Causes & Treatment of Enuresis in Children
Request Call Back
Overview
Diurnal and nocturnal enuresis may occur in children of young age. Usually this condition goes unnoticed by the family until the child is 5-6 years old as it can be considered normal or ignored. But persistence of the problem as the child gets older may prompt the family to see a specialist.
The condition is usually associated with bladder development and subsides as the child grows older. When we look at the causes of diurnal and nocturnal enuresis, it can be seen that it is mostly physiological. Small bladder size, too much liquid consumption, unwillingness to go to the bathroom while too busy playing, bladder muscles that are not yet fully developed, deep sleep at night and not being able to feel the urge to urinate during night sleep can be the cause. In addition to these, psychological reasons can also be a factor.
What the family should do in such a situation is not to blame the child, to avoid all sorts of psychological or physical violence and not to put pressure on the child to master potty training or hygiene practices. Support from a specialist doctor can be sought. After the causes are confirmed by examinations and tests, a treatment plan should be drawn up and treatment should be started. Treatment may involve alarm therapy, medication or psychological therapy. The family’s attitude towards the child in the whole process is crucial and they should always support the child.
What are the causes of enuresis in children?
It should be known that the underlying causes of enuresis in children can be both physiological and psychological. However, when examined in detail, it is seen that the reasons are mostly physiological. Some of these reasons include not realizing that the bladder is full while sleeping at night, insufficient bladder capacity and heavy sleep. In general terms, the causes of enuresis can be listed as follows:
● History of enuresis in the mother, father or both
● Not yet sufficiently developed bladder muscles in children
● Excessive fatigue or too much fluid consumption before sleep
● Structural problems in the urinary system (urogenital system)
● Intense stress and anxiety experienced by the child (efforts to attract attention due to sibling rivalry, changing schools, etc.)
● Emotional issues (children not receiving the love and attention from busy working parents)
● Exposure to pressure and violence during potty training
● Diabetes
● Pressure on the bladder due to constipation
● Attention deficit
● Hyperactivity disorder
● Insufficient ADH (antidiuretic hormone) production during sleep
● Small bladder
● Overactive bladder
● Difficulty feeling the sensation of a full bladder during sleep
● Obstructive sleep apnea syndrome
● Urinary tract infections.
These signs and symptoms can be present in both diurnal and nocturnal enuresis. The presence of only one symptom may be the cause, or it may be the result of several symptoms occurring at the same time. The causes of only diurnal enuresis include:
● Too much liquid consumption (especially caffeine-containing drinks such as soda)
● Unwillingness to go to the bathroom while too busy playing or watching something
● Urinary retention (failure to empty the bladder completely)
● Small bladder
● Bathroom located not inside but outside the house (fear of going to the bathroom)
● Pressure on the bladder due to constipation
● Not urinating often enough
● Structural problems in the urinary tract
● Urinary tract infections.
Children who are constipated may wet their pants more often, especially if they think it will hurt when they go to the bathroom, or if they are afraid of going to the bathroom. As the child gets older, enuresis can lead to stress, embarrassment and anxiety. Self-confidence issues may also develop. Therefore, it is important to take precautions, to consult a specialist doctor and to support the child’s physiological and psychological development while the child is still young. The problem should be navigated with the support of a doctor and necessary treatment should be started.
How is enuresis diagnosed in children?
Enuresis is a common problem that can occur in most children. Some children have difficulty learning bladder control and therefore take longer to toilet train. Girls often have bladder control before boys. Hence, enuresis may be more common in boys.
There are certain causes that will be first evaluated by the doctor, including:
● Urination habits
● Stool habits
● Hydration habits
● Sleep conditions
● Mental health (has the child been exposed to a stressful situation recently?)
● Family history of urinary problems
● Pain or burning sensation when urinating
● Constipation
A chart can be used to determine the child’s urination habits. The data should be recorded on that chart and shared with the doctor. The doctor will perform a physical exam and take blood and urine samples for laboratory testing. Based on test results, the presence of urinary tract infection or diabetes should be investigated.
