Nocturnal Enuresis In Children: Causes And Treatment
Nocturnal Enuresis: A Nightmare For Parents
Enuresis mainly at bed time (nocturnal enuresis), especially in children could be due to several reasons. As mentioned earlier by Bewaqoof, the psychological and genetic factors are most important culprits. Nocturnal Enuresis is classified as primary and secondary depending upon the age of onset of disease.
Nocturnal Enuresis: Psychological aspects of Nocturnal Enuresis:
· Panic, behavior problems, emotional and physical abuse, misbehavior with children etc. Like for instance, the fear of having been punished, mental torture, parent's or teacher's misbehavior with a child may mimic such types of things.
Nocturnal Enuresis: Social aspects of Nocturnal Enuresis:
· Embarrassment, loss of self esteem, anxiety, lack of interpersonal relationship, poor quality of life, school performance etc. these things usually develops or found in children as a result or due to them in children suffering form Nocturnal Enuresis.
Nocturnal Enuresis: Genetic Aspects of Nocturnal Enuresis:
· There is strong genetic or hereditary link found in children with Nocturnal Enuresis. It has been observed that family members exhibit such type of behavior at some times in their lives. This disease is transmitted as Autosomal Dominant. Chromosome no 22 is identified to have a locus at Denmark. The other nations have different locations for locus at different chromosomes.
Physical and Organic aspects of Nocturnal Enuresis
· In many cases the cause remain unknown (idiopathic)
· Small bladder and its capacity
· Overactive urinary bladder
· Infection of bladder (Cystitis)
· Obstruction or hurdles in the passage of urinary tubes
· Neurological causes – originated from brain
· Hormonal disbalances etc
Nocturnal Enuresis: Diagnosis Of Nocturnal Enuresis
Since the cause has to be find out in order to treat the problem fully, following labs and investigations are usually advised.
· Urine DR
· Different blood tests including hormonal levels
· Uroflowmetery etc
Nocturnal Enuresis: How to tackle with Nocturnal Enuresis in children:
· Minimize the embarrassment and anxiety of a child
· Parents should not show frustration since it may impact directly on the mind of the child and he would also become frustrated
· Family members don't let the child to feel alone, share things with him and provide moral support
· Parents should adopt positive attitude and think that the child is suffering from a disease and this is not his habit. therefore; show love and tackle the situation gently
· The doctor should also show positive attitude and work for the behavioral therapy for the child. A good psychiatrist would work better in this regard.
· Explain the problem to all of the family members with expected causes. Remember organic causes are rare, and in majority of cases, the cause is psychological. Every family member must act positively for the treatment of this problem
· Investigations and tests discussed above would only be done in case of no psychological causes. The doctor would tackle the situations on the assumptions of psychological perspectives first.
· Parents should observe how the child passes urine during day time. It that normal pattern or not? Does he pass frequently, or less often etc.
· The child must be encouraged to pass urine before going to bed and to school. Also encourage to pass urine after awakening in the morning as soon as possible
· Children should be encouraged to pass urine twice at school at least. Teachers should be informed about the problem of the child so that she must know about the problem and as per need she may tackle the situation.
· Train the child not to hold the urine as much as possible. He should use the optimal posture while passing urine. He should not be hurry to pass the urine
· Child should be advised not to take enough water during the day and especially before going to bed. Also he should not take enough water during meals.
Treatment Of Nocturnal Enuresis: Alarm Therapy:
If the above measures don't work with in three months time period then other measures should be started.
· In alarm therapy a specific alarm is attached in the pajamas of the children and it sound in those postures which are adopted by them during Nocturnal Enuresis. Once the alarm rings, the child awakes (mostly the parents get awaken instead of a child and they assist him to the bathroom to pass urine). However; this techniques is not 100% successful but it may diminish or improve the condition.
Treatment Of Nocturnal Enuresis: Bladder Training Exercise:
These are the exercises that could be learned easily and tought to the children, who then lean how to control the desire to pass urine. With the passage of time they would be trained enough to control over enuresis. A doctor can guide in person easily the steps of this exercise to the parents and children. This exercise however; would not be useful for very little children.
Treatment Of Nocturnal Enuresis: Medical Therapy:
The three common modalities are used;
A doctor may give these medications as per requirement after physical examination and once the above methods would not work effectively.
Treatment Of Nocturnal Enuresis: Surgical Treatment:
In very few cases surgery could be done if there is any structural problem found.
For Ehtesham Ahmed:
The name of that muscle is Detrusor muslces and this is one cause of Nocturnal Enuresis. There are certain other causes as well discussed above.