doctor’s prescription.

Several recommendations can complement conventional therapy to overcome this condition, such as: avoiding drinking too much at night, always urinating before going to bed, rewarding the child if he/she does not wet the bed for several nights, etc.

Photos: © mmphotographie.de – Fotolia.com

Definition

Nocturnal enuresis (bed wetting) can be defined as a complete emptying of the bladder, done involuntarily and unconsciously during a night’s sleep, that is, it is an emission of urine in bed instead of in the bathroom.
During the day, the child has no problem and goes to the bathroom normally without wetting his clothes.

The problem of wetting the bed, also called nocturnal enuresis, is relatively frequent in children. It is estimated that around 10 to 15% of 5-year-old children are affected by nocturnal enuresis. Already at the age of 10, it is estimated that there are still about 6% of enuretic children (who wet the bed) and that even 1% of adults may suffer from this problem.

Some sources, mainly North American ones, start talking about nocturnal enuresis only from the age of 7 (for drug cases, read on drugs against nocturnal enuresis ). Under the age of 5 (or 7) it is estimated that wetting the bed is a natural and normal process, which the child will resolve on its own over time. You should know that most children control their nighttime urination (stay dry and clean) between the ages of 2 and 3.

We sometimes distinguish between primary and secondary nocturnal enuresis.

Primary enuresis occurs in children who have never been able to control urination at night or during a nap.

In the case of children with secondary enuresis, they were able to control sleep urination for at least 6 months and then returned to bedwetting.

Epidemiology

In the United States, one in 10 7-year-olds wet the bed at least twice a week (source: Webmd.com January 2014).

Causes

It is very difficult for the medical and scientific community to pinpoint a precise cause for nocturnal enuresis.

The hereditary (genetic) factor is very important, so if a relative suffered from enuresis during childhood or still suffers in adulthood, the child will be more likely to develop it.

It is also suspected that it is a hormonal problem. It is believed that in certain children, during the night, the body does not synthesize enough antidiuretic hormone (vasopressin or ADH in English, for antidiuretic hormone) which causes a more frequent and spontaneous emission of urine. The child is then unable to retain the urine that is found in large amounts in his bladder. The antidiuretic hormone (vasopressin or ADH) favors the reabsorption of urine in the kidneys to lead to the emission of urine with a reasonable and controlled frequency.

Another theory that prevails in the medical community is based on the immaturity of the nervous system, in relation to the urinary tract of children, which is why, even if the bladder is full, the child does not receive the signal that he should urinate.

Other causes are also identified as causing nocturnal enuresis, however this topic is too long and complex to be discussed here.

Note, however, that in the case of secondary enuresis, psychic causes may play a key role.

We finally observed that there would not necessarily be a psychic cause in the development of nocturnal enuresis. In any case, nocturnal enuresis should in no way be considered as a shame or error on the part of the parents, it is linked to a development that can occur involuntarily, without cause linked to a particular family or social context.

According with the doctor. Steve J. Hodges, American physician, constipation (constipation) can be a cause of urinary incontinence. If a child suffers from constipation and wets the bed, he advises treating any constipation with a mild laxative.

Hyperactivity can be a risk factor for nocturnal enuresis. We know that urinary incontinence is more common in children with attention deficit and/or hyperactivity disorder.

Symptoms

The symptoms of bed wetting (nocturnal enuresis) are characterized by an involuntary nocturnal emission in inappropriate places (bed), unconsciously. During the day, the child has no problem holding urine and going to the toilet properly.
We also noticed that children who suffer from nocturnal enuresis are often very deep sleepers and therefore have difficulty waking up, even while wetting the bed.
The big problem for a child suffering from nocturnal enuresis is the difficulty of getting the body used to waking up and getting up to urinate. 

However, the diagnosis of nocturnal enuresis requires a detailed medical examination , which can be performed by a pediatrician, general practitioner or endocrinologist, as it is important to ensure that it really is nocturnal or nocturnal and daytime enuresis, and not another condition. of the urinary system.

Photo: Photos: © mmphotographie.de – Fotolia.com

Treatments

There are mainly two axes of treatment to cure nocturnal enuresis (= bedwetting).

1. Bedwetting alarm  (also known as urinary alarm or pee stop )

– It is a device that wakes up the child as soon as it detects a drop of urine, as a way of getting the child used to going to the bathroom when necessary. Be careful with the sound of the device so as not to wake up the whole house and disturb the sleep of other family members. Children have a deep sleep, but this technique can be a good alternative.

2. Medicines against nocturnal enuresis (based on desmopressin )

– Medicines based on antidiuretic hormone derivatives (=ADH or vasopressin) can have a very positive effect in the treatment of nocturnal enuresis. It is a drug whose active ingredient is desmopressin. It can usually be found in pill form. For treatments based on desmopressin, it is absolutely necessary to carry out a medical visit, as this medication can only be requested with a medical prescription. The effectiveness of hormone-based treatment is proven for those who respect the treatment (ask your pharmacist or doctor for advice).

Note: 1. + 2. – Combination of the two treatments

When used simultaneously, it is possible to achieve very good results (about 80% cure). We also note that 15% of children are cured each year without the need for treatments (pipi stop or medicine). That is, 85% need adequate treatment, so talk to your doctor to find the best solution.

According to some theories, read more in causes , curing constipation with mild laxatives could cure nocturnal enuresis, talk to your doctor.

Herbal medicine

Walnut oil
– According to the Swiss chemist (specialist in natural products) Claude Roggen who wrote in 2015 the bestselling book called “Les secrets du Druide ” for the “bois carré” edition, pour 1 to 2 teaspoons of walnut oil on a slice of bread, covered with butter and jam or honey and eaten for dinner, helps to fight urinary incontinence, especially in the case of young children. According to the medicinal plant expert, this would be a very effective remedy. It is also possible to massage the child’s abdomen with walnut oil.

St. John
‘s Wort – St. John’s wort (hypercoa) can help with the psychological causes of bedwetting.

Tips

  If your child is taking any drug treatment (based on desmopressin ), respect your doctor’s advice (eg do not drink at night, respect the doses, reduce the dose when necessary,…)
 It is advisable for the child to avoid excessive consumption of drinks at night. Some pediatricians recommend not drinking liquids after 6:30 pm.
 The child must absolutely go to the bathroom before going to bed (empty the bladder completely). A good tip is to run your fingers or hand under cold water (this can help empty your bladder completely).

 To correctly follow and control the nights when the child was wet or dry, you can make a calendar in which you will draw a cloud on the days that the child was wet or a sun on the days that he was dry.

– Encourage your child to make regular visits to the bathroom during the day, such as every two hours.

– The child should avoid consuming drinks or foods rich in caffeine at night, such as coke or chocolate soft drinks.

 On the part of the parents – avoid giving too much importance to this problem, this will help to avoid psychological problems in the child. This does not mean that a solution should not be sought, but it is important not to dramatize the situation so that the child does not lose self-confidence.

– If the child has stayed dry for several nights, you can reward him (small gift, food he loves, etc) to encourage him to continue on this path.

– If, on the other hand, the child wets the bed, do not punish him because he is not clean.

– Do not talk about it in public, this could harm the child and develop a feeling of shame in him.

– You can leave the light on to clearly indicate the way to the bathroom.

– Set an alarm clock for the time when the child has the habit of wetting the bed. Wake the child and take him to the bathroom.

By Xavier Gruffat  (pharmacist)

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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