Diagnosis, Tests, Management and Treatment

Overview

What is bedwetting?

Bedwetting, also known as nocturnal enuresis, is the accidental or involuntary release of urine during sleep. Bedwetting is a common problem among children, even after they have been toilet-trained.

Most children gradually stop wetting the bed on their own as they grow older. Usually, children stop wetting the bed between 3 and 5 years of age. Bedwetting is considered a problem if the child is over age 7 and continues to wet the bed two or more times a week for at least three months in a row.

Although bedwetting is not a serious condition, it can cause stress for the child and family. Children who wet the bed may feel ashamed or embarrassed. They might avoid taking part in activities, such as sleepovers or camping, because they are worried that they might wet the bed while they’re away from home.

Are there multiple types of bedwetting?

Yes. There are two main types of bedwetting — primary and secondary nocturnal enuresis:

• Primary nocturnal enuresis is a condition in which the person has never remained dry throughout the night for six months in a row or longer.
• Secondary nocturnal enuresis is a condition in which the child has started wetting the bed again after not wetting the bed for six months or more. Secondary enuresis is more likely to be caused by a medical or psychological condition.

How common is bedwetting?

About 5 million children in the United States wet their beds. It happens more often among younger children—about 30% of children age 7 and under and about 5% of 10-year-old children. About 2 to 3% of people over 18 have primary nocturnal enuresis. Bedwetting occurs more often among boys.

Symptoms and Causes

What causes bedwetting?

Usually, there is not one medical or psychological condition that causes bedwetting. A small percentage of children do have a medical condition that causes them to wet the bed. More commonly, there are many factors that could cause bedwetting, including:

• Family history: Children with a parent or parents who were bedwetters are more likely to wet the bed.
• Constipation: Pressure from extra stool inside the rectum may interfere with the nerve signals that the bladder sends to the brain. A full rectum can also reduce the amount of urine that the bladder can hold or prevent it from emptying completely during urination.
• Hormones: A hormone called vasopressin limits the volume of urine that the body produces during the night. Vasopressin works by causing water in urine to be reabsorbed by the bloodstream, so a smaller volume of urine enters the bladder. Children who do not produce enough vasopressin might be more likely to wet the bed.
• Small functional bladder capacity: Children with small functional bladder capacity have normal-sized bladders, but they sense that their bladders are full even when the bladder can still hold more urine. They tend to urinate more often during the day and might have a sudden urge to run to the bathroom to prevent an accident. They also are more likely to wet the bed during the night.
• Failure to awaken during the night: Sometimes children are unable to wake up in time to get to the bathroom. As the bladder fills with urine, it sends a signal to the brain, which sends a signal back to the bladder to relax so it can hold more urine. A full bladder continues to send signals to the brain so that the child will awaken. Bedwetting happens when the child has not yet learned to respond to these internal signals.
• Psychological or emotional problems: Emotional stress caused by traumatic events or disruptions in a child’s normal routine can cause bedwetting. For example, moving to a new home, enrolling in a new school, or the death of a loved one may cause bedwetting episodes that become less frequent over time.
• Sexual abuse: In some cases, children who begin wetting the bed again after they have learned to stay dry may be victims of sexual abuse. Other signs of abuse include:
• Medical conditions: Disorders that are associated with bedwetting include urinary tract infections, diabetes, sickle cell disease, and sleep apnea. Neurological problems or kidney or bladder abnormalities may also be causes. If bedwetting recurs after your child has been dry for six months or more, a medical condition may be causing it.

Diagnosis and Tests

How is bedwetting diagnosed?

In most cases, the child’s pediatrician will be able to determine if a medical condition is causing the bedwetting by taking a detailed medical history and performing a physical examination. The doctor may request a urine sample to rule out a urinary tract infection.

If your provider suspects that the bedwetting is due to a medical disorder, he or she probably will order blood tests or a radiological exam.

Management and Treatment

How is bedwetting treated?

If there is no medical cause for bedwetting, your provider can provide tips on managing the condition. Bedwetting can be treated by changing the child’s behavior or with various oral (taken by mouth) medications.

What changes can I make to my child’s behavior or routine to help with bedwetting?

Your healthcare provider may suggest trying behavioral changes to begin. Behavioral techniques are changes you can make to your child’s nighttime routine that don’t involve medication. These techniques can include:

• Limiting fluids before bedtime: Don’t give your child anything to drink at least two hours before bedtime. Make sure your child drinks plenty of fluids during the day.
• Going to the bathroom before bedtime: Make sure your child goes to the bathroom and empties his or her bladder completely before going to bed.
• Enuresis alarm: This is a device that makes a loud noise or vibrates to awaken the child when he or she starts to wet the bed. It has a wetness sensor that triggers the alarm so that the child can wake up and finish urinating in the bathroom. Over time, the child learns to wake up when he or she feels the sensation of a full bladder, and eventually might be able to sleep through the night without having to urinate. This technique may take several months to be successful.
• Bladder therapy: This approach is aimed at gradually increasing the bladder’s functional capacity by making the child wait to go to the bathroom. Increasing the length of time between bathroom visits helps enlarge the bladder to allow it to hold more urine.
• Counseling: Psychological counseling may be effective in cases where the child has had a traumatic event or is suffering from low self-esteem because of the bedwetting.

What medications can I give my child to help with bedwetting?

The following medications may be used alone or in combination with behavioral techniques to treat bedwetting:

• Desmopressin: This is the man-made version of the hormone vasopressin, which causes the kidneys to produce less urine. It is effective in about half of all cases, with better results in older children who have normal bladder capacity. The drug can lower sodium levels in children who take it, so you should limit the amount of fluids your child drinks after dinner.
• Oxybutinin: This medication is used to treat overactive bladder by reducing bladder contractions. It can be used along with desmopressin or the enuresis alarm method. It may be effective for children who wet the bed more than once each night and who also have daytime wetting.
• Imipramine: This drug is effective in 40% of cases, but it must be used with caution because of the risk of serious side effects.

Outlook / Prognosis

Will bedwetting be a long-term issue for my child?

Bedwetting does not typically last forever. Only 1 to 2% of adults wet the bed. It may take time to manage, and ultimately stop bedwetting, but it is a treatable condition. It can be a very stressful issue for both children and parents. It’s important to remember that your healthcare team is there to provide support and help you through this time. Reach out to your healthcare provider to discuss any management or medication questions you might have.

Urology | Adult Bedwetting (Enuresis) Causes & Symptoms

Nocturnal enuresis or bedwetting is the involuntary release of urine during sleep. Bedwetting can be a symptom of bladder control problems like incontinence or overactive bladder or more severe structural issues, like an enlarged prostate or bladder cancer. Studies shows that 1 to 2 percent of adults wet the bed, though researchers think that statistic is underreported due to the embarrassing nature of the problem. Rather than hiding your secret, you should explore effective treatments that can help lessen the likelihood of bedwetting and reduce the anxiety of going to sleep at night.

NOTE: This section focuses on bedwetting when it affects adults. For more information on childhood bedwetting, please visit the

Beaumont GROW (Get Rid Of Wetness) program

.

What causes Enuresis?

Hormonal Causes

The body produces an antidiuretic hormone at night called ADH, which slows the kidney’s production of urine while you sleep. In people with enuresis, this hormone is not produced in significant enough quantities to slow the production of urine, which often leads to bedwetting. This can be a symptom of both Type I and Type II Diabetes.

Neurological Causes

People who suffer enuresis can also have a smaller functional bladder capacity, meaning the amount of urine they can hold before the bladder sends a signal to the brain that it’s full is smaller than average. Coupled with overactive bladder or bladder instability, this can lead to bedwetting.

