12 March 2019 Author : Jorge Marcelino If there are no other daytime urinary disorders, it is known as monosymptomatic nocturnal enuresis. When there are other symptoms, it is called polysymptomatic nocturnal enuresis. Are there different types of enuresis? Enuresis is classified as: Primary - if the child has never gained control over their bladder at night; Secondary - if there has been a period of at least six months of continence. The prevalence of primary enuresis varies with age and is more common in boys. It occurs in around 9% of seven-year-old boys and 6% of seven-year-old girls. Its falls to 7% and 3% , respectively, by the age of 10 . What causes nocturnal enuresis? The family history of children with enuresis very often contains reports of childhood enuresis in direct family members. The likelihood of a couple where only one suffered from enuresis having a child with enuresis is around 40% . It increases to around 70% if both parents suffered from the problem. Some researchers have identified genes that seem to be responsible for the mechanisms involved in nocturnal enuresis, such as: Difficulty waking from deep sleep; Higher urine production at night; Low bladder capacity. What are the effects of nocturnal enuresis? Children with enuresis often develop: Feelings of shame and anxiety; Low self-esteem; Trouble socialising; Loss of quality of life and school performance; Higher risk of physical and emotional abuse. Parents have problems such as: Sleep disturbances; Anxiety; Aggression; Greater emotional tension; Frustration; Family stress. What can we do about nocturnal enuresis? Always remember the child should never be blamed for having nocturnal enuresis, as urination occurs without them being able to consciously control the situation. Enuresis requires attention, assessment and careful treatment , as it can have significant negative effects on the child’s and the family’s lives. When we conduct surveys of how adults experienced their own enuresis as children, most of them say it was a traumatic experience with serious repercussions in their lives. What can we do then? If their child has nocturnal enuresis, parents should take the child to their family doctor, who will monitor the situation and decide whether it is necessary to send them to a specialist. How is nocturnal enuresis diagnosed in children? A clinical assessment involves detailed analysis of different aspects of the child’s daily life , including: Fluid intake; Urination habits; Daytime bowel movements; Type and quality of sleep; Loud snoring; Type and frequency of night-time urination. It is important a written record is kept, as it is an important tool for the doctor. Fluid intake habits are particularly important and many of these children drink more in the late afternoon and evening. This encourages greater night-time urine production. Sugary or caffeine drinks also exacerbate enuresis. It is important to treat constipation , which exacerbates enuresis, and swollen adenoids or tonsils. The emotional impact of enuresis on the child and family needs to be assessed. It is also necessary to pinpoint situations that may be disturbing the child’s emotional and psychological balance, such as: Birth of a sibling; Parents divorcing or separating; A death in the family; Being a victim of abuse; Difficulty fitting in at school. In most cases, a urine test should be conducted and it may also be necessary to conduct a post-urination kidney and bladder ultrasound. There are more complex situations in which it may be necessary to perform other diagnostic tests. Can nocturnal enuresis in children be treated? Treatment requires the doctor, child and family to work closely together. In addition to advice on practical changes in the child’s life, treatment with medication is possible, depending on the characteristics of each case. Treatment is based on desmopressin , which reduces the amount of urine produced at night, and/or anticholinergics , which regulate bladder sphincter function. This treatment may be associated with some kind of alarm device that detects the presence of urine at night. It also helps the child develop mechanisms for waking up when their bladder is full. At the hospitals and clinics in the Hospital da Luz network, there are paediatric specialists who monitor the health of children and young people. Meet the pediatrics team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