In cases of diurnal enuresis, the child’s bladder wall thickness should be measured with the help of devices such as uroflowmetry, cystourethrography and ultrasonography. Next, the amount of urine remaining in the bladder after urination can be checked. In addition, if there is a suspicion of a neurological cause, X-rays and MRI scans should be performed on doctor’s orders and the results should be checked by the doctor.
What methods are used to treat enuresis in children?
The first-line treatment of enuresis is usually to control daily habits and change them if necessary. For this, parents should avoid any overly critical behaviors that might put pressure on the child and not treat the child in ways that might make them feel ashamed or embarrassed. Instead, supportive behaviors should be exhibited and care should be taken not to leave bad marks that may traumatize the child. Practices that your doctor can recommend in addition to these include:
● Reducing excessive fluid intake at night,
● Limiting fluids about 2 hours before bedtime,
● Limiting consumption of caffeine-containing beverages,
● Going to the bathroom before bedtime,
● Waking the child to go to the bathroom at certain times of the night,
● Avoiding consumption of fried foods and carbonated drinks,
● Urinating every two hours for frequent full bladder check,
● Going to the bathroom every two or three breaks at school,
● Stooling regularly every day,
● Toilets used by children should preferably be seated (toilet bowl) and a step should be placed under their feet for height adjustment,
● Types of behaviors that can be exhibited to develop and support self-esteem in children.
Enuresis treatment can be started if no results are obtained even after changing behavior with the specified practices. These treatments can include alarm therapy or medication.
There are devices that make a loud noise or vibrate to awaken you or your child when they detect wetness. However, the child should be of a certain age for this type of therapy. You should wait until your child is 8 years old and then start the treatment and continue for approximately 2-3 months. This technique has been shown to be highly successful in children. Albeit very low, there is a slight chance of recurrence after alarm therapy.
The aim of medication used in enuresis treatment is to reduce involuntary bladder contractions and grow the bladder. This treatment can continue for approximately 1 year or longer. As with almost all medicines, there may be some side effects of the medicines used in enuresis treatment. The most common side effects are:
● Dry mouth,
● Blurred vision,
● Facial flushing,
● Elevated body temperature,
● Decline in school success
If enuresis in a child is due to an underlying condition such as constipation or urinary tract infection, these problems should be solved and treated first.
Besides, it should be kept in mind that enuresis in children may also have psychological causes, which should be treated with therapy. A child psychiatrist should be consulted to help the child cope with life changes or other stress-inducing factors. Families should know that their child has no control over the wetting is an issue beyond the child’s control and that their child does not release pee on purpose but accidentally. Enuresis is a health issue that should not be ignored and requires detailed examination by a specialist doctor in a full-fledged hospital. Remember that the best person to seek help from is a specialist doctor.
http://tip.fusabil.org/pdf/pdf_FUSABIL_423.pdf
https://dspace.trakya.edu.tr/xmlui/handle/trakya/1038
Other Treatments
Life During and After IVF Treatment: What Patients Should Know
Prostate Cancer Treatment in Turkey
Coronary CT Angiography: Advanced Non-Invasive Imaging for Heart and Coronary Artery Health
Toxic Shock Syndrome and Tampon Use: What Women Should Know About This Rare but Serious Condition
Neurosurgery and Brain Health: Modern Approaches to Complex Neurological Conditions
Living with Allergies: Daily Management, Nutrition, and Long-Term Strategies
Hypertension Management and Lifestyle Changes
IVF (In Vitro Fertilization) Abroad
DEPARTMENT
Pediatric Urology
Pediatric urology is a surgical specialty that deals with the urinary tract and reproductive organs in children.
Psychiatry
Psychiatry is a specialty that deals with the diagnosis and treatment of individuals’ mental illnesses. In our clinic, many diseases such as depression, bipolar disorder, obsessive-compulsive disorder, anxiety disorders, sexual dysfunctions, schizophrenia, attention deficit and hyperactivity disorder, substance addiction, social phobia, eating disorders, grief reactions and sleep disorders are diagnosed, treated and monitored.
