Synonyms in the broadest sense
Wetting, urinary incontinence English: enuresis
Definition
Bed-wetting (enuresis) is the involuntary excretion of urine in children who have reached the age of 5 years. Enuresis occurs several times in one month. There are three different forms of enuresis (bed-wetting).
If the wetting occurs only during the course of the day, it is called diuresis diurna. Enuresis nocturna is the term used to describe wetting at night. The combination of both types is called Enuresis nocturna et diurna.
Furthermore, a distinction is made between primary and secondary enuresis. In the primary form, the child has never been dry at any time; in the secondary form, the child has voluntarily controlled its urine excretion for at least six months. Ultimately, the distinction between the different forms hardly plays a role in the therapy, but serves primarily for diagnosis.
Often organic causes, such as an open back (spina bifida) or malformations of the urethra are responsible for the wetting. In addition, psychological problems are known to be the trigger, especially for secondary enuresis. Because of the many different causes and the high level of suffering for the child, especially in social interaction, a doctor should be consulted for clarification. There are various treatment options available, whereby wetting can usually be successfully treated by behavioural therapy and counselling.
Wetting still with 6 years
Each individual child takes a different amount of time to mature the bladder control in the brain. The main cause of night-time wetting is due to the fact that the connection between a full bladder and the child waking up is not yet securely established. This means that children are not too comfortable getting up in the night and simply do not notice the urge to urinate.
This is why some children take a little longer to get dry at night and during the day. Up to the age of 5 years, night-time wetting can be seen as part of a delayed development. Bedwetting is only referred to from the age of 6 and should then be the subject of a detailed diagnosis to find out the possible cause.
In addition to an organic bladder voiding disorder, psychosocial factors can also play a significant role. In the case of age-related development, the cause can also be a disturbance in the hormonal regulation of the water balance. A hormone called ADH regulates the water balance and causes the bladder to fill up less at night, which means that there is less need to go to the toilet at night.
This hormonal regulatory circuit is not yet fully developed in some children and therefore promotes nocturnal wetting. As a rule, bed-wetting only becomes a problem when it places an enormous burden on the child and his family. Older children in particular withdraw from their social life very much and limit themselves in their everyday life due to feelings of fear or shame, because they fear to be discovered during school trips or overnight stays with classmates.
The frequency of bedwetting varies according to childhood. About 30% of five-year-olds suffer from involuntary bedwetting. Up to this age, the disease occurs equally frequently in boys and girls.
With increasing age, boys are significantly more frequently affected than girls. In total, 5 out of every 100 children in the ten-year-old age group still wet themselves, and the disease has a frequency of 2% in young people between the ages of twelve and fourteen. Overall, secondary enuresis, i.e. wetting with previously achieved urine control, is the rarer form.
It must first be noted that arbitrary urination is an important step in the development of the child. However, this is associated with a very complex learning process in which both the filling of the bladder and the arbitrary opening and closing of the bladder muscle must interact with each other. The beginning of this development begins approximately at the age of 2 years.
However, each child is at a different pace until it is finally completely dry and the learning process is complete. For this reason the problem usually solves itself. If this has not happened by the child’s 5th year of life, the causes of the wetting should be found out.
There are two main pillars to explain the causes of bed-wetting. On the one hand there are the biological and physical causes, which usually result in primary enuresis. This includes a genetic predisposition, which is present in about two thirds of all affected children.
Some children have a disturbed regulation of the hormone vasopressin, which is needed to control the water balance. In these children the hormone is not released in a certain rhythm as usual, so that they do not have a less full bladder at night than during the day. However, malformations and anatomical variants of the urinary tract, such as defective nerve supply to the bladder muscles, also belong to this group and can cause bed-wetting.
Increased urinary tract infections are also a risk factor for their development. Children who are delayed in their overall development or who have not yet matured physically can also show enuresis. The psychosocial and psychological aspects must also be considered.
Besides organic causes or disorders in the child’s maturation process, psychosocial factors can also play a significant role in the occurrence of nocturnal wetting. Children can be severely burdened by external factors in their everyday environment and build up a great deal of insecurity and a lack of self-esteem. In particular, drastic experiences such as a death in the family, parental separation or the birth of a new sibling can be an acutely stressful situation and act as a trigger for nocturnal bedwetting, even though the child was already dry before.
On the other hand, a complex learning process lies behind the ability to control the bladder. This can be slowed or misdirected by various measures, such as inconsistency or rigour, or in intellectually impaired children, and can lead to the development of the disease. Especially in children with a secondary developed enuresis, a psychological cause of the symptoms is often found.
Additional risks are accompanying diseases such as disorders in the social behaviour of children or an already known attention deficit or hyperactivity syndrome. In some cases, in addition to wetting, additional defecation can also occur. If psychological causes come into question, a visit to a child and adolescent psychiatrist can be helpful to work out the cause, but at the same time it can also strengthen and relieve the child and also involve the parents in the healing process.
For a complete diagnosis it is important to know at what time of day, how often and with what intensity the wetting occurs. If the above mentioned criteria vary greatly from day to day, the present enuresis is more likely to be an anatomical malformation or insufficient nerve supply. If there is a functional disorder behind the wetting, the children sometimes show behaviour that is intended to help them to hold the urine, such as pressing the thighs together or jumping from one leg to the other.
It can also be observed whether small amounts of urine can be found in the underpants just after tensing the abdomen, for example when coughing or sneezing. Sometimes the wetting occurs at the same time as an involuntary rectal check (encopresis). Sometimes the children show low self-esteem and exclude themselves from social activities because they are ashamed of being discovered or are afraid of the reactions.
