Do not worry if your child urinates in bed. Bedwetting is very common. Some children simply cope with incontinence later than others. One child of 20 at the age of 10 years still "walks" to bed. Foods and drinks containing caffeine can worsen the situation. The same applies to constipation. Experts believe that urinary incontinence or nocturnal enuresis in children can be associated with a slight hormonal imbalance or "hyperactivity" of the bladder. But, regardless of the reasons, the vast majority of children cope with this problem over time, so be patient. But at all to ignore the given disease all the same it is not necessary. This article examines the main causes, symptoms and methods of treatment of childhood enuresis with specific drugs, which will be useful to learn about each parent.
What is enuresis?
Urinary incontinence (nocturnal enuresis) means that the baby empties his bladder during sleep. Many parents expect children from the age of three years of dry bed. Although many children at this age usually need a waterproof diaper, and often even before school age. But, you will be surprised, even in schoolchildren bedwetting is a common occurrence.
About 1 in 7 children under the age of five, and 1 in 20 children at the age of 10 have this problem. A child who has never been a dry night already suffers from a "primary" nocturnal enuresis. A child who initially had a period of dry nights, but later began to develop bedwetting, has an "average" bedwetting. This disease is three times more likely to be experienced by boys than girls.
What causes enuresis?
Most children have no specific reason. Factors that can contribute to this include:
- False expectations of parents. Some children simply develop later, including in the bladder area, than others. This is normal and does not involve intellect or other developmental problems! Although it is convenient for parents that the baby is dry before the age of three, the bladder can not be ready for this for several more years.
- Low capacity of the bladder. Some children go to the toilet more often than others on average during the day. As a rule, they can not tolerate a long time. Their bladder is "hyperactive". This usually changes when the child becomes older.
- A small imbalance of hormones. In children with urinary incontinence, the problem may be the inability to produce the hormone ADH (antidiuretic hormone) at night. This hormone reduces the amount of urine in the body at night. With less content of this hormone, the body tends to produce more urine. If this is one of the factors, this tends to improve when the child becomes older.
- Failure of "internal alarm clock". A child simply can not receive a signal about a full bladder on time and not wake up specifically to go to the toilet. Again, if this is one of the factors, the situation changes when the child becomes older.
- Genetic factors. Bedwetting is often of a family nature. About 1 in 7 children, whose parents, brothers or sisters had a similar problem, also face this problem in their childhood.
There are things that could affect the development of bedwetting or worsen existing problems. These include the following:
- Stress can affect the onset of enuresis after a period of dryness. For example: going to school, the appearance of a new child, illness, moving, cruel treatment, etc.
- Drinks and products containing caffeine. These include tea, coffee, colas and chocolate. Caffeine increases the amount of urine, this is a real diuretic.
- Constipation. Large accumulations of feces in the rectum can press and irritate the posterior wall of the bladder. In particular, children with chronic constipation often have a diagnosis of bedwetting. It was found by research that 1 out of 3 children with chronic constipation suffered from enuresis.
- Children with attention deficit hyperactivity disorder (ADHD) have an increased risk associated with the problem of bedwetting.
Other "medical" causes of enuresis are quite rare. For example: infections of the urinary tract, sleep apnea due to obstruction of the airways, diabetes and rare diseases of the bladder. The medical nature of incontinence is more likely if the daytime baby also "wets" pants. The doctor, as a rule, excludes these reasons by studying the child and testing the urine. Sometimes children are subjected to additional tests to check for rare problems of the bladder.
How to prevent enuresis in a child?
Diapers.
If you decide: "Now is the time to get out of diapers" - just stop using them. Forever. Do not allow yourself to make life easier with a diaper. This gives children little motivation to try to be dry. Yes, there is a risk of wet panties and bed linen for a while. However, young children usually quickly realize that being wet is "bad" and unpleasant. And they cope with this problem on their own.
Patience, consolation and love.
Of course, the enuresis in the child is an unpleasant moment for the parents. But it is important to know: there is no treatment for children under the age of five! Even if your child suffers from night incontinence to the school itself, there is a high probability that he will stop shortly. There are many examples where children are "cured" of this ailment on their own.
Do not punish children for bedwetting! It's not their fault! But they should always be encouraged if you notice any improvement. Try to be sensitive to any violations in the family or school that can be stressful for your child. If bedwetting occurs after a period of dryness, it can reflect latent strain and fear (eg bullying in school, etc.).
Parents explanation.
Once your child is old enough to understand some of the laws of nature, just explain the following things to him. The body produces water all the time and keeps it in the bladder. The bladder is like a balloon that is filled with water. We open the "tap" when the bladder becomes full. The bladder fills at night when we sleep. However, the "crane" of the bladder should not sleep and should wake us up when the bladder is full.
Children's responsibility.
When the child grows up (at the age of five or six years), ask him to help you overdo his wet bed. This may be surprising, but many children react to this quite adequately. This can give an additional argument to get out of bed and go to the toilet, avoiding the change of bed linen.
