Enuresis - Symptoms, causes and treatment

Enuresis or bedwetting is the inability to control the flow of urine, so that urine comes out involuntarily. This condition is generally experienced by children, especially under the age of 7 years. When a person wets the bed during the day, it is called diurnal enuresis, whereas if we wet the bed at night, it is called nocturnal enuresis. Some children generally have nocturnal enuresis, although it can also be experienced by both.

Urine produced by the kidneys will collect in the bladder. Under normal conditions, nerves in the bladder wall send a message to the brain when the bladder is full, which the brain responds by sending a message to the bladder to regulate bladder emptying, until the person is ready to urinate in the bathroom. But in enuresis, there is a disturbance in the process, causing people to wet the bed involuntarily.

In children, good bladder control so that the child does not wet the bed again, is usually achieved at the age of about 4 years. Bladder control during the day is usually achieved first, followed by bladder control at night. However, the age of bladder control may vary from child to child.

In addition to bladder control, certain medical conditions can also cause enuresis in children. Enuresis can be an embarrassing experience for both the child and the parent. To overcome this, several efforts can be made so that children do not wet the bed again.

Symptoms of Enuresis

Enuresis can be a symptom of certain conditions that require medical attention, and is usually characterized by:

  • Children still wet the bed after the age of 7 years.
  • Bedwetting followed by pain when urinating.
  • Excessive thirst.
  • Snoring.
  • Urine is pink or red.
  • The stool becomes hard.
  • The child returns to wetting the bed after a few months of not wetting the bed.

Causes of Enuresis

So far the exact cause of enuresis or bedwetting has not been ascertained. However, several factors have a role in the development of enuresis, including:

  • Hormone disorders. The disorder occurs in antidiuretic hormone (ADH), which functions to reduce urine production. ADH hormone in patients with enuresis is not sufficient so that the body produces more urine, especially at night. This condition is usually caused by diabetes insipidus.
  • Bladder problems. These problems can include a bladder that is too small to accommodate large amounts of urine, bladder muscles that are too tense to hold a normal amount of urine, inflammation of the bladder (cystitis)., and a fault in the nervous system that controls the bladder so it doesn't give a warning or can't wake a sleeping child when the bladder is full.
  • Sleep disturbances. Bedwetting is a sign of a disorder sleep apnea, in which breathing is disturbed during sleep, either due to enlarged tonsils or adenoids. Another sleep disorder occurs when a child sleeps too soundly to not wake up when going to urinate.
  • Enuresis disorders can be inherited from parents, and usually occur at the same age.
  • Too many consuming caffeine. This can lead to frequent urination.
  • Medical conditions. Several medical conditions that trigger enuresis include diabetes, urinary tract infections, abnormal urinary tract structures, constipation, spinal cord injuries, and injuries during sports or accidents.
  • Psychological disorder. Psychological stress or pressure can also cause stress. In children, stress can be triggered by the death of a relative, adaptation to a new environment, or family fights. In addition, learning to urinate in the toilet (toilet training) that are imposed or started at an early age, can also be a contributing factor in enuresis.

Although enuresis can occur in both men and women, the majority of cases affect men and children with ADHD.

Based on the cause, enuresis can be divided into two, namely primary and secondary enuresis. Primary enuresis indicates a disorder of the nervous system in controlling the bladder so that the child cannot realize the sensation when the bladder is full. While secondary enuresis indicates the presence of physical or psychological conditions, such as diabetes, urinary tract structure disorders, or stress.

Enuresis Diagnosis

The diagnosis of enuresis is carried out after the child is 5-7 years old. After discussing the symptoms he is experiencing and conducting a physical examination of the patient, the doctor also needs to find the condition that causes the patient to wet the bed. The search for these causes can be done by:

  • Urine test (urinalysis). This examination aims to identify the occurrence of infection, diabetes, or consumption of drugs that cause enuresis as a side effect.
  • Scanning with X-rays or MRI to see the condition of the kidneys, bladder, and the structure of the urinary tract.

Enuresis Treatment

Most people with enuresis recover on their own. But the doctor will recommend lifestyle changes to reduce the frequency of bedwetting. These lifestyle changes are in the form of:

  • Limit fluid intake at night.
  • Encourage the child to urinate frequently, at least every two hours, especially before bedtime or when awake.

If there is a special medical condition that causes a person to experience enuresis, such as: sleep apnea or constipation, then these conditions need to be treated first before treating bedwetting disorders.

If lifestyle changes have not been able to relieve enuresis, then the doctor can perform therapy to change behavior. Behavioral therapy can be done by:

  • Using an alarm system that can sound when the child wets the bed. This therapy aims to improve the response to the sensation of a full bladder, especially at night. This therapy is quite effective in relieving bed-wetting disorders.
  • Bladder exercise. In this technique, the child is accustomed to urinating in the bathroom with increasing time intervals so that the child is accustomed to holding urine for a longer period of time. This exercise can also help stretch the size of the bladder.
  • Giving rewards every time the child manages to control the bladder urge so it doesn't wet the bed.
  • Techniques for imagining positive images. The technique of imagining or thinking about waking up dry and not wet, can help your child stop bedwetting.

If these efforts have not been able to improve the enuresis disorder, the doctor can give drugs, including:

  • Drugs to reduce urine production at night, for example desmopressin, Giving this drug is not recommended if the child also has a fever, diarrhea, or nausea. This drug is given orally and is only intended for children over the age of 5 years.
  • Bladder muscle relaxants. This drug is given if the child has a small bladder, and serves to reduce the contraction of the bladder wall and increase its capacity. Examples of this type of drug are: oxybutynin.

Although medication can relieve bed-wetting, this disorder can return when the drug is stopped. On the other hand, consideration of side effects also needs to be considered before giving these drugs to children. Therefore, the administration of this drug should be combined with behavioral therapy. Giving drugs can help behavior therapy until the therapy can show improvement in the patient's condition.

Most people with enuresis get rid of bed-wetting as they get older, with spontaneous self-healing. Only a few cases of enuresis persist into adulthood.

Enuresis Complications

Enuresis usually does not cause severe complications in sufferers. Complications can be in the form of psychological problems, namely feelings of shame and guilt that lower self-confidence or lose the opportunity to do activities with other people, such as staying at a friend's house or camping. In addition, due to frequent bedwetting, complications that can arise are rashes in the rectum or genitals