Structural Causes

Enuresis can also be a symptom of problems in the

urethra,

prostate

or

pelvis, including urinary tract infection, urinary tract stones, enlarged prostate, prostate cancer and bladder cancer.

Medication and Diet

Bedwetting can be a side effect of certain insomnia medications and drugs taken for psychiatric purposes like Thioridazine, Clozapine and Risperidone. Bladder irritants such as alcohol and caffeine can also contribute to bladder instability and act as diuretics to increase the production of urine.

How can Enuresis be treated?

Many treatments for enuresis have been effective. Consult your doctor before trying any treatment on your own.

Behavioral Treatment

• 
  Monitoring Fluid Intake:
  
  The first step towards preventing bedwetting is limiting the intake of fluids in the afternoon and evening, which creates a decrease in the amount of urine produced at night. Reduce or avoid caffeine and alcohol intake, which act as diuretics and increase the likelihood of accidents.
• 
  Bladder Volume Control:
  
  This technique attempts to increase bladder capacity in those with smaller functional bladders. Training involves drinking large amounts of fluid during the day and refraining from urinating for as long as possible to increase functional bladder capacity.
• 
  Bedwetting Alarm System:
  
  Wet-detection alarms can be used in underwear or on the bed itself to vibrate or give off sound when bedwetting occurs. This wakes you and allows you to stop the flow of urine and finish in the restroom. Eventually, the body conditions itself to wake before the urge to urinate gets too strong.
• 
  Waking:
  
  Setting a random alarm each night to get up and urinate may be helpful in preventing bedwetting. Avoid setting an alarm at the same time each evening in case your body becomes accustomed to emptying at a set time each night.

Medication

Medication can be an effective treatment for enuresis, but only for as long as it is taken. Medication only deals with the symptoms rather than the underlying causes of bedwetting, so it’s recommended that you try behavioral treatments as well. The most common medications mimic the hormone ADH, slowing production of urine in the kidneys and lessening the instances of bedwetting.

Surgery

Surgery should only be considered once other non-invasive options have been exhausted.

Talk to your health care professional about other options before choosing surgery.

• 
  Sacral Nerve Stimulation:
  
  Sacral nerve roots are stimulated, causing decreased activity in the bladder muscles, which helps the muscle to relax and not contract constantly. This form of surgery is recommended if you also have moderate to severe urge incontinence.
• 
  Clam Cytoplasty:
  
  The bladder is cut open and a patch of intestine added to increase bladder capacity and reduce bladder instability.
• 
  Detrusor Myectomy:
  
  A portion of the exterior muscle surrounding the bladder is removed, strengthening bladder contractions and reducing the number of them.

Learn more about possible treatments for bladder control problems.

Bedwetting: Causes & Treatments | Sleep Foundation

Bedwetting is a familiar problem many people experience at some point. Still, bedwetting can be uncomfortable and upsetting for both children and parents, especially when it happens in older children. If this sounds familiar, you’re not alone.

What Is Bedwetting?

Bedwetting, also called “nocturnal enuresis,” is involuntary urination during sleep in children over five years of age. Bedwetting affects five to seven million children in the US and 5 to 10% of all seven-year-olds. Although bedwetting is slightly more common in boys than in girls, it affects children of all genders.

When Is Bedwetting a Problem?

Bedwetting can be expected in young children, but it becomes less common and less frequent with age. Rates of bedwetting in children generally drop noticeably around age five, with only 1% of this group wetting the bed nightly. Twenty percent of five-year-olds wet the bed at least once per month, even after they are otherwise potty trained. By adulthood, less than one percent of all people wet the bed at least once per month.

Since each child matures and hits developmental milestones at a different pace, different children stop wetting the bed at different ages. Generally, occasional bedwetting is considered normal in childhood and is nothing to worry about.

• In rare cases, bedwetting indicates an underlying problem. Parents might want to explore medical testing if their children experience any of the following issues:
• Sudden onset of bedwetting episodes in older children or teenagers after a long period of dry sleeping
• Painful urination
• Cloudy or discolored urine
• Daytime incontinence
• Bowel movement issues, such as constipation or a lack of bowel control
• Sleep issues, such as being unable to be woken up
• Excessive thirst

Potential Causes of Bedwetting

Most bedwetting is normal and doesn’t have any underlying cause. That said, there are a wide range of potential causes that can lead to bedwetting. They include:

• Anxiety: Research shows that children who experience bedwetting are significantly more likely to have anxiety issues than children who do not wet the bed. Anxiety can be the result of a chronic, ongoing state of distress or a direct response to a specific stressful condition or event. Children who struggle with bedwetting are more likely to experience generalized anxiety, panic attacks, school phobia, social anxiety, and separation anxiety. If bedwetting is a persistent issue, parents might want to consider having their child checked for an anxiety disorder.
• Eating and drinking habits: Certain foods and drinks are diuretics, which means that they cause the body to produce more urine. Some children are more sensitive to diuretics than others. Caffeine, especially that found in coffee and tea, is a major diuretic. Also, when a child drinks can impact how likely they are to wet the bed. For this reason, many parents restrict their children’s fluid intake in the evening as bedtime nears.
• Urinary Tract Infections (UTIs): Sometimes, children wet the bed because they have a urinary tract infection, or UTI. Common symptoms of a UTI include frequent and unexpected urination, as well as inflammation of the bladder, both of which can cause bedwetting. Though UTIs are easily treatable, they often go initially undiagnosed in children, who sometimes lack the ability to explain their symptoms.
• Sleep apnea: Sleep apnea causes the body to repeatedly stop breathing during sleep. It is relatively common among adults, but recent research has shown that it is found in children as well. One potential effect of sleep apnea is the production of a hormone called “atrial natriuretic peptide” (ANP). ANP causes the kidneys to produce extra urine during sleep, which may lead to bedwetting.
• Constipation: Constipation causes excess waste to accumulate in the rectum, which can make it bulge. The rectum is located right behind the bladder, so in some cases, a bulging rectum pushes on the bladder. As a result, regular constipation can cause bedwetting. Children experiencing both constipation and bedwetting should treat constipation first, then see if the bedwetting subsides.

Less common, but potentially more severe causes of bedwetting include:

• Kidney Issues: The kidneys play a major role in urine production and disposal, so bedwetting can sometimes be caused by enlarged kidneys or chronic kidney disease. Children with kidney disease might experience weight loss, increased thirst, or increased urination in addition to bedwetting.
• ADH Insufficiency: In a healthy person, the brain produces a hormone called “antidiuretic hormone” (ADH). This hormone slows the rate at which the kidneys produce urine during the night. When there is insufficient ADH production, or when the body does not properly process or respond to ADH, urine production will not sufficiently slow down at night, which can cause bedwetting.
• Diabetes: Diabetes is caused by insufficient production of the hormone insulin, which helps the body process sugar. In untreated patients, diabetes causes the body to dispose of sugar through the urine, which leads to hyper-frequent urination. One of the most frequent first symptoms of diabetes in children is a marked uptick in urination, often including bedwetting.

In addition, certain factors increase the risk of bedwetting, especially in children. These include:

• Family History: Recent evidence suggests that bedwetting is hereditary. The average child with no family connection to bedwetting has around a 15% chance of struggling with the issue themselves. If a child has one parent who struggled with bedwetting, their risk factor increases to 50%, while a child with two parents who experienced bedwetting has a risk factor of 75%.
• ADHD: Bedwetting is more common in people with ADHD, especially children. While the link between bedwetting and ADHD is not yet fully understood, research shows that kids with ADHD do have an increased risk of bedwetting compared to their neurotypical peers.
• Being a “deep sleeper”: Children who wet the bed are often described as “deep sleepers. ” Being a particularly deep sleeper can affect the way the body communicates with the brain when it comes to urination. A deep-sleeping child may have a harder time developing an effective signaling system that wakes them up when they need to urinate. Instead, the child’s pelvic floor relaxes during sleep, and bedwetting occurs. Brain-bladder control develops naturally over time and will improve with age, but children who are deep sleepers often take longer to become fully continent at night.

