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Bedwetting (Enuresis nocturna)

May 17, 2017 | Illnesses

Bedwetting (Enuresis nocturna)

In medical practice, problems related to bladder control are encountered less frequently. I believe this stems from the fact that involuntary urination is much less of a problem than faecal soiling. Bedwetting is most common at the preschool age. In this text, we would like to draw attention to several facts that may be useful.

Bedwetting can last until school age, which is also the latest time for bladder control to be normally established. In the case of secondary nocturnal enuresis – i.e. when bedwetting reoccurs once bladder control has already been established – caution is advised and explorations are justified into possible organic causes (neurological diseases, diseases of the endocrine or urinary system) or psychological difficulties. In cases like this, one should seek the help of a paediatrician.

The following symptoms point to an organic (physical) cause of nocturnal enuresis:

  • excessive urination during the night – if the volume of urine exceeds the amount calculated by the following formula: “age+1x30ml”. Urine that “slips” into the diaper or bed linen should be measured
  • the child urinates more than six times during the day without consuming excessive amounts of liquid
  • involuntary urination during the day
  • sudden and strong urge to urinate which the child finds difficult to control
  • urination is not uninterrupted; rather, the urine typically comes out in an interrupted flow
  • obstipation

Regardless of whether the child is suffering from primary (the child has never been successfully trained to control urination) or secondary enuresis (the child successfully learned to control urination but has reverted to bedwetting), you should consult your paediatrician if you encounter symptoms that point to organic causes.

In the case of primary nocturnal enuresis, it is important to be patient and not express one’s own (parental) frustration over the problem. To meet this goal more easily, it is good to know that the child does not need to learn to control urination until school age. Children who urinate during the night are often very sensitive and emotionally demanding. Expressions of parental frustration create in them a feeling of guilt, which typically exacerbates the problem. A calm and gentle approach is recommended; however, at the same time it is important to express a certain degree of firmness, faith that the child can learn to control urination, and determination that the child has to assume part of the responsibility for the consequences of urination. The child should therefore actively participate in changing the bed linen and pyjamas. The use of night diapers is not recommended as it prevents the feeling of discomfort created by wet clothes. The lack of discomfort prevents the establishment of a control reflex, which significantly prolongs the problem. It is recommended to “train” the bladder during the day by holding in the urine for as long as possible. This increases bladder capacity and raises the threshold for perceiving it as full, and triggering the process of emptying. Make sure the child urinates right before going to bed. Preventive rising during the night is generally not recommended, especially not with children who protest when woken up. Denying liquid intake during late afternoon is useful. Children who continuously consume sweet drinks from the bottle (tea, juice) usually consume much more liquid then they objectively need. They drink because it creates a pleasant sensation in their mouths (the teat and the sweet taste). At that age (after the third year), children should satisfy their emotional needs through different channels, in other ways. Words and play in which the parent offers all their warmth gradually supplant the pleasure created by the bottle teat and sweet drinks.

Children with enlarged tonsils who mostly breathe through the mouth consume more liquids due to a feeling of dryness in the oral cavity. Sometimes, nocturnal enuresis can occur when children are suffering from a cold, as their nose becomes congested and their liquid intake increases.

Nocturnal enuresis that continues into school age requires specialised medical assistance.

prof. dr. sc.  Milivoj Jovančević

General Pediatrics

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