Saturday, 24 June 2017

Bed Wetting (nocturnal enuresis)

Presented by M. Suleiman

Bed wetting or nighttime urinary incontinence also known as nocturnal enuresis is unintentional urination while asleep after the age which an individual is supposed to have achieved bladder control. Although bed wetting is a common paediatric issue, it can occur with the adults.
However most bedwetting cases occur as a result of developmental delay (hormonal) and few if this case is associated with health challenges ( e.g urinary tract infection, diabetes melitus amongst other conditions).

At the age of six, many girls must have achieved bladder control and can stay dry at night while many boys must have achieved bladder control at the age of seven and can stay dry through the nights. Averagely, at the age of ten 95% children can stay dry through the nights. Bed wetting in adult is estimated to abt 0.5% - 2%.

Bed wetting as a condition is divided into two categories which are Primary Nocturnal enuresis and Secondary Nocturnal enuresis.

This is the most common type of bed wetting. Bed wetting is counted as disorder if a child is old enough to stay dry but still continue to bed wet atleast twice in a week.

This type of bed wetting occurs when a patient goes through a long period dryness (about 6months) then reverts to bed wetting. Secondary nocturnal enuresis can be caused by emotional stress or a some medical cconditions such as bladder infection.

Two functions ccontrol bed wetting.
The first mechanism is through development of an antidiuretic hormone (also known as Arginine vasopresin) that control urine production capacity of the kidney. This prevents the bladder from getting full thus maintaining dryness through the night. This hormone is not present at birth. Some children ddevelope it between the age of two to six or six to end of puberty. Some don't even develop this hormone.

The second mechanism is the ability of the individual to wake up when the bladder is full. This ability develop during the development of the hormone named above but its different from the hormone cycle.

° Use of caffeine at night increase rate of urine production.
° Alcohol consumption increase the rate of urine production.
° Children with Attention deficit hyperactivity disorder (ADHD) are more like to suffer bed wetting.
° bladder infection can cause bed wetting.
° chronic constipation. When the bowel is full it can put pressure onghe bladder.
° Insufficient production of anti diuretic hormone.
°Type 1 Diabetes melitus classically aassociated with polyuria, poydypsia and polyphagia.

Nocturnal enuresis may require treatment if the cause iinclude some of the common medical conditions like bladder infection, diabetes melitus amongst other causes.
It is advisable for parents not to set punishment for children ssuffering from bed wetting as this can make them psychologically stressed and thus fear of being punished can make them prone to repeated bed wetting .Embarrassment in front of age mayes can also affect their level of self esteem and social interaction.
Using absorbent pants or diapers can be of help people suffering from nocturnal enuresis and also make it easier for clean up and also their caregivers.

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