How Bedwetting Affects Sleep

There are many ways in which bedwetting can affect sleep. For one, wetting the bed can cause a child to wake up, which often leads to a prolonged sleep disruption while they either clean themselves up or get a caretaker to help clean them up. It can often be difficult to fall back asleep after this sort of nighttime disruption.

In addition, struggling with bedwetting can cause psychosocial problems. For example, children might feel anxiety around bedtime, which can make it more difficult to fall asleep. Bedwetting can also lead to feelings of shame and depression, as well as social embarrassment, which can affect a child’s emotional wellbeing and lead to further sleep difficulties.

Finally, some cases of chronic bedwetting can cause rashes and irritation from exposing the skin to urine, which can lead to discomfort that can further affect sleep.

How To Stop Bedwetting

Addressing a bedwetting problem may seem daunting at first, but it’s often much less complicated than it seems. There are a wide variety of actions you can take to help get to the root of most bedwetting issues. Try items on the list below to help your child reduce their bedwetting.

• Ask your child if something is wrong. It may sound obvious, but one of the best tools a parent has when it comes to bedwetting is communication. Ask your child if there is anything that is bothering them, or making them worried, angry, or sad. If you know that something has been upsetting your child lately, or know that they are going through a significant change in their lives, ask how they are feeling about those things in particular. If the root of the bedwetting is emotional or psychological, this sort of conversation can help your child feel safe communicating with you about it. It’s also helpful to ask children about their bodies, with a focus on anything new that they might be experiencing. This can help identify a potential behavior to adjust or an underlying medical cause.
• Maintain a supportive attitude and steer clear of punishment. Most children who wet their beds are not doing it intentionally. Though bedwetting can be alarming and inconvenient to parents, it should not immediately be considered a behavioral issue or treated with punishment. Rather, it should first be considered an involuntary, relatively common developmental hiccup, and should be addressed compassionately and without anger or shame. Make sure to let your child know that you love, support, and empathize with them while discussing and dealing with bedwetting.
• Keep a calendar. Recording dry days vs. bedwetting days can help parents get a better sense of the problem and identify potential triggers. Parents can also keep a bedwetting calendar with their child, incorporating it into an incentive system for meeting milestones by providing rewards for one full dry night, week, month, etc. This is considered to be a form of behavioral therapy. Some children are positively motivated by visually tracking their progress, and by earning rewards when they reach goals.
• Improve sleep hygiene. Many sleep-related problems can be helped with the improvement of “sleep hygiene.” Improving sleep hygiene means creating an environment and set of habits that facilitate a good night’s sleep. As with other sleep issues, improving sleep hygiene may improve nocturnal bladder control since bedwetting and poor sleep hygiene are related. Tips for improving sleep hygiene include having a regular wake-up time and bedtime, developing routines before bed, creating a comfortable, quiet sleep environment, and going screen-free for an hour before bedtime.
• Adjust daytime and nighttime drinking times. If possible, try to keep children from drinking for 1-2 hours before bed, so they will be less likely to need to urinate during the night. It’s also important to make sure your child stays hydrated and drinks regularly throughout the day, in order to avoid a “thirst overload” near bedtime.
• Adjust bathroom scheduling/habits. Make sure your child goes to the bathroom as close to bedtime as possible. It should be one of the very last things they do in their nighttime routine and may be repeated if necessary. In addition, schedule regular bathroom breaks throughout the day to keep your child’s kidneys and bladder healthy and help them pay attention to their bodies’ needs.
• Avoid bladder irritants. Some people believe certain foods and drinks cause the body to produce more urine, or irritate the bladder and reduce bladder control. Other experts advise against changing a child’s diet to manage bedwetting. If you think your child might be experiencing bladder irritation or excessive urination due to their diet, consult with your pediatrician before making any dietary changes.
• Biofeedback. Some studies suggest biofeedback could be a successful treatment for children who struggle with bedwetting. Biofeedback allows children to become more aware of their body’s physiological responses. The biofeedback process involves connecting a child to electromechanical equipment that notifies them of changes in bodily processes such as temperature, muscle tension, breathing, brain activity, and more.
• Pelvic Floor Exercises. Research shows pelvic floor exercises can successfully eliminate bedwetting in many children. Though more research needs to be done about this method, pelvic floor exercises are a potential solution to try when other treatments aren’t working.
• Use a wetness alarm. Wetness alarms work through a small sensor placed in a child’s pajamas or sheets. If the child starts to urinate, the sensor detects the moisture and the alarm goes off, ideally waking the child and giving them the chance to get to the toilet. When used over the course of time (usually around 12 weeks), the alarm can help train children to wake up naturally before they begin to urinate. A wetness alarm should only be installed if a child consents and understands the alarm’s purpose. Otherwise, it may only cause further humiliation, shame, and frustration.
• Ask your pediatrician. If your child continues to wet the bed, ask your pediatrician if there are potential underlying factors that you should be concerned about. In some cases, your pediatrician may run tests to rule out or identify underlying causes. Your pediatrician can also help you develop a bedwetting management plan that fits your child’s needs.

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Bedwetting | Caring for kids

Bedwetting happens when a child pees during sleep without knowing it. Many children will use the toilet well during the day long before they are dry through the night. It can be many months, even years, before children stay dry overnight.

Most children, but not all, stop bedwetting between the ages of 5 and 6 years old. Bedwetting is more common in boys and in deep sleepers.

What causes bedwetting?

Bedwetting is most often related to deep sleep—the bladder is full but the child doesn’t wake up. Some children have smaller bladders, or produce more urine during the night. Constipation can also lead to bedwetting because the bowel presses on the bladder.

If your child has always wet the bed and has never had 6 months or more of dry nights, there is nothing “wrong” with your child. This type of bedwetting is NOT caused by medical, emotional or behavioural problems.

But if your child has been dry overnight for at least 6 months and starts to wet the bed again, talk with your doctor.

Does bedwetting run in families?

Yes. In fact, scientists have discovered a gene for bedwetting. A child with one parent who wet the bed when they were young is 25% more likely to wet to the bed. If both parents wet the bed as children, that number rises to about 65%.

When do children outgrow bedwetting?

Most children will outgrow bedwetting on their own over time.

• At 5 years of age, 15% of children wet the bed.
• By 8 years, 6% to 8% of children wet the bed.
• Without treatment, about 2% of children still wet the bed by 15 years of age.

Does bedwetting need to be treated?

Usually not. The more important question is whether the bedwetting is a problem for your child. If bedwetting isn’t upsetting them, then you probably don’t need to seek treatment. Most children eventually outgrow it.

However, by 8 to 10 years of age, bedwetting may start to affect your child’s self-esteem and interfere with social activities like sleepovers. If this is the case, you can talk to your doctor about the following options:

• An alarm that your child wears at night. The alarm goes off when your child starts to pee and helps teach them to wake up when they have a full bladder.
  • It’s a good idea to talk to your doctor before you decide to buy one because they can provide advice on how to use the alarm properly.
  • The alarm needs to be used daily over a 6 week to 3 month period to be effective.
• Desmopressin acetate (or DDAVP) is a medication that has been used to treat bedwetting since the 1970s. It comes as an oral melt (a tablet that melts under the tongue) or a pill. Studies show that it works for most children on nights the medication is given. It won’t stop bedwetting completely, but it may be useful for special situations, such as sleepovers or camp.
  • Children should not drink water 1 hour before and 8 hours after taking DDAVP.
  • DDAVP can have mild side effects, such as headache or stomach pain. It can have severe side effects if not used properly or if your child has certain medical conditions such as cystic fibrosis or problems with fluid balance.  Have a discussion with your child’s doctor if your child has any side effects.
  • Like all medications, DDAVP should only be used as prescribed by your doctor.