More general tips for preventing enuresis.
- Make sure that the child does not have any hidden fears and problems getting up at night. For example, fear of darkness, spiders, etc. Try to leave the light on the toilet for the night.
- Do not limit the consumption of drinks before bedtime! The bladder should get used to filling and holding the urine. If you restrict the drink all day, then the bladder can not develop normal functions. Most children need to drink about 6-8 cups of fluid per day. In addition, as mentioned above, tea, coffee or cola can affect the development of bedwetting. Therefore, they should be avoided a few hours before bedtime.
- Do not wake the child at night! This has little benefit, and can even prolong this problem. The child must get used to awakening when their bubble is full. Children often do not remember how they were raised, and this usually does not help them achieve their own control over the condition of the bladder. However, make sure that your child goes to the toilet before going to bed.
- If your child has constipation, consult a doctor for advice and treatment. Treatment of constipation often heals and enuresis too. In one study, about one-third of children with persistent constipation suffered from night urinary incontinence. Treatment of constipation also cured enuresis in two out of every three children.
Variants of treatment of nocturnal incontinence in children.
The drug desmopressin.
Desmopressin is the most popular drug used to treat urinary incontinence. The dose is given just before bedtime. It is supplied both in the form of tablets that are swallowed, and in the form of "sublingual" tablets. The advantage of the latter is that their action does not depend on food in the stomach. Previously released desmopressin in the form of nasal spray. However, it was withdrawn from production because of the increased risk of side effects compared to the same drug in tablets.
How does desmopressin work?
It works mainly due to the reduction in the amount of urine produced per night by the kidneys. Thus, the bladder does not fill very much at night.
How effective is desmopressin?
In most children who take desmopressin, there is an improvement. This can be less "wet" nights than usual, rather than being completely "dry" every night. About 1 in 5 children who take desmopressin are completely cured of enuresis.
What are the benefits of desmopressin?
Because of how he works (reducing the amount of urine), he has an effect already on the first night of treatment. This can be very encouraging for the child.
If the drug had no effect in a few days, it is unlikely to work. However, sometimes the first dose is not high enough. The doctor may advise to increase the dose, if it does not work, at first glance. In addition, it is possible that food can affect the absorption of desmopressin into the body. Therefore, if it does not work, then try giving the dose at least an hour and a half after eating. And do not feed your baby before bed.
What are the drawbacks of desmopressin?
It does not work in all cases. In addition, children who took it, there is a high probability that bedwetting will return after the drug is discontinued. Some children develop side effects, but they are rare.
When and how is desmopressin applied?
It is usually prescribed only to children over the age of seven, but sometimes also to children for a year or two younger. If it works, its application can be extended for a while. After three months of treatment, desmopressin should be discontinued for at least one week to assess the child's condition.
Desmopressin can also be useful for occasional cases. For example, for holidays or time away from home (hiking, etc.). It can also help a child who struggles with bedwetting to show an example of a "dry" night.
A child should drink only a small amount of fluid before and after taking desmopressin.
Side effects of desmopressin.
Side effects are rare. These include headache, nausea, and a softer stool. These side effects are not serious and immediately disappear if treatment is stopped.
Very rarely, taking the drug can lead to fluid overload (too much fluid in the body). This can lead to seizures and serious problems. It should be emphasized that this is an extremely rare sporadic effect and it is unlikely to happen. However, as a precaution:
- A child should not drink too much in the evening. Normal "doses" for alleviating thirst are good, but not extra drinks for pleasure, such as cans with lemonade.
- A child should not drink more than one cup of liquid (about 240 ml) one hour before taking desmopressin and up to eight hours after that.
In addition, desmopressin is not given to a child who has diarrhea or vomiting until the disease recedes. Children with vomiting and diarrhea should be given plenty of fluids.
Medicinal tricyclic antidepressants.
These drugs have been used for many years to treat night urinary incontinence. They include imipramine, amitriptyline, and nortriptyline. The dose is given just before bedtime.
How do tricyclic antidepressants work?
Their action has nothing to do with the action of antidepressants. They have an additional effect on the bladder.
How effective are tricyclic antidepressants?
Success is about the same as with desmopressin. And there is also a high likelihood that bedwetting will return after discontinuation of treatment.
When are tricyclic antidepressants used?
As a rule, they are prescribed only to children over the age of seven. These drugs are not as popular as desmopressin. This is because the probability of side effects is higher. In addition, these drugs are dangerous in case of an overdose. Keep them away from children. However, tricyclic antidepressants are an option if desmopressin does not work.
What are the possible side effects?
Most children do not experience side effects. These include: dry mouth, constipation, blurred vision, tremors, anxiety, anxiety, drowsiness, insomnia. Any of these side effects occur after the drugs are withdrawn. A rare but serious side effect is a violation of the heart.