Soaking/Enuresis

With Enuresis is the term used for children who have already learned to empty their bladder in a controlled manner.

Causes

In the 3rd to 6th year of life, stable bladder control develops - initially during the day, later also at night. At the age of seven, 10 % of children still wet at night and 2 to 9 % during the day. Only about one third of those affected seek help from the health service - a clear indication of a highly divergent assessment of the symptoms within the family.
By the end of the four years of age normally developed children usually learn to control urination (= micturition). With a primary enuresis however, this is not the case. It may be that the nervous system (sympathetic/parasympathetic system), which controls the function of the bladder and thus transmits information about the filling state to the brain, is not yet fully developed. In this way it comes to about every 10th child older than four years to repeated wetting, because it often does not notice the pressure on the bladder in time. But also psychological stress can lead to the fact that the already "dry" child does not have his bladder under control. This is called secondary enuresis designated.

Symptoms

If the child wets the bed, especially at night, we speak of a enuresis nocturna. However, if it happens mostly during the day, it is not necessary to assume a enuresis diurna the speech. If both are the case, the specialist summarizes this as enuresis diurna et nocturna. In addition, parents can often observe a passive attitude of the child when addressing the issue.

Diagnosis

The physical examination focuses on indications for an organic cause of the enuresis. This can be functional disorders of the spinal cord or the renal bladder system itself. It is therefore recommended to perform a pediatric urological examinationto exclude such organic causes. A record of incontinence events (urinary/stool incontinence) should be kept for two weeks. Urinalysis is required to exclude a urinary tract infection.
With the Sonography (ultrasound examination) one looks for abnormalities of the kidneys (wide renal cavity system, duplication of the kidney, reduction of the kidney), bladder and rectum. Excessive residual urine after urination and significant thickening of the bladder wall are indications of bladder emptying disorders.
The urge to urinate, holding manoeuvres, incontinence events and micturition behaviour are also analysed on the basis of several micturitions (= bladder emptying). The observation can be combined with residual urine determinations and uroflowmetries (= measurement of the bladder emptying pattern).

As a rule, however, these "organic" causes are rather the exception. Rather, there is a maturation disorder of the bladder emptying center in the brain, which, by the way, is often inherited, i.e. genetically determined. Wetting is then often triggered by psychological pressure or a lack of body awareness, e.g. in the context of attention deficit disorder.

Therapy

The child should master bladder control again. This can be learned in the course of behavioural therapy or bladder training. If these methods do not help, you can go to a medicated Transition therapy.

Tdrinking and micturition plan

Modifications of drinking and micturition behaviour are the basic element of treatment. The toilet should be visited when there is an urge to urinate, as well as in the morning and evening and before longer trips. In the case of nocturnal enuresis, a reduction in the evening fluid intake is advisable (last portion 2 hours before going to bed). The "7-cup rule" has proved its worth. It means the intake of age-appropriate amounts of fluid in 7 portions distributed throughout the day.

Toilet training

In case of urinary incontinence due to micturition delay, the child must go to the toilet regularly. Self-responsibility can be achieved if reminder times (every 2 to 4 hours) are programmed on a digital clock or mobile phone and the child visits the toilet independently. Micturition plans and calendars have a positive reinforcing effect.

Alarm therapy/clinging pants

AVT with alarm systems/alarm devices is the method of first choice. Before therapy begins, it must be clarified whether the therapy-related stresses can be integrated into everyday family life: A detailed explanation of the therapy method with the need to fully awaken the child is essential for treatment success. Usually 30 to 50 nights of therapy are required before success becomes apparent. Response rates are 50 to 70%, long-term success rates after discontinuation of therapy are 40 to 50%.

Drugs

In case of high nocturnal urine volume, oral hormone therapy with the ADH analogue desmopressin is promising. In 70% of the children the wet nights can be reduced; 25% become completely dry. After discontinuation, most children relapse. Structured tapering increases the success of therapy and reduces the relapse rate. Due to its rapid onset of action, desmopressin is suitable as an on-demand medication to bridge critical situations (holiday trips, school trips). Severe side effects are rare.
There is little data on the effectiveness of alternative procedures such as acupuncture, hypnosis or chiropractic therapy; the published studies are rare, based on small case numbers and are often methodologically questionable.

Dispensable therapeutic measures

Still commonly practiced measures such as fluid restriction during the day, night waking or punishment are not effective and should not be used.