Whether you and your doctor decide to treat the bedwetting or simply wait for your child to outgrow it, be sure that your child knows that bedwetting is not a bad behaviour or laziness. Don’t ever punish your child for bedwetting. It is not their fault. Your comfort and support are very important.

What else can I do to help my child?

• Make sure your child doesn’t drink too much fluid before bedtime.
• Avoid drinks with caffeine (such as pop).
• Encourage your child to go to the bathroom before bedtime.
• Use training pants instead of diapers.
• Make sure your child can easily reach the bathroom at night. For example, use a night light in the hall or in the bathroom.
• Use a hospital-strength plastic mattress cover to avoid damage to the mattress.
• Place a large towel underneath the bed sheet for extra absorption.
• It’s not necessary to change a sleeping child who is wet. There is no harm in sleeping in wet PJs. Leave a towel and change of clothes in case your child does wake up.
• Don’t wake your child up to pee when you go to bed. It doesn’t help with bedwetting and will just disrupt your child’s sleep.
• When your child wets the bed, help them wash well in the morning so that there is no smell.

When should I talk to my doctor?

Talk to your doctor if your child:

• is concerned or upset by the bedwetting.
• is having daytime accidents.
• has been dry for many months and suddenly starts bedwetting.
• has other symptoms, such as a frequent need to pee or a burning sensation when peeing.
• is still wetting past 5 to 6 years of age.

Reviewed by the following CPS committees

• Community Paediatrics Committee

Last updated: November 2017

Why Does My Child Wet the Bed?

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

Information from Your Family Doctor

What is enuresis?

Enuresis (say “en-yur-ee-sis”) is the loss of bladder control that leads to the release of urine. There are several kinds of enuresis. Nocturnal enuresis is also called “bed-wetting,” because it happens during the night while a child is sleeping. Bed-wetting is fairly common; about 5 million to 7 million children wet the bed. It may happen more often in boys than in girls.

What causes bed-wetting?

Bed-wetting isn’t caused by drinking too much liquid before bedtime. It’s not a psychological problem. It’s not because the child is too lazy to get out of bed to go to the bathroom. And children do not wet the bed on purpose, out of spite or to irritate their parents.

Some of the causes of bed-wetting include the following:

• Genetic factors (it tends to run in families)

• Difficulties waking up from sleep

• Slower than normal development of the central nervous system—this reduces the child’s ability to stop the bladder from emptying at night

• Hormonal factors (not enough antidiuretic hormone—this hormone reduces the amount of urine made by the kidneys)

• Urinary tract infections

• Abnormalities in the urethral valves in boys or in the ureter in girls or boys

• Abnormalities in the spinal cord

How can my family doctor help?

First, your doctor will ask questions about your child’s daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis). Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.

The doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child’s bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will ask about your family life, because successful treatment may depend on important changes being made at home.

How will my child’s bed-wetting be treated?

Most children outgrow bed-wetting without treatment. However, it’s up to you and your doctor to decide if your child needs treatment. There are two kinds of treatment for bed-wetting: behavioral therapy and medicine. Whichever treatment is chosen, it’s most successful when the parents, the child and the doctor work together to be supportive for the child. A diary that keeps track of wet and dry nights is helpful during treatment. It will help you and your doctor see your child’s progress. It will also remind your child about how well he or she is doing during the treatment.

What is behavior therapy?

Behavior therapy is a treatment that doesn’t use medicine. It’s often tried before a child is given medicine. Some kinds of behavior therapy are motivational therapy, behavior conditioning, bladder-training exercises, and diet changes (limiting caffeine, dairy products, and citrus fruits or juices). Because bed-wetting is a very emotionally stressful problem for older children, your doctor might also suggest counseling.

Motivational therapy tries to take away the guilt your child feels about bed-wetting. It tries to give emotional support to your child (and to you). This treatment may work better if your family uses positive reinforcement (such as verbal praise) and reward systems to help your child keep track of his or her progress.

Behavior conditioning uses an alarm. The alarm rings or buzzes when your child first begins to wet the bed. When the alarm goes off, it wakes your child. This gets him or her into the habit of waking up in the night to go to the bathroom.

There are two kinds of alarms: one kind makes a sound and the other kind vibrates. You should keep track (in a diary) of when the alarm system is used. You should also make sure the moisture sensor is in the right place. Write down your child’s response to the alarm, and keep track of his or her progress.

Bladder-training exercises help your child wait longer between trips to the bathroom. Although you may feel that your child has a “small bladder,” this usually isn’t a cause of bed-wetting. However, trying to hold the urine longer during the day may help your child increase the amount of urine his or her bladder can hold at night.

What kind of medicines are used to treat bed-wetting?

Your doctor may give your child medicine if your child is seven years of age or older and if behavior therapy hasn’t worked. But medicines aren’t a cure for bed-wetting. The medicines work in two ways. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. The medicines may have side effects.

How can I make my child not feel so bad about wetting the bed?

Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It’s true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry), but your child shouldn’t be made to feel guilty about something he or she can’t control. It’s important for your child to know that bed-wetting isn’t his or her “fault.”

It may help your child to know that no one knows the exact cause of bed-wetting, but that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child). It also helps to know that they can get “better” faster if everyone (the child, the family and your doctor) works together. When your child has some dry nights, he or she will begin to feel better.

How to Help Older Children Overcome Bedwetting

At what age is bedwetting a problem? It’s a common question fielded by pediatricians everywhere.

Bedwetting among older children is common, but can be uncomfortable and embarrassing for children and frustrating for parents. Because it’s rarely talked about among friends and extended family members, both parents and children can feel like there is something wrong with them when bedwetting continues into the elementary years and beyond.

So how can you get an older child to stop wetting the bed?

What parents should know about bedwetting

Jennifer Kirk, MSN, CPNP, a nurse practitioner in the Division of Urology at Children’s Hospital of Philadelphia (CHOP), works with dozens of families every year to help children overcome bedwetting.

Her first piece of advice is to recognize how common bedwetting is, and that most children naturally outgrow it. Experts estimate that 15 to 20 percent of children between the ages of 5 and 7 wet their beds at least occasionally. The numbers drop steadily as children age, down to about 2 percent at age 16. “About 15 percent of children who wet the bed will become dry every year,” says Kirk.

Bedwetting causes

Why do children wet the bed?

• In many cases, bedwetting is a genetic pattern, inherited from a parent, aunt or uncle.
• Most older children who wet the bed are very sound sleepers, so the signals of a full bladder aren’t strong enough to wake them.
• Some children have small bladders or don’t produce enough of a hormone (vasopressin) that reduces urine production during sleep.
• Bedwetting can be triggered by stress and by changes in the family, even positive ones, like a new baby or a different bedtime schedule over vacation.

In some cases, especially when bedwetting is a new occurrence, it can be a sign of another health problem. If your child is older than 7 and has started to wet the bed after many months of being dry, talk to your pediatrician. Your child’s primary care provider will ask if there have been any stressful events or changes in your child’s life, and can screen for health problems such as diabetes, constipation, sleep apnea or a urinary tract infection.

“You should only consider bedwetting a problem if your child does, for example if they feel embarrassed or upset, or if there is a medical cause for concern,” says Kirk. “The motivation to stop bedwetting needs to come from the child.”

How parents can help a child who wets the bed

“The key thing is not to blame or shame your child,” says Kirk. “Instead, focus on positive encouragement and practical steps you can take together.”

What are some of those practical steps to stop bedwetting?

