With the production of urine more than normal at night, nocturnal enuresis may occur. Symptoms may vary depending on the type.
What is Nocturnal Enuresis (NE)?
Nocturnal enuresis (nocturnal wetting) can be defined as urinary incontinence in children over 5 years of age, unable to control urine at night.
They have no complaints during the day, only bed wetting at night. Approximately 20% of five-year-olds have nocturnal incontinence at least once a month.
It occurs in 5% in boys and approximately 1% in girls. Considering all age groups, it is 2 times more common in men.
By the time they reach puberty, only 1.8% of these children continue to leak urine.
Are There Types of Nocturnal Enuresis?
Nocturnal enuresis is divided into 2 groups as primary and secondary. In primary nocturnal enuresis, the patient incontinent only at night from the beginning without any dryness. Genetic, psychogenic and organic factors play a role.
Secondary enuresis is the start of urinary incontinence again for a period of at least 6 months after no urinary incontinence in nocturnal. Psychogenic and organic factors can play a role. It is usually seen between the ages of 5-8.
Do People With Nocturnal Enuresis Have Other Symptoms?
In patients with nocturnal enuresis, there may be additional symptoms (polysymptomatic) such as frequent urination, sudden urgency, as well as nocturnal enuresis (monosymptomatic).
What Causes Nocturnal Enuresis?
The most important risk factor in nocturnal enuresis is familial transmission. If both mother and father wet the diaper when they were children, the probability of having children is around 77%. If there is only one of the parents, it is around 50%.
Many factors such as psychogenic factors, unbalanced release of ADH hormone that keeps water at night, sleep disorders, delayed development of nervous system, parasitic infections, urinary tract infections are held responsible in nocturnal enuresis.
Do Children With Nocturnal Enuresis Have Heavy Sleep?
Families of children with urinary incontinence always say that their sleep is heavy and they cannot wake up.
Studies have shown that it is not much different from other children. However, it is a little difficult for these children to wake up compared to other children. They usually wake up after getting wet.
How Are Children With Night Wetting Evaluated?
It is important to take a detailed medical history. When questioned, there is 70% family history. The age must be over 5. It is also important whether it is primary or secondary. While 80% is primary, 20% is secondary.
With a detailed physical examination, it should be investigated whether there is any abnormality in the genital area or elsewhere. Especially in secondary enuresis, it should be questioned whether there is frequent urination, sudden urgency or even daytime urinary incontinence.
In addition, it is necessary to question whether there is nocturnal incontinence, constipation, stool incontinence or not. After all these, if necessary, urinalysis and ultrasonography can be done. If there is any suspicious situation, additional analysis may be required.
How is Nocturnal Enuresis Treated? (Urinary Incontinence Treatment)
- Behavioral therapy such as filling a voiding diary, restricting liquid and liquid foods 2 hours before bedtime is the primary step and 25-50% of the cases can be treated in this way. Additional treatments are required for the rest.
- Desmopressin (minirin) treatment is given daily to patients who do not respond to behavioral therapy, desmopressin tablet or spray. 80-100% answers are received. However, most of them relapse after treatment.
- Alarm therapy is a very old treatment method, but it is very effective. If there is a response to treatment for up to 1.5 years, it is driven. The answer is around 70% and recurrence is very rare.
- Imipramine (tofranil): a drug that reduces bladder contraction. Approximately 50% answers are received.