What are the causes of dry skin? How can it be treated?
Causes & Treatment of Enuresis in Children
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.
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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.
References:
https://acikerisim.erbakan.edu.tr/xmlui/handle/20.500.12452/5424
http://tip.fusabil.org/pdf/pdf_FUSABIL_423.pdf
