Nocturnal enuresis in children is a common phenomenon. The incidence of nocturnal enuresis varies from report to report. Generally speaking, up to 15% of children have nocturnal enuresis at the age of 5, 5% to 6% at the age of 10, and 1% at the age of 15, and is more common in boys than girls.
As the nervous system continues to develop, the control of urination by the bladder in normal infants and young children will develop naturally and does not require special guidance or training. However, if unconscious urination after sleep occurs repeatedly in children 5 years of age or older, more than twice a week and for at least 6 months, but not in the waking state, it should be considered abnormal and clinically referred to as primary nocturnal enuresis. If the enuresis comes from organic factors, such as disease, disability, side effects of medication, aging, etc., it is called secondary enuresis. Pediatric nocturia is mostly primary.
How is nocturia in children formed?
(1) Genetic factors.
May be one of the factors for the development of this disease, the family incidence of this disease is very high. If one parent has the disorder, there is a 50% chance that the baby will be born with the disorder, and if both parents have had the disorder, the chance of the child having the disorder can increase to 75%.
(2) Psychiatric factors.
The prevalence of psychiatric disorders in children with this disorder is higher than in normal children, and enuresis often starts or worsens after mental stimulation, indicating that psychological factors play a role in some affected children.
(3) Deep sleep.
These children sleep deeply at night and are not easily awakened. After awakening, they are often still confused and half-awake, so they cannot accept the urge to urinate from the bladder and awaken to occur reflex urination, and nocturnal enuresis occurs.
(4) Education and training factors.
Poor parental training in urination habits, improper education, failure to develop normal urination habits, or irregularity in children’s lives, excessive physical activity during the day or overburdened with schoolwork can cause nocturnal enuresis due to inappropriate urination.
(5) Instrumental factors.
Some of the causes of enuresis are due to local stimulation of genitourinary organs, such as prepuce, prepuce, vulvodynia, congenital urethral malformation, urinary tract infection, etc., followed by systemic diseases such as spina bifida, epilepsy and diabetes mellitus.
(6) Functional bladder volume reduction.
In 1970, someone had studied 63 children with enuresis using intravesical pressure measurement and found that the bladder capacity was 30% less than expected.
(7) Endocrine factors.
A hormone called diuretic hormone is secreted in the human brain that can make urine concentrated. Part of the children’s urine concentration function is affected due to the relatively insufficient secretion of anti-diuretic hormone, and children urinate a lot at night, plus they cannot wake up in time to go to the toilet and nocturnal enuresis occurs.
II. Treatment of pediatric nocturia
Nocturnal enuresis is a rather systematic project that requires the full cooperation of doctors, patients and relatives, combined with medication, life management, psychotherapy and functional training, in order to achieve real results.
If it is caused by organic disease, nocturia will be corrected accordingly if the primary disease is cured. If it is caused by mental factors, the child should be encouraged to build up confidence in overcoming bedwetting, so that the child knows that bedwetting is a temporary neurological dysfunction that can be completely cured, and that the child should be woken up regularly to urinate to form a time conditioned reflex. You should also pay attention to the child’s daytime activities and establish a reasonable living system, so that the child’s life and diet are regular to avoid excessive fatigue and mental tension.
Parents should not tease their children before bedtime, do not let them get excited, do not let them engage in strenuous activities, do not watch thrilling and tense movies and videos, so as not to make them overexcited. Do not drink “herbal tea” during the day, eat less watermelon, Sydney and other fruits with more water, and drink less Coke, Sprite and other carbonated drinks with more sugar. Dinner should be mainly dry food, every day after 4 pm less water, 3 to 5 hours before bedtime appropriate to limit water.
It is not advisable to eat watermelon, oranges, raw pears and other fruits and milk before going to bed to reduce the amount of urine stored in the bladder at night. Make it a habit for your child to urinate cleanly and thoroughly every day before bedtime to empty the bladder of urine. The bedding your child sleeps on should be clean, warm, and should be changed promptly after wetting. It is important to note that enuresis can make the affected child shy, anxious, fearful and cowering. If parents do not take into account the self-esteem of the affected child and use scolding, threats and punishments, it will make the child more aggrieved and depressed and increase the psychological burden, and the symptoms will not be reduced, but will be aggravated.
Specific measures are as follows.
Behavioral therapy
From the first day of treatment, parents are asked to set a schedule for the child to keep a daily record (a calendar can be used). When bedwetting occurs, try to find factors that may contribute to bedwetting and record them on the schedule, such as not sleeping on time, being too excited before bedtime, being too excited during the day, too much fluid intake in the evening, etc. When the child is bedwetting-free, a star is drawn on the schedule and verbal praise or material reward is given. Meet with the physician once a week.
Establishing conditioned reflexes
From the beginning of treatment, parents are asked to wake up the child with an alarm clock half to one hour before the time when bedwetting often occurs at night, so that the child can wake up and get up to urinate, so that the bell to wake up the child and the stimulus of bladder filling can be presented at the same time. In addition, the child should be encouraged to urinate on his own, so that he can urinate in a more awake condition.
Bladder Function Exercise
Encourage the child to drink more water during the day and try to extend the interval between urination to increase the volume of urine and gradually increase the capacity of the bladder, and encourage the child to interrupt urination in the middle of urination, count 1 to 10, and then urinate again to improve the control ability of the bladder sphincter.
Medication
Under the guidance of a physician, chlorpromazine can be used, 12.5 mg per day for children aged 4 to 7 years, 25 mg for children aged 8 to 11 years, and 37.5 mg for children aged 11 years or older, taken after dinner, and then continued for 2 to 3 months after producing the effect; then the dosage is gradually reduced, and the same dosage is taken every 2 days at bedtime for a month and a half. Then take the drug once every 3 days for a month and a half, and then stop taking the drug for 6 months. You can also use chlorhexidine to wake up, 10mg each time, 2 to 3 times a day, or ephedrine 12.5 to 25mg, taken orally once a day before going to bed. In addition, acupuncture and auricular acupuncture therapy and herbal medicine are also good treatments for nocturia.
If the child’s enuresis improves once, the training must not be interrupted, otherwise the conditioned reflexes that have been established will disappear and the previous work will be lost. This also suggests that consolidation therapy has an important value in the whole treatment process of enuresis.