Manage daytime fluid intake and urination

“Focus on what is going on during the day,” says Kirk. “The timing of fluid intake and urination during the day affects what happens at night.”

• Work with your child to make a habit of urinating every two or three hours during the day, even when they don’t feel the need. Have them void twice at bedtime — once an hour before they go to bed and then again right before they go to bed.
• Have your child use a calendar tracker to understand urination patterns over time. CHOP offers two of these trackers on its website, one for children and preteens and one for teens. This can give your child a sense of control over their bedwetting and help them see and feel good about progress.
• Encourage your child to drink plenty of fluids early in the day, rather than waiting until the end of the day to quench their thirst. Children who participate in sports late in the day should hydrate before their practice or game, then try to limit fluid intake during the evening.

Minimize disruption and discomfort at night

Use a waterproof mattress cover and keep a clean set of sheets and sleepwear at hand in case a change is needed.

Consider a bedwetting alarm

Bedwetting alarms have a moisture sensor that triggers a bell or buzzer when the child’s pajamas start to get wet. “The alarm is for the parent, at least at first,” says Kirk. “A child who can sleep through a wet bed will sleep through the alarm.” So you might want to put a baby monitor in the child’s room.

The process takes time, but after three or four months most children (not all) learn to awaken when the alarm sounds and to get up and use the toilet.

“The alarm requires a motivated child and a motivated family to work,” says Kirk. “Timing is important. Pick a time free of stressors and when the family isn’t overcommitted.”

Talk with your child’s primary care provider about medication

Some children are helped by a medication — DDAVP^®, or desmopressin — taken as a pill before bedtime to reduce the amount of urine produced during sleep. DDAVP can be a valuable tool for special events like sleepovers and sleep-away camp when used in addition to fluid and voiding management during the day.

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Bedwetting solutions: Expert pediatrician offers help for kids | Patient and family resources

Bedwetting, also known as nocturnal enuresis, is common in childhood and most children will grow out of it as they age. We asked UC Davis pediatrician Lena van der List about causes, strategies and solutions that can help families beat the bedwetting blues.

What causes bedwetting?

In the majority of young children who experience bedwetting, the main issue is sleep arousal. The brain is not signaling to awaken when the bladder is full, and, at times, doesn’t even signal the child to wake up when wet. Frequently, these kids are extremely heavy sleepers. Kids may also produce more urine than expected at night (which is called nocturnal polyuria) or have small bladder capacity (with frequent small urinations throughout the day and night), which may increase their risk for bedwetting.

Other causes for bedwetting:

1. Constipation, which, if appropriately treated, can alleviate the problem. Constipation causes bedwetting because a large amount of stool may actually push up against the bladder and prevent the bladder from expanding all the way. Doctors may prescribe a medication to help “clean out” the stool and keep your child more regular. The most commonly used medication is a laxative, polyethylene glycol, with the brand name Miralax.
2. Urinary tract infections
3. Genetic predisposition. If one parent experienced problems with nocturnal enuresis, on average, half of their children also will. If both parents did, then three-quarters of their children will.
4. Sleep disorders like obstructive sleep apnea. It is estimated that 30% of kids with sleep apnea will also have nocturnal enuresis. A child with symptoms of sleep apnea may snore at night, have periods where they seem like they pause breathing or be excessively sleepy during the day – although some kids may exhibit more hyperactivity. Sleep apnea can be diagnosed with a sleep study (these are frequently performed by pulmonologists). If a child is found to have sleep apnea, the most common treatment is removing the tonsils and adenoids (tonsillectomy/adenoidectomy). This allows for a more open airway at night and resolves the apnea. One study from 2016 looked at kids with bedwetting before and after tonsillectomy/adenoidectomy were performed for obstructive sleep apnea. After the surgery, 76% showed complete resolution of bedwetting, however the studies have been mixed on this.
5. There are other more serious conditions including diabetes, spinal cord issues that prevent a normal functioning bladder, and metabolic issues. While these are extremely rare, they should be considered in older kids with persistent enuresis that does not respond to typical treatment.

How can pediatricians help with bedwetting kids?

When you visit your doctor with a bedwetting concern, they may ask you questions like how long has it been going on? What time does it occur most nights? How much fluid and what types of fluid does your child drink in a day? Has your child had any previous “dry” periods? How often do they stool and what is it like? Do they ever have continence issues during the day?

Your child’s physician will perform an exam, which may include a genital exam and a neurologic exam. He or she may perform a urinalysis (where they ask your child to pee in a cup) to make sure there isn’t an infection or signs of diabetes, or extremely diluted urine.

Some physicians may ask you to keep a diary documenting all elimination (stools, day and night-time urination), fluids consumed, or even at times the volume of urine to help pinpoint the problem.

If the doctor doesn’t find a medical problem, how can parents help stop bedwetting?

Well, the first criteria is that the child is motivated for it to stop. If the child is not bothered by the bedwetting, each of these proven methods is much less likely to work:

1. Limit their nighttime fluid intake. A good rule of thumb is for the child to consume two-thirds of their fluid goal before the end of the school day and then one-third of the fluid after school with no more drinking in the last one to two hours before bed.
2. Have a stable bedtime routine. Going pee before bed and first thing upon awakening should always be encouraged.
3. Consider stopping pull ups or diapers at night once they are reliably potty trained during the day. For some kids, these may be used as a crutch and could continue to trick their brains into thinking they don’t have to wake up to urinate.

Do bedwetting alarms work?

Bedwetting alarms are recommended by the International Children’s Continence Society. It is worn attached to the pajamas or underwear and will alert the child as soon as wetness or moisture is detected. At first, the alarm may not wake the child so parents need to play active roles in waking up their kid, walking him or her to the bathroom. Their child should help change the sheets before going back to bed.

The alarm needs to be used nightly and may take two to three months to work, but it has been shown to be very successful in up to two-thirds of children. It also costs about $60 and is typically not covered by insurance so this can be a barrier for some families. It is recommended that parents and kids continue to use the alarm until two weeks of consecutive dry nights!

Are there medications that can help?

The most commonly used medication for bedwetting is called desmopressin. It reduces the amount of urine produced overnight so it may be more beneficial in those kids that produce more urine at night. Studies have shown a 20-30% response. One side effect of the medication can be low sodium, so parents need to be aware of the signs, including confusion, weakness and even seizures.

One other bedwetting medication that is occasionally used is called imipramine. It belongs to a class of medications called tricyclics and is also used to treat depression. It is less frequently prescribed these days because if too much is taken, an overdose may occur. Before starting on this medication, the heart needs to be monitored with an EKG.

There are a few other medications that have been used, but they have a higher likelihood of side effects and are therefore not routinely recommended as a first line of treatment in kids.

What is dry bed training, and how do I do it?

Dry bed training is a more hands-on, parent-led approach.

1. On the first night, awaken the child once every hour until 1 a.m., asking if he or she has to use the bathroom. At the 1 a.m. awakening, tell the child to try using the bathroom, even if he or she is dry.
2. The second night, wake him or her only once, three hours after falling asleep.
3. The third through fifth nights, wake the child once each night. Start at two-and-a-half hours after falling asleep, and keep diminishing the interval each night, so that on the fifth night, the child is awakened one hour after falling asleep.
4. On the sixth night, tell the child to self-awaken from then on.

One older study reported a great than 90% success rate with this method.

What do you recommend when a child has had a dry period for more than six months and then begins to wet the bed again?

This is referred to as secondary nocturnal enuresis. This is often related to a psychological stressor like a divorce or the birth of a new sibling. Exploring what may be bothering your child is a good idea. But the above other medical diagnoses should also be considered.

What’s the best way for parents to respond to bedwetting while still making sure they are being sensitive toward the child?

