Like to know its complete solution and details …
Normal complete evacuation of urine during wrong time & wrong place twice a month is known as enuresis.
It is of 2 types
- Primary Enuresis: it is repeated passage of urine during night time of child > 5years of age who has never been dry through out.
- Secondary Enuresis: child has been dry for some time and again started wetting the bed.
What is the treatment of this?
This condition can be treated by 2 ways either by giving drugs or non pharmacological treatment
Non pharmacological treatment includes bladder exercise – ask child to hold the urine for more time during day, ask to frequent stoppages during micturation, making child to micturate after 2 hours of sleep, stop giving liquid diet during evening hours. Even using wet bed alarms, know about types of alarm.
Drugs: Desmopressin, oxybutinin, imipramine are drugs of choice are prescribed for 3-6 months see details below in this article.
Remember: Don’t punish your child for wetting the bed. It will not help! Your child cannot help it. There are many different treatments, and things you can do. Your child’s doctor can help you decide which would be best for your child. Here are some tips and treatments:
- Be patient and understanding—most kids will become dry without treatment.
- If an adult in your family used to wet the bed, have them talk to your child about it. Then your child will not feel so alone or ashamed.
- Respect your child’s privacy, and do not talk about the bed-wetting in front of others.
- Have your child change their pajamas and the wet bedding themselves. (But just have them do it in a matter of fact, “taking responsibility for themselves” kind of way—not as a punishment.)
- Younger kids may want to wear a “pull-up” over their underwear, so that they can feel that they are wet, but not get the bedding all wet.
- Use a reward system, such as a sticker chart on the bedroom wall for dry nights. Put the focus on being dry, to keep the tone positive.
- Above quotes are taken from med.umic
Drug of choice is Imipramine its SSRI with trade name Dapsonil prescribed as 25 mg daily for six months.
Do not prescribe imipramine if patient is allergic to aspirin, pregnant women, hypertension, taking antidepressive drugs, anticoagulants, asthma, seizures.
There are a number of causes for nocturnal enuresis. Primary nocturnal enuresis is often caused by a chromosomal abnormality and is a hereditary disease. Children whose parents or siblings experienced bedwetting are at increased risk. If one parent had the condition, the risk is approximately 45% and if both parents had the condition, the risk is approximately 75%.
Other causes of PNE include the following:
- Abnormally positioned ureter (ectopic ureter, more common in female)
- Enterobius Vermicularis infection (also known as pin worm infection)
- Smegma on glans of penis causes irritation causes eneuresis
- Excessive urine output (polyuria, be due to excessive fluid intake)
- Cardiac condition that causes an irregular heartbeat (heart block)
- Neurological disorders (e.g., cerebral palsy, spinal cord disorders like spinal bifida, neurogenic bladder)
- Sleep arousal disorder (e.g., not awaking in response to sensory signals)
- Urinary tract infection (UTI; e.g., cystitis)
- Urethral obstruction (congenital or acquired as a result of trauma or infection)
Second drug on choice is Desmopressin (DDAV – 0.5 mg) for 6 months, however its side effects are rash, itching, confusion, nausea, rapid weight gain.
Cystoscopy, voiding cystourethrogram, ultrasound of abdomen, cystourethrogram and MRI scan.
History of Enuresis includes fluid and dietary intake, day time voiding frequency and volume, sleep timings, snoring etc.
Examination includes, genitalia examination, abdomen examination for kidney, bladder, and lower spine (back examination), take blood pressure, neurological examination for muscle strength, tone, sensations and reflexes, eneuresis can be due to some infection or tumor in brain.
Watch out the video on nocturnal enuresis by healthsciencechannel at youtube