Enuresis in Children
Enuresis is more commonly known as bed-wetting.. The condition is diagnosed if the child is 5 years or older and the behavior either occurs at least twice a week for at least 3 consecutive months or results in clinically distress or social, functional, or academic impairment. Enuresis can be divided into primary and secondary forms.
Types of enuresis include:
- Nocturnal enuresis ( bed wetting), which is the most common type of elimination disorder.
- Daytime wetting is called diurnal enuresis.
- Mixed enuresis, includes a combination of nocturnal and diurnal type.
- Primary enuresis refers to children who have never been successfully trained to control urination.
- Secondary enuresis refers to children who have been successfully trained ( are for at least 6 months dry) but revert to wetting in a response to some sort of stressful situation.
Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders such as anxiety. Enuresis also appears to run in families, which suggests that a tendency for the disorder may be inherited (passed on from parent to child, particularly on the father’s side). In addition, toilet training that was forced or started when the child was too young may be a factor in the development of the disorder, although there is little research to make conclusions about the role of toilet training and the development of enuresis.
Children with enuresis are often described as heavy sleepers who fail to awaken at the urinary urge to void or when their bladders are full.
The diagnosis initially is by taking medical history and performing a comprehensive physical examination to rule out any medical disorder that may be causing urine incontinence. The most important screening test in a child with enuresis is a urinalysis.Blood tests usually are not needed unless diabetes or kidney diseases aresuspected.
Causes of Enuresis:
Enuresis also may be associated with certain medicines that can cause confusion or changes in behavior as a side effect. If no physical cause is found, the doctor will base a diagnosis of enuresis on the child’s symptoms and current behaviors.
The most important reason for treating enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by the parents. Most children with enuresis feel very much alone with their problem. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic.
Preliminary management focusing on behavioral modification and positive reinforcement is often helpful. The only therapies that have been shown to be effective in randomized trials are alarm therapy and treatment with desmopressin acetate or imipramine.
Bladder training exercises are not recommended. With this therapy, the child is asked to ingest large quantities of fluid and to hold the urine in the bladder without voiding until uncomfortable.
Enuresis is not a surgically treated condition. However, ectopic ureter and obstructive sleep apnea (OSA) respond to specific surgical interventions.
Patients with primary enuresis (PE) are asked to keep a diary and should return for evaluation on a monthly basis to assess their progress.
Relapse of the enuresis is the most common complication and requires restarting the treatment that resulted in an improvement or cure the condition. Even without treatment, the reported spontaneous cure rate is about 15% per year. However, children who wet every night are unlikely to become dry in the short term and many of these children continue to wet until adolescence.
When daytime symptoms are also present, the prognosis depends on the underlying cause, for example , the prognosis is excellent when enuresis is due to cystitis, ectopic ureter, OSA, diabetes mellitus, diabetes insipidus, or seizure disorder.
♦ Doctor Layla Al Haddad ♦ – Family Doctor
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