Bed-wetting in children

Bed-wetting is a common problem in childhood; where children do not learn to control when passing urine only when they become able to feel the fullness of their bladders, and this happens when the child is in the fourth year of age.
But their ability to control the process of nocturnal urination usually take longer than this, usually between the fifth and seventh year of age.

- And the problem of wetting the bed down at night with age, they see the 16% of children aged 5 years, and decreases to 1-2% of children aged 15 years.
- The proportion of nocturnal urination in males twice as high in females.

• the causes of bed-wetting in children:
- Often does not indicate nocturnal urination on a health problem, and go away automatically, without any treatment. But it would cause embarrassment to the children and parents. Sometimes the problem is worrying for parents because of fear of the disease and the presence of a potential successor. One of the main theories put forward to explain this phenomenon:
• delayed bladder maturation of the normal time for the child (child's bladder to accommodate a smaller amount of urine from the bladder of).
• genetic reasons: parents who wet their beds are more likely to have the children wet their beds as well!
• low levels of Alvazobrice (hormone anti-generation).
• deep sleep that prevents the child from the sensitivity of bladder fullness (this theory is still controversial).
• physical or emotional problems rarely cause urination at night.
• Some diseases: Most children who wet their beds do not suffer from any underlying medical problems. The most important problems that may lead to urinate for the following: diabetes mellitus, and urinary tract infection, and faecal incontinence, and pinworms, and renal failure ... Most of these cases can be diagnosed easily.
• Constipation: a common problem in children, and can be a cause to urinate at night. And all notes or limited number of times when her bowels should seek medical help.

Diagnosis:
- May be difficult to know when the problem is urinary incontinence, Age is that it can control the complete bladder emptying and varies from child to child ..... for example when there is a story of the brothers or parents night to urinate in childhood may not have parents concerned about the repeated This story is one of their children at the age of 6 years ... while we find another family to the doctor to the problem of a child with a 4-year-old pees at night in bed, while his older brother was able to control the process of urination since the age of three ..
- Incontinence is a problem when most of the children when conflicts with their ability to communicate with their peers, and it's important for parents to rest assured that incontinence suffered by their child not because of a medical problem.

• clinical history:
- Must focus on the following points:
Does the child suffer from difficulty in controlling urination during the day? Is there a story of a family night to urinate in bed? Number of bed-wetting, the impact of the phenomenon on both the child and family, and what treatments have been tried - if any?
- It is useful to monitor the child to estimate the amount of drink fluids, urine volume and posed in 24 hours. Where it is recorded the time and quantity of drink, as well as the number of times to urinate Go and measure the volume of urine before if possible.

• urinalysis urinalysis:
- A survey procedures to detect the presence of a disease cause to urinate in bed, and can be analyzed in a clinic doctor examiner immediately.
- No need to conduct other surveys or refer the child to the doctor, except in a few cases, disorderly and bladder function even in time of the day, and natural assets in the analysis of urine screening or estoppel.

Treatment options:
- Include: treatment motivational motivational therapy, and training of bladder control, and the organization of fluid intake, and behavioral therapy (using stimulants), and rare medicines.
- It is important before starting treatment to take into account the child's readiness and ability to help us in treatment, if your child is not mature enough to carry much of the burden of the application of treatment, it is not feasible to force him to do so.
- Treatment often takes a long time to be crowned with success, may have fluctuated during the treatment period between success and failure, and must include a vigorous follow-up treatment by the parents with the physician (approximately every four months). The parents should be aware that bedwetting is not necessarily involuntary, it should not be punished if the child does get wet, as well as the same hitting or verbally scolded, because that would worsen the situation will be delayed and the child's ability to empty the bladder control (stay dry).



• When we ask the competent help?
• If the child feels the need to urinate frequently or urgently.
• extreme thirst during the day.
• burning when urinating.
• swollen feet and ankles.
• the return of the phenomenon of wetting the bed after several months of successful treatment.

- These signs may indicate more serious disease, and should see a doctor as they emerge to investigate the cause before treatment urination at night.

- If the problem is only the child for bed-wetting night without the problems of former situation is not ambulatory and can consult a doctor at any time. And behavioral therapy can be tried first.