As kids get older, typically closer to around 6-8 years old, they begin to get self-conscious and embarrassed by bedwetting. They may resist sleepovers. This can affect their self-esteem and friendships. It’s important that the child doesn’t feel like it’s their fault or something is wrong with them.

They should not be shamed. For example, never say “I can’t believe you did this again” or “You are costing us a lot of money having to wash your dirty sheets every night.” It’s important that bedwetting is not discussed in front of the child’s siblings or friends. Parents should reassure the child that it’s normal for his or her age. Act as an ally to the child and show that you’re going to tackle this as a team.

Parents may want to teach the child to do the laundry so they can wash their sheets and pajamas on their own. This should not be treated like a punishment; it is an opportunity for the child to have control over it and limit who knows about it. This also helps develop responsibility. If you approach it in this supportive and collaborative way, most kids will outgrow it.

90,000 Urinary incontinence in women | City Clinical Hospital. V.M.Buyanova

Urinary incontinence in women is manifested after the implementation of everyday life actions: prolonged laughing, coughing, prolonged physical exertion, changing the position of the body during sleep, lifting heavy objects, sexual intercourse.

Almost every fifth woman in the world faced this problem. At the same time, not all of them seek treatment. In Moscow, only 1.5% of women make an appointment with a doctor with urinary incontinence.In America and Europe, the statistics are much worse – 30-40%.

The most common cases are:

– stress urinary incontinence in women. It can occur anywhere, depending on the complexity of the surrounding situation, its psychological, emotional side. It is considered the most common problem in urology;

– coughing incontinence in women. There is a sharp jump in pressure inside the abdominal cavity, the muscles of the bladder are in strong tension.If the sphincters are weak, urine will leak. The same situation is observed with urinary incontinence when sneezing in women. The reasons for the rejection are completely similar.

– nighttime urinary incontinence in women. Uncontrolled urination process. As a rule, children suffer from “enuresis”;

– postpartum urinary incontinence in women. It occurs due to a violation, weakening of the pelvic floor muscles;

– urinary incontinence in young women. May occur due to all of the above reasons;

– urinary incontinence in elderly women.It is divided into three types: stressful (due to pressure on the abdominal cavity), forced (with any sudden urge), total (uncontrollable, occurs constantly).

Spontaneous loss of urine does not harm a woman’s life in any way. At the same time, it brings serious physical and mental inconvenience, affects various aspects of the activity.

Most women do not dare to tell about their problem even to the doctor. This is due to her deepest intimacy, as well as ignorance of a quick way to eliminate urinary incontinence.

Symptoms of urinary incontinence in women

The main symptom of urinary incontinence in women is the spontaneous flow of urine when performing various daily activities, physical activity and other situations. Also, the symptoms of the disease include sudden urges, a feeling of incomplete emptying of the bladder, a feeling of a foreign object in the vagina.

Causes of urinary incontinence

A disease such as urinary incontinence in women may have different causes.The main ones are:

– pregnancy, difficult childbirth;

– strong physical activity;

– operations;

– genetic predisposition.

Age also affects the development of this disease and is a common cause of urinary incontinence in women after 50 years. If the manifestations are minor, conservative treatment with special drugs is used. If the situation is difficult, there are pronounced changes in anatomy, surgical intervention is prescribed.

The causes of bedwetting in women is the lack of muscle control. At this point, they are relaxed. In addition, infectious diseases and disorders of the nervous system can also affect urine leakage.

What is the danger of urinary incontinence in women?

At its core, the disease does not harm a woman’s health in any way. But with its seemingly minimal danger, urinary incontinence can completely ruin life, limit it, make it restrained.A woman will lose her mobile phone and will experience constant discomfort. This can affect your career and professional growth.

Prevention, diagnosis and treatment of urinary incontinence

The first step in diagnosing urinary incontinence in women is to consult a specialist. The doctor prescribes a complete examination that helps to identify the causes of the disease. In the future, the most acceptable method of treatment is selected.

For a successful operation, specific, clear indications are required.Without them, intervention cannot be carried out; it can only exacerbate the problem.

Treatment of urinary incontinence in women is carried out using minimally invasive surgery using the most modern instruments and equipment.

A special synthetic implant is placed under the middle of the urethra – a mesh, which reliably supports the organ, adjacent tissues, and prevents urine leakage. The prosthesis is made of the most modern materials – polypropylene, which has been used in medicine for several years.Its structure freely passes blood cells, thereby preventing the occurrence of inflammatory processes. The implant is inserted through a small 1 cm incision in the vagina. Also, incisions with a length of 2-3 mm are made on the inner thighs. The operation takes 20-30 minutes.

Treatment of bedwetting in women can also be carried out with the help of implants. Depending on the complexity of the case.

The patient is discharged after surgery every other day. During the next month, it is necessary to adhere to sexual rest, as well as limit physical activity.

Urinary incontinence and pregnancy

Urinary incontinence is considered a common occurrence during pregnancy. The longer the period, the stronger the disease becomes. It can also persist after childbirth.

Causes of involuntary urine leakage during pregnancy:

– The pelvic floor muscles weaken. This is due to changes in the hormonal background of the woman’s body;

– changes in the size of the uterus. The organ enlarges, thereby compressing the bladder;

– child’s movements.When pregnancy is late, the fetus is actively moving. The baby’s arms and legs can hit the bladder.

Despite all the safety of the disease for the health of the body, it brings significant discomfort to a woman’s life. And only timely treatment will normalize the situation. The main thing is not to be ashamed of this and immediately consult a doctor!

obstetrician-gynecologist

Head of the Department of Gynecology

candidate of medical sciences

Registration by phone

obstetrician-gynecologist

candidate of medical sciences

Registration by phone

Telephone for inquiries and registration: +7 (495) 321-57-40 (department of paid medical services).

A MODERN LOOK AT THE PROBLEM OF NIGHT INSURANCE IN CHILDREN | Gusarov

1. Neveus T., Eggert P., Evans J. Evaluation of and treatment for vonosymptomatic enuresis: a standardization document from the international children’s continence society. J. Urol. 2010; 183 (2): 441.

2. Petit J. L. Trite des maladies chirurgicales et des operations qui jeur convennent.Paris. 1774. P. 117.

3. Lane W., Robson M. Evaluation and management of enuresis. Engl. J. Urol. 2009; 360: 1429. 4. Kovalev VV Semiotics and diagnostics of mental illnesses in children and adolescents. Moscow. 1985.S. 203–204.

4. Glybin AS Violation of urodynamics of the lower urinary tract and the activity of the autonomic nervous system in functional disorders of urination in children.Abstract of thesis. dis. … Cand. honey. sciences. Moscow. 1984.

5. Dvoryakovskaya G. M., Ivanov A. P., Bryazgunov I. P. et al. The state of internal organs in children with nocturnal enuresis according to echography. Ultrasound diagnostics. 1996; 2: 33-36.

6. Kovach L., Panchenko E. L. Primary nocturnal enuresis: a new look at an old problem. Consilium Medicum.1999; 1 (6): 23–31.

7. Leshchenko NA, Moskvichev O. K., Smirnova NN Night enuresis – the problem of children and parents. Nephrology. 1998; 4: 12-17.

8. Eiberg H., Berendt I., Mohi I. Assignment of dominant inhented nocturnal enuresis (Enur 1) to chromosome 13q. Nature Genetics. 1995; 10 (3): 354-356.

9.Holman E., von Gontard A., Eiberg H. et al. Molecular genetic, clinical and psychiatric correlation in nocturnal enuresis. II Proceedings of the l-st Congress of the International Children’s Continence Society. Paris. 1997. P. 28-29.

10. Antropov Yu. F. Psychosomatic disorders in children and adolescents. Moscow. 1997.198 p.

11.Isaev DN Psychosomatic disorders in children. A guide for doctors. SPb .: Peter. 2000; 507 s.

