Persons aged 18 years and older, approximately 1-2% remain enuretic. Families of bed-wetters can experience disturbed sleep, turmoil, and a drain on energy and resources. Children have never achieved complete nighttime control. They have always wet the bed at least two times a month. Children with ADHD are 2.7 time more likely to have bedwetting issues. Difficulties waking up from sleep is cause of enuresis. Stress is controversial as a possible cause of bedwetting. Sleep issues are another controversial potential cause of bedwetting. Chronic constipation can cause bedwetting. Most bedwetting is caused by neurological-developmental problems involving multiple factors. Bedwetting cases are caused by specific medical situations. Bedwetting cases are caused by infection or disease, most common of which is a urinary tract infection. Bedwetting has a strong genetic component. Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively. Caffeine increases urine production. Tricyclic antidepressant prescription drugs with anti-muscarinic properties (i.e. Amitriptyline , Imipramine or Nortriptyline ) may be used to treat bedwetting with much success for periods up to 3 months. Diapers can reduce the embarrassment and mess of wetting incidents.
Causes of Enuresis
Common causes and risk factors of Enuresis
Difficulties waking up from sleep
Slower than normal development of the central nervous system.
Urinary tract infections.
Abnormalities in the urethral valves in boys or in the ureter in girls or boys.
Abnormalities in the spinal cord.
Inability to hold urine for a long time because of small bladder.
Signs and Symptoms of Enuresis
Common sign and symptoms of Enuresis
Children have never achieved complete nighttime control. They have always wet the bed at least two times a month.
Children may suffer significant psychological stress and develop feelings of low self-esteem.
Families of bed-wetters can experience disturbed sleep, turmoil, and a drain on energy and resources.
Treatment of Enuresis
Common Treatment of Enuresis
Tricyclic antidepressant prescription drugs with anti-muscarinic properties (Amitriptyline , Imipramine or Nortriptyline ) may be used to treat bedwetting with much success for periods up to 3 months.
Diapers can reduce the embarrassment and mess of wetting incidents.
Positive attitude and motivation to be dry are important components of treatment. Children with NE benefit from a caring and patient attitude by their parents; punishment has no role.
Alarm therapy offers the possibility of sustained improvement of NE and should be considered for every patient.
Desmopressin acetate (DDAVP) is the preferred medication to treat children with NE. Numerous studies report total dryness in 38-55% of children treated with DDAVP.
DDAVP tablets should be administered at bedtime. The recommended starting dose is 0.2 mg, and the drug can be titrated as necessary to a maximum of 0.6 mg.
Anticholinergic medication may be helpful in some patients, especially those with urge syndrome, dysfunctional voiding, or neurogenic bladder. These medications reduce uninhibited detrusor contractions, increase the threshold volume at which an uninhibited detrusor contraction occurs, and enlarge the functional bladder capacity.
Children should be instructed not to drink to excess with the evening meal and to minimize fluid intake after mealtime.