- Stimulus processing and organization of fluid intake are the best options when young children, the stimulants and medicines often not prescribed for children before the age of seven.

The most important therapeutic means:
- First line of treatment is a behavioral and educational guidance, for example:
• warned the child every night to leave the bed and use the toilet when he needs to urinate.
• Children are also warned to empty his bladder before bedtime.
• help the child locate the toilet easily by using night lights in the bathroom and the hallway leading to it.
• You may need to develop a (portable urinal seat) in a child's room if the bathroom away from that room.
• stop using the nappies at home because it may prevent the child from the desire to leave the bed, especially in children above 8 years, and can we use in special situations such as visits all night long with family or friends.
• Protect the child Bashrishv bed (sheet) is the influence of water to avoid unpleasant smell of urine.
• After the incidents of wetting the bed during the night, we encourage the child to go to the bathroom even before the change Bejammth dry!
• You can put a towel to dry the wet part of the bed, or make the bed is composed of several layers of alternating (cloth appropriate cushiony non-permeable to water) to allow removal of the wet part quickly and easily and avoid the need for re-cleaning and preparing the bed again.
• leave the dry pajamas and towels in place can be up to the child easily.
• ask the child to help in cleaning the bed in the morning, including the removal of bed sheets and wash them.
• make sure the baby shower is also a day to avoid foul smell of urine on the skin.
• shall not make fun of a child who wets the bed because it is beyond his control!

Line II - Catalytic treatment Motivational therapy:
Motivational therapy and a good way for a first attempt at younger children.
- Includes maintaining the registration of the evolution of the situation to grant more rewards as much as a child to maintain longer periods of drought and lack of bed Thblalh.
- Must be consistent with the child the reward in advance, and can be labeled and sequentially on the calendar for each dry night! And gets the child to award a book example, preferred when it is completed for seven consecutive dry nights!

Third - the organization of fluids Fluid management:
- Include determining the amount of fluids your child drinks a day, and the organization of time taken over the 24 hours of the day, and disposed of properly during the times of waking up in order to avoid over-full bladder during the night ..
- Where is recommended to provide 40% of the fluid in the morning, and 40% in the afternoon, and only 20% in the evening. And fluids should be caffeine-free evening.

IV - waking self Self-awakening:
- Self-awakening therapies aim to teach children how to know the fullness of his bladder during the day, hoping to be able to recognize this feeling during the night.
- Resort to this method in children with ages above 6 years.
- And the child should practice self-awakening routine before bed every night (lying on the bed, pretending that the time is midnight, and feel that the bladder is full)!
- Ask your child to imagine that his bladder says: "Wake up before it's too Alawaaaaan!", To go after that child to the bathroom.
- And children should be trying to practice techniques of self-awakening during the day as well.
- When you feel that he needs to go to the bathroom during the day and urgently, you should ask him to go to bed and pretend to be asleep, and tell him to remain lying down it and quietly, while his mind is busy that his bladder is full and he needs to wake up from sleep, and after a short period must get up and go to empty in the bathroom.
- If there is not the process of waking self the result you want, and awaken the child once, at least during the night, using the least possible inducers waking possible such as: occupancy of light gradually, say the name of the child, touching his shoulder or his face, shaking gently, use the alarm clock. It should be here to go to the bathroom and the child alone without assistance.

V - bladder training Bladder training:
- It is useful for children with small bladder capacity (ie the bladder with a quantity of urine is less than normal compared to his age), a common cause of bed-wetting ..
- The goal of bladder training is to increase slowly _ _ amount of urine bladder, which carries the child so as to match the natural age. Bladder training is recommended before resorting to stimulants or drugs.
- You can measure the current capacity of your bladder measuring the amount of urine posed at different times during the day and evening. As you can calculate the capacity of the bladder has a natural for his age by adding 2 to age in years (up to age 10).