12. Badalyan LO, Zavdenko NN Enurez in children. Review of Psychiatry and Medical Psychology. 1991; 3: 51-60.

13. Buyanov MI Systemic neuropsychiatric disorders in children and adolescents. Moscow. 1995.S. 51-60.

14.Zavadenko N.N., Petrukhin A.S., Pylaeva O.A.Enuresis in children: classification, pathogenesis, diagnosis, treatment. Bulletin of Practical Neurology. 1998; 133-137.

15. Abramovich EE Diagnostics and treatment of enuresis in the conditions of a children’s polyclinic: Dis. … Cand. honey. sciences. Moscow. 2000.192 s.

90,000 Enuresis in a child – what to do?

Enuresis is involuntary urination during nighttime and / or daytime sleep.

Urinary incontinence is a fairly common complaint from parents. The disease occurs 1.5-2 times more often in boys.

The formation of independent control of urination by 3 years is formed
in about 65% of children, in 75% by 4 years, in the vast majority of children by 5 years of age. Consequently, persistent urinary incontinence over 3-5 years of age is considered a disease, and requires an appeal to a specialist nephrologist, pediatric urologist.

The root causes of this problem are:

• Urinary tract infections,
• Malformations and dysfunctions of the kidneys, bladder and urinary tract,
• Damage to the nervous system (delayed maturation of the nervous system),
• Neuroses, mental disorders,
• Psychological stress,
• Family (genetic) burden.

Allocate primary and secondary enuresis . Primary continues from birth, without “light” gaps. Secondary – urinary incontinence resumes after 3-6 months of “dry” period. Of great importance in the success of the treatment of this pathology is the elimination of the traumatic factor, ensuring the correct daily regimen, rational nutrition with the necessary amount of vitamins, especially of group B, normalization of sleep, ensuring an adequate stay in the fresh air, the use of therapeutic massage and therapeutic exercises aimed at strengthening the muscles of the anterior abdominal wall, pelvic floor muscles, drug treatment prescribed by a specialist nephrologist-urologist, reflexology, physiotherapy and hydrotherapy.

Tips for Parents

• Only a doctor can tell you how to treat bedwetting in your child. Be sure to consult a specialist to diagnose and identify the causes of bedwetting. Only after the cause of enuresis has been established, the correct treatment can be prescribed.
• Enuresis is a disease and the child is not guilty of it. Never scold him or punish him for a wet bed.

Treatment of nocturnal enuresis in children is a long and complicated process.That is why it is very important for parents to help the baby in this difficult struggle, actively taking part in it and celebrating children’s victories.

Here are some simple bedwetting guidelines you can follow to help your child cope with this problem more quickly.

• At least 2 hours before bedtime, it is better not to give the child anything to drink. In the daytime, it is better to exclude highly carbonated artificial drinks.
• Supper preferably at 6-7 pm.
• Dinner is washed down with half a glass of ordinary weak tea with lemon, diluted with juice.
• Treatment of bedwetting in children is more likely to be beneficial if the child adheres to the regimen. Therefore, try to put your child to bed at the same time, no later than 10 pm.
• Eliminate active play and emotional transmission 2 hours before bedtime. You shouldn’t watch TV for more than forty minutes a day and before bed. Computer games no more than 40 minutes a day.
• An hour before bedtime and before going to bed, the child should go to the toilet. Put a pot next to the bed, you can leave a burning night light in the room.
• It is good for a child to sleep in the afternoon. Let the main loads fall on the first half of the day.
• Develop a baby’s forced urination rhythm when you expect your baby to get wet.

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90,000 Enuresis in children

The problem of urinary incontinence in childhood has not only medical but also social significance.There is daytime and nighttime urinary incontinence, the latter is called enuresis.

Daytime urinary incontinence is a sign of neurogenic dysfunction of the bladder, in particular an overactive bladder, which, in addition to urinary incontinence, combines frequent urination (more than 8 times a day), and urgent (imperative) urge to urinate. This has no direct relation to enuresis.

It should also be noted that enuresis is subdivided into primary, which appears from an early age of the child.At the same time, there are no long (3–6 months) periods of “dry nights”. Secondary enuresis occurs after a long period of dry nights. There is also a combination of enuresis and daytime urinary incontinence.
Currently, due to the massive use of diapers and insufficient efforts by parents in the formation of “toilet behavior” of the child, urination control during sleep appears in children at a later age than it was decades ago. As an age criterion for establishing the diagnosis “Enuresis” is considered the age of a child 5 years, since by this time all children should have control over urination at night.

Earlier it was believed that children with deep sleep suffer from bedwetting. This is a misconception, since deep sleep is the norm and even a necessity. It is in the “deep” phase of sleep that the body functions are restored and rest. Enuresis occurs in children with impaired neuro-regulation of the bladder to one degree or another. The disorder can be at any level: pelvic nerves, lumbosacral spinal cord, brain. The causes of such disorders can be various types of neuropathy, organic damage to the brain or spinal cord, endocrine disorders, temporary “functional instability” or “immaturity”, etc.d.
There is also an opinion about the hereditary nature of enuresis, inheritance occurs in an autosomal dominant manner. Children suffering from genetically determined enuresis, in comparison with other children also suffering from enuresis, excrete more low-concentrated urine at night (2/3 or more of the daily urine output).
All children with enuresis require additional examination to identify the type and level of dysregulation of the bladder.

First of all, it is necessary to study the functional state of the lower urinary tract, since, depending on the disorders found during the examination, the treatment will be different.
Evaluation of a child with enuresis should include: urination diaries, dry / wet night diaries, uroflowmetry with residual urine volume, combined urodynamic examination (CUDI), x-ray of the lumbosacral spine, and sometimes encephalography.

Early examination of a child with enuresis is the key to successful treatment and psychological comfort of the child and his parents. Modern medicine has at its disposal many tools and techniques to cope with enuresis.But the cornerstone is identifying the cause of the impaired control and choosing the exact therapy shown to this particular child.

Where can bedwetting (urinary incontinence) be cured in children?

To resolve the issue of urinary incontinence treatment, it is necessary to get a consultation at the Consultation and Diagnostic Center Research Institute of Urology and Interventional Radiology named after N.A. Lopatkina ! After the consultation, it will be necessary to undergo an examination or a pre-examination, after which an interdisciplinary consultation of doctors will be held, at which a decision will be made on the chosen method of treatment.

Department of Urodynamics and Neurology, Research Institute of Urology and Interventional Radiology named after N.A. Lopatkina is the leading department of the institute in the treatment of patients with various disorders of urination and urinary incontinence.

Head of the department urologist – ROMIKH Victoria Valerievna

Call us today so we can help you!

Moscow, 8 (499) 110 – 40 – 67

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Enuresis – What we treat “Children of Indigo”

What is enuresis

“You described yourself again ?! How dare you!”.Parents often scold their children for bed-wetting, considering it a shameful thing. And if peers find out about it, they will torture them with mockery, which will only aggravate the situation.

First of all, parents should understand that punishment in such a situation is not appropriate. The child needs professional help, since in most cases we are talking about a disease, the cause of which lies in neurological abnormalities.

Important!

Enuresis is a disease, a syndrome of bedwetting, has deep neurological and psychological roots.

Enuresis was described in medical treatises by ancient scientists. And then, and several decades ago, bedwetting was considered a serious disease. But modern doctors are increasingly inclined to believe that enuresis in children is a kind of transitional stage in physiological development that can be easily corrected.

According to medical statistics, 95% of those who suffer from nocturnal enuresis are children, followed by adolescents – 4.5%, in adults this disease is extremely rare (only 1%).Moreover, 90,025 enuresis in boys occurs 2 to 4 times more often than enuresis in girls . In boys, enuresis is more often nocturnal, and in girls, enuresis is daytime.