Especially during excursions or visits to friends, this disease is a problem for the children and increases their suffering. In order to be able to detect the disease bed-wetting in children, the doctor must first conduct a detailed interview. In doing so, attention is also drawn to the family history.
How was the development of cleanliness in the parents or siblings? Questions are also asked about the child’s current situation in order to identify any psychological stress. Possibilities that could possibly maintain the wetting are also clarified, such as the wearing of diapers and methods of cleanliness education used so far.
In addition, physical examinations, also with the help of ultrasound and urine tests in the laboratory, will be carried out. This involves measuring the bladder, detecting any residual urine accumulation in it and assessing the composition of the urine. It is also clarified whether a urinary tract infection is present.
Psychological tests can also be part of the examination. In order to record all these points, it may be necessary to admit the child to hospital. In general, good spontaneous healing is observed with enuresis.
In addition, small measures, which are discussed during a consultation with the doctor, often lead to success. These include refraining from threats and punishments in case of renewed enuresis and rewarding the child with a “dry” day or a “dry” night. The child should drink a lot in the morning and reduce the amount of fluid towards evening.
The family can be relieved by using mattress protectors or washable bed covers. The child can also be consciously woken up at night and put on the toilet to prevent wetting. However, the illness can become chronic and lead to other, also social problems, so that treatment is necessary.
Due to the different causes of wetting, the therapy must be individually adapted to the respective patient. Roughly speaking, the therapy options can be divided into three groups. On the one hand there are drugs available.
Imipramide antidepressants are used, which lead to a relaxation of the bladder muscle. Since this has been observed to cause increased damage to the heart muscle, this drug is increasingly being avoided. The synthetically produced hormone desmopressin, which regulates the reabsorption of water into the kidneys and can be taken as a tablet or nasal spray, has hardly any side effects.
There is also a muscle-relaxing (spasmolytic) and locally pain-relieving drug containing oxybutinin as the active ingredient. All these drugs are only used in the case of an impossible behaviour therapy and are by no means the only treatment scheme. Furthermore, behavioural therapies are used as treatment methods.
In the center of attention is a wake-up device, a bell pant as an alarm system. There are also behavioural therapies that work with rewards at every dry night or day or precautionary waking at night. All in all, almost all of the above-mentioned behavioural therapies require a high degree of motivation on the part of the caregivers, but also on the part of the children, and this is the basis for a successful therapy.
Bladder retraining is the third possibility of therapy. Here the child should develop his bladder control completely through practice. By interrupting urination (micturition), the child learns to influence its urine excretion arbitrarily.
Often the above mentioned therapy options are combined and used together, which also provides the best chances of success. The first choice therapy for nocturnal bed-wetting, without organic causes, is the alarm system in the form of bell pants or bell mats. These systems are equipped with a sensor that reacts to moisture.
In modern bell pants, this sensor is attached to the genital area of the pants. If it comes into contact with moisture, an electric circuit closes and a bell, which is attached to the top of the pyjamas, emits a sound that is intended to wake the child up so that he or she can go to the toilet and empty the bladder completely. This alarm system is also available in the form of so-called bell mats.
Here the moisture sensor is located in the mattress. With this system, the bell is on the bedside table and is louder than the bell on the bell pants. This is particularly advantageous if a difficult awakening is one of the reasons for wetting the mattress at night.
These alarm systems are always combined with a toilet diary that records how often the child wets, when he or she stayed dry and the amount of urine that was passed during the subsequent visit to the toilet. If the child has been dry for 2 weeks without interruption, the bell device can be stowed away in most cases. About 60-70% are completely dry at the end of the therapy period after treatment with one of these alarm systems.
Nowadays, the retail trade offers a wide variety of diapers in the form of trousers, pyjamas or boxer shorts for bed-wetters of all ages. They look like normal underwear, but have the function of a diaper by being absorbent and absorbing moisture. They come in different colours, sizes and shapes and they are made of a fabric that doesn’t rustle or crackle.
These nappies can be put on by the children themselves and can be disposed of immediately after single use. Wearing nappies at night can make things easier for many children, as they do not have to wake up in a wet bed in the morning and develop a feeling of security. Older children in particular find this particularly humiliating, embarrassing and frustrating.
They also offer an alternative for children who want to spend a night away from home but are very afraid of getting wet again. However, wearing such diapers should only be a short-term solution as it does not solve the underlying problem of night-time wetting. In addition, one should never force the diapers on the child or use them as a punishment, as this has a very degrading effect on the children.
In addition to orthodox medical treatment options, homeopathic remedies are now also used in the therapeutic treatment of bedwetting in children. When choosing the right remedy, it is especially important to consider whether the affected child has never been permanently dry until now or whether it is a psychologically induced relapse. The treatment should last several weeks, as only then the first successes can be seen.
The remedies are administered in the form of globules in the evening. For children who have not been dry before, Equisetum, Sepia officinalis or Pulsatilla pratensis can be used. These are medicinal herbs which are used especially for small, delicate and insecure children.
If a relapse occurs in the context of psychological stress, Belladonna or Causticum is used in most cases. In general, when using homeopathic remedies, contact should always be sought with a therapist with additional homeopathic training, as the treatment must be adapted to the individual child. salts can also be used in the therapy of bed-wetting in children.
The salts Potassium bromatum No. 14 and Potassium aluminium sulfuricum No. 20 are mainly used in conditions of restlessness and nervousness.
Children can take one tablet per salt before bedtime. They are intended to reduce stress and tension and thus prevent bed-wetting. In general, the prognosis for healing enuresis is good. Behavioural therapy can achieve success in 80% of children.