Example: A child age 6 years should be the normal bladder has a capacity of about 8 ounces or 240 ml (1 ounce = 30 ml).
- When using bladder training for a child his bladder is small, we ask him to lock his urine for long periods and increasingly during the day. For example: the child may start to go to the bathroom every 30 minutes, Vensad this time about 15 minutes every few weeks. The goal is to make progress in access to urinate every two hours or three hours and then get the normal size expected from the urine for the child's age.
Measure and record the amount of urine in transit at certain times during the day and night once a week to follow the situation and success in treatment.

VI - stimulants Alarms:
- The most effective way to control bed-wetting, but generally used with children older than 7 years. Do not use a first line treatment because they are rather expensive and require considerable attention by the child and parents. And we can say that the use of this method of treatment is after 3-6 months of behavioral treatment methods before using other drugs.
- Working stimuli through the first sensor detects a drop of urine on the underwear of the child. Then Atfl sensitive, sends a signal to the alarm clock, which awakens the child through sound or light or Vibrate ...
If the alarm clock helps train the child to wake up or stop before it turns off voiding. See the accompanying figure ..

- The child must be responsible for the alarm, and is testing it every night before going to sleep, taking him because both of sound and vibrate. He must learn Maeval after waking up the alert:
• stop the alarm.
• rise from the bed.
• complete the voiding in the bathroom.
• back to bed and change sharshaf and solvency (with the help of his parents if necessary).
• wipe sensitive or replace him.
• re-operation of the alarm clock and sleep.

- It is important that the child shall be registered on the book both nights and wet the bed that did not moisten them with history, and must have the moral support for each night will not wet the bed and every time in which the previous instructions.
- Some children Aistikzawn on the alert at the beginning of treatment and must be woken up immediately after the alert, and Siatadon gradually waking up to themselves.
- Use the alarm clock every day until the child achieves 3-4 consecutive weeks of successful nights (without wetting the bed). And it usually takes 3-4 months (from 5 weeks to 6 months). And you return to the beginning of treatment when there is a recurrence (the child wet the bed after the previous success).

• over-learning (Overlearning):
- Can help long-term treatment success Bmenbhat urinary incontinence. Is through the use of the alarm clock to succeed the child four weeks and then the child is allowed to drink 6 ounces of water (3 \ 4 cup) before the hour of sleep. Then the child wears the alarm clock and sleep here and test the child's ability to wake up before wetting the bed (where our mother is full bladder before going to sleep) and this is the idea of ​​over-learning (exam skills acquired).

• alarm clocks:
You can use a regular alarm clock to treat bed-wetting. Where it is calibrated to wake the child every two to three hours. The wake-up times can be adjusted through the hours, guess where the bed-wetting more likely to alarm and shame before this time.

VII - drug therapy
Do not resort to drug therapy only after the failure of behavioral and educational treatments for 3-6 months; because the drugs can be expensive also have unwanted side effects, and that the probability of relapse in the largest drug treatment than in the behavioral treatment.
Drug therapy depends on two groups of drugs:

1) Aldezmobrice: Desmopressin (DDAVP)
- Given in the form of oral pills before bed, and leads to decrease urine production during the following hours to eat it. It's best used for short periods.
- Aldepsmobrice does not lead to serious side effects, except in rare cases, such as shakes the child plenty of fluids before bedtime. So you should not deal with children more than 240 mg a liter of fluid Baadasah fifth evening. It also prevents children from eating any liquids before giving Aldezmobrice one hour for eight hours after the person.
- Be a high relapse rate and up to 60-70% of children after stopping the drug.

2) tricyclic antidepressants: Tricyclic antidepressants (TCAs)
- The most important: Alaimipramen imipramine, and Alomitreptlin amitriptyline, and Aldesimbiramen. Desipramine course, are drugs to treat depression patients primarily. But can use smaller doses for children who suffer from nocturnal urination in bed.
- Side effects are rare, but should be kept out of reach of children, because high doses may cause serious heart complications.
- Also a high rate of relapse after stopping the drug is approximately 75%.

VIII - CPU complementary and alternative therapies:
Kalmaaljh acupuncture Chinese acupuncture, manual exercises, massage the spine chiropractic maneuvers, and hypnosis hypnosis. But there are no accurate scientific evidence on the effectiveness of these treatments. In general, no longer use the means Mstsahna therapeutic alternative at the moment ...