When is enuresis diagnosed

Such a diagnosis as enuresis can only be talked about when the child reaches 5 years of age. According to doctors, children at this age should already be able to retain urine when urging. Uncontrolled urination in a younger period is not a deviation from the norm.

Causes and types of enuresis

Depending on the reasons that caused the development of enuresis, various forms of the disease are distinguished.If a child pees in bed often precisely at the beginning of the night, when the fast phase of sleep is in progress, but at the same time does not experience emotional discomfort, quickly forgets about what happened and does not have physiological problems, this form of enuresis is considered uncomplicated. Experts suggest that the hereditary factor plays an important role here. As a rule, this form of bedwetting is easy to treat, moreover, it does not cause psychological trauma to the child.

But if the “problem” causes negative emotions in the child, he experiences, they speak of a neurotic form of enuresis in children.In this case, the following symptoms accompanying enuresis should be noted:

• Irritability, emotional instability
• Crying, capriciousness
• Frequent fears
• Sleep disorders

Enuresis, manifested against the background of the general nervousness of the child, is congenital in nature, the cause may be birth trauma or pathology of the perinatal period. In this case, professional diagnostics and timely measures are required to treat bedwetting.

There are complex, secondary forms of the disease. Secondary bedwetting in children may appear after the problem seems to be resolved. Doctors set the border at least 6 months. If after some time there is a relapse, it means that there is a high probability that there is a serious disease (endocrinological, neurological, etc.), against the background of which nocturnal enuresis reappeared.

Often companions of enuresis, especially enuresis in boys, are infectious diseases of the genitourinary system and urological problems.

Endocrinopathic enuresis accompanies serious diseases such as obesity and diabetes mellitus.

Epileptic enuresis can be manifested by urination during an epileptic seizure.

Dysplastic enuresis appears with severe dysfunctions of regulation in the body. Here, in addition to nocturnal enuresis, there is also urinary incontinence during the day, as well as fecal incontinence.

There is also such a form as 90,025 stress enuresis in children .Urination occurs from pressure on the abdominal cavity during exercise, coughing, laughing.

Children’s scoliosis can also trigger the development of bedwetting. The displacement of the vertebrae in the lumbar spine prevents the proper formation of the pelvic organs. The displacement of the vertebrae in the cervical spine constricts blood vessels and nerve endings, which affects the activity of the brain, which regulates all processes in the body. Eliminating the root cause – childhood scoliosis – can radically solve the problem of childhood enuresis.

A mixed type of enuresis is also distinguished, which manifests itself in various symptoms.

Important!

In the list of the main causes of bedwetting, doctors put the mental health of the child in the first place.

Researchers have even compiled a kind of portrait of a child prone to enuresis: short, thin, with a suppressed will, unsure of himself. Such children, especially boys, give in to difficulties, are afraid of strict adults, boys’ bedwetting can be a form of protest against the demands of their parents.

How to treat enuresis in a child

In general, bedwetting in children responds well to treatment. The main thing is not to make problem # 1 out of bedwetting, not to create undue attention around the painful issue.

The specialists of the Center for Pediatrics and Neurology have a wealth of practical experience in the successful treatment of enuresis in children. Before answering the question of how to treat enuresis in a child, an examination will be required. Frequency-response diagnostics will help establish the true cause of urinary incontinence.

Treatment of enuresis in Moscow price, causes, symptoms, diagnosis of nocturnal enuresis, the cost of treating urinary incontinence in women and men: Medical Center “Doctor near”

The syndrome of uncontrolled, involuntary urination is called enuresis. Contrary to popular belief, not only children of preschool and primary school age suffer from urinary incontinence, although it is in them that this disease occurs more often. However, enuresis occurs in older men and women, and is a rather serious problem not only of a medical, but also of a psychological nature.It affects self-esteem and the emotional state of a person, preventing him from building relationships with friends or the opposite sex, forcing him to withdraw into himself, and makes it difficult for him to adapt in society.

Causes of enuresis

The causes of bedwetting can be:

• infections of the genitourinary system,
• malformations,
• pathology or disorders in the development of the nervous system,
• neuroses and other mental disorders, including childhood traumas,
• depressive and stressful conditions,
• sleep disorders,
• physiological pathologies,
• inflammatory diseases,
• injuries and lesions of the spine and spinal cord, etc.

Features of enuresis in women

Enuresis in women has the same causes as enuresis in men: mental problems, stress, infections, inflammatory diseases, physiological pathologies, etc. In addition, women have an increased risk of urinary incontinence after childbirth and with age. It especially increases during menopause – weak, stretched or damaged muscles of the abdomen, bladder and vagina, surgeries, problems with excess weight, kidney disease, hormonal changes seriously increase the risk of this disease in women after 40-45 years.Women with bedwetting experience great psychological difficulties because of it, which can lead to depression.

Treatment of urinary incontinence

Enuresis responds successfully to treatment, and the sooner you see a doctor, the faster and easier recovery will come. Self-medication for enuresis is not just undesirable, but unacceptable, since you can seriously harm your health by missing a serious illness and not starting its timely treatment.

Urology consultation

In most cases, the diagnosis and treatment of bedwetting is successfully carried out on an outpatient basis.Hospitalization is necessary only in cases where enuresis is a symptom of serious pathologies of the genitourinary system.

Treatment of bedwetting is carried out after the study, when the cause of the disease becomes clear. The therapy is complex and may include medication and non-medication methods, including psychotherapeutic treatment, physiotherapy, etc. In cases where enuresis is a symptom of another disease, it is necessary to cure the original disease.The urinary incontinence will most likely stop after recovery.

Prevention of enuresis

When treating bedwetting, you need to reduce the risk of uncontrolled urination at night – do not drink water and drinks later than 2 hours before bedtime. Various drinks with a diuretic effect (cranberry and lingonberry juice, rosehip broth, green tea, etc.) are also recommended to be excluded. Dinner should be no later than 3 hours before bedtime, after dinner it is allowed to drink no more than 150 ml of liquid.It is imperative to empty your bladder before bed.

The danger of bedwetting in adults is that this problem is very delicate, and adults very often hide it, embarrassed to admit even a doctor about a “childhood” illness. If a situation with urinary incontinence happened once, it can still be attributed to overwork, stress, hypothermia, or alcohol. But if the problem with bedwetting occurs constantly, this is a sign that this is a medical condition that requires treatment.Enuresis may itself be a symptom of another disease, such as prostate adenoma in men or pyelonephritis.

Tricyclics and similar drugs for the treatment of bedwetting in children

Relevance :
Nocturnal urinary incontinence (nocturnal enuresis or enuresis) is the involuntary flow of urine during sleep that is not caused by a physical disorder (somatic illness).It can lead to social, emotional and psychological problems and a reduced quality of life. This disorder occurs in about 15-20% of 5-year-olds, and can persist in adults with an incidence of up to 2%. Many different types of drugs are used to treat bedwetting, either as a single treatment or in combination with other treatments. Tricyclics are antidepressants that have been used to treat bedwetting since the 1960s. Probably, their effect is due to the antispasmodic effect on the bladder.This review examined 64 clinical trials of tricyclic drugs, involving 4071 children.

Main Findings :
Imipramine is the most commonly used tricyclic for the treatment of bedwetting. Compared to placebo, tricyclics reduce bedwetting by about one night per week during treatment, and about a fifth of children achieve 14 dry nights. However, when the tricyclic treatment is discontinued, most nights become “wet” again.

Adverse Effects:

Tricyclics are as effective as another commonly used drug, desmopressin. However, they have more side effects such as seizures, heart, liver, and blood effects, including low white blood cell counts, especially in overdose, which can be serious.