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What is bed wetting?
Bed
wetting, which is also called nocturnal enuresis (NE), is the
involuntary passage of urine while asleep. Inherent in the
definition of NE is satisfactory bladder control while the child is
awake.
Are there types of nocturnal enuresis (NE) ?
What is primary nocturnal enuresis (NE)
?
Primary NE is generally viewed as a delay in
neurological maturation. At 5 years of age approximately 20% of
children wet the bed at least once a month with about 5% of males
and 1% of females wetting nightly. By 6 years of age only about 10%
of children are bedwetters - the large majority being boys. The
percentage of all children who are bedwetters continues to diminish
by 50% each year after 5 years of age. A strong family history of
primary NE is well known. If one parent was a bedwetter, the
offspring have a 45% chance of a similar plight condition.
What is the basic problem in primary NE ?
The fundamental problem faced by children with primary NE rests in the inability while asleep to recognize neurologic messages sent by the full bladder to the sleep arousal centers of the brain. In addition, bladder capacity is often smaller in NE children than in their peers.
Is primary nocturnal enuresis (NE) due
to emotional problems ?
Parents sometimes believe that
their childıs primary NE is emotional. No medical or scientific
literature exists to support this impression.
How is primary nocturnal enuresis (NE)
treated ?
The "cure" for primary NE is "tincture (or
passage) of time." However, since many parents and children are
appropriately frustrated with bed wetting as it starts to interfere
with self esteem or social events (e.g. sleepovers), a step by step
approach can be anticipated to have a successful outcome in over 75%
of such patients.
An excellent text (Waking Up Dry: How to End Bed wetting Forever, Martin Scarf, Ph.D., Writerıs Digest Books, 1986) provides parents with children who are motivated to overcome bed wetting a behavioral approach utilizing "bladder stretching" exercises and instructions in alarms. The book also provides an overview of the various medications available by prescription for treating NE.
How common is secondary nocturnal
enuresis ?
Only approximately 2%-3% of all children
with NE have a medical cause for the condition.
What causes secondary nocturnal enuresis
?
Urinary tract infections, metabolic
disorders (e.g. various types of diabetes), external pressure on the
bladder (e.g. extreme constipation
by a large rectal stool mass) as well as neurologic disorders of the
spinal cord must be considered among the causes of secondary NE.
How is the cause of secondary NE
diagnosed ?
Generally, a complete history and thorough
physical exam provide the initial evaluation of a child with primary
NE. A urinalysis
and urine culture generally complete the work. Further laboratory
and radiological studies are usually reserved for the youngster who
presents with secondary NE.
What is the treatment for secondary NE ?
Therapy of secondary NE is directed at the
primary pathology provoking the symptom of wetting the bed. As
expected, cure rates vary with the primary cause of the loss of
control.
What is the outlook (prognosis) for
children with bed wetting ?
In the medical world of today, both
primary and secondary NE should be a manageable condition with a
reasonable goal of successfully eliminating both parental and
patient anxiety, frustration and embarrassment.
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