Research Topics: Nocturnal Enuresis

Nocturnal Enuresis

Introduction               What is bed wetting? It is a condition where an individual urinates during nighttime unintended. It is common in a child over five years old all over the world (Butler R.J, 1998). In this case, it is very embarrassing to the child especially in this stage. In bed wetting we can’t conclude that the child is lazy to wake up at night or afraid to wake up during night time, it is so happen that there are factors that we need to consider of having this condition. First is, we must consider the differences in bladder muscles and having a small bladder and other biological problems and lastly the environmental factors. Bed wetting becomes a concern if the child still wet at night at age of seven but if it is below age of six, it is consider normal because at that age our urinary system is still developing. Parents and siblings play a major role in managing this type of condition because it involves the psychological development of a child to correct this problem. Kinds of  Nocturnal Enuresis   The kinds of nocturnal enuresis are primary and secondary enuresis. Primary Enuresis refers to a condition in which a child doesn’t have nighttime control.  They wet on bed twice a month. In such kind of enuresis there is no underlying medical cause, emotional or any psychiatric disorders. Causes of primary enuresis are low functional bladder capacity, sleep or arousal disorder, food sensitivities, irregular bowel movement and genetics (Fletcher T.B, 2000). Low functional bladder capacity is a situation wherein the bladder of the child cannot hold the normal volume of urine that let the child’s bladder muscles not to feel the urge to urinate. On the other hand sleep or arousal disorder is believed to take place if the child lacks internal alarms that signal them to urinate. Some believes that the child sleeps deeper than others or some doctors say that the alarm is not going of (Fletcher T.B, 2000). This cause is the most controversial among other causes. When children become sensitive especially when it comes to food, it is regarded as food sensitivities. Caffeine and chocolates are restricted to the children who are having nocturnal enuresis (Fletcher T.B, 2000). Caffeine and chocolates are bulk forming stools that can lead to constipation which can alter the urinary system which is also lead to nocturnal enuresis. If it is so happens that the rectum is so full it will compress the bladder resulting to less stimulation that causes the bladder fullness, irregular bowel movement will occur thus we must be careful in giving foods especially at night. The last cause of primary nocturnal enuresis is Genetics. Research shows that the dominant gene is located at chromosome 13 and some from chromosome 12. Studies show that children experiencing nocturnal enuresis is most likely inherit from their parents especially those parents are both enuretic than those parents who are not enuretic (Fletcher T.B, 2000). Usually the fathers are more often affected than the mothers. It is presented in the study that the boys have seven percent of enuresis at age of less than six than girls have only three percent (Harare and Moulden (2000). Secondary Nocturnal Enuresis is more serious and less common than primary nocturnal enuresis because it may have an underlying medical problem. It is a condition also that a child is starting to wet again after drying up for six months. The child may suffer from emotional changes, behavioral changes, anxiety and stress that sparked a child to bed wet again.  It is advisable also for the parents to seek a doctor determine if it is triggered by emotion or other reason like Urinary Tract Infection  (UTI) that lead to further complications (Fletcher, Harare and Moulden (2000) . Treatments of Nocturnal Enuresis   Nocturnal Enuresis is a condition which is very embarrassing to the child and limits their activities, and for these reasons treatment and tips for the mother may be desired. First is to have thorough physical and history medical examinations to rule out the underlying cause such infections to prevent for further major complications before giving the tips to the mothers. These tips are not also beneficial to the mothers but also to their children as well because it will help the young ones to track their progress. To wit, the tips are to make a Calendar which will help the child to encourage having more dry nights than wet nights because they are the one who will mark the calendar. It enables them to track whether they are progressing or not; keeping sheets and bed clean which is fairly important in order to make the bed more comfortable when sleeping. This will also avoid irritation that can trigger a wet bed. It is also important not to punish the child if ever he will get wet because they don’t mean it; buy an alarm clock to allow the parents as well as the children to wake up in the night to check if they are urinating.  It should be set in different few times to know the interval of bed wetting (Bed Wetting Journal (2003). Aside from giving tips to the mothers to lessen their agony of their children as well to their selves there are also behavioral strategies being recommended to them before letting their child go to sleep. These strategies are to have toilet training to their child especially before bedtime, accessible of the toilet for the child’s assurance, restricting of giving chocolates, food and drinks containing caffeine, and too much fluids before going to bed, have to urinate first, and lastly limit the activities of the child (Buttler, RJ (2000). As parents, they are very concerns to their child’s condition; most of them seek alternative treatments like herbal medicines if behavioral therapy doesn’t work out. Herbal medicines need to have caution while giving it. There are specific herbs for bladder control; these include juniper, marshmallow’s root, parsley root, and lobelia and uva ursi (Egger J, Carter CH, Soothill JF, et al, 1992). Although these alternative medicines has no evidence to improve the conditions,  but lots of native people used these but it needs precaution especially the uva ursi which has a toxic effects. Other treatments include hypnosis and acupuncture. Lots of client use hypnosis because of its comfortable effect. It helps relax the patient while on this therapy and it will allow the patient to explore their weakness and build strength while having this therapy. Another therapy is acupuncture. Although lots of people believe in this therapy, but study shows that has no strong evidence to prove that they are effective (Reed WR, Beavers S, Reddy SK, et al.(1994).     Conclusion I conclude that males are higher percentage than females. Males which account only seventy percent while females only accounts thirty percent. It is not true also that children bed wet because they lack of attention from others especially from their parents. Parents play a major rule in this matter because their children need them to support and understand in order to correct their problem. Siblings must be encouraging and supportive. Embarrassment and limitation of the activities may experienced by the child. Increased of fluid intake may cause nocturnal enuresis especially to those children have small bladder capacity and bladder disorder. Caffeine and chocolates are not allowed to the children because it is bulk forming stool that compresses the bladder that it will decrease the sensitivity to go urinate. However there are other treatments to treat the nocturnal enuresis, such as hypnosis, acupuncture and herbal medicines, but these treatments need further precaution while giving these, because there is no strong evidence to prove the effectiveness of these treatments. In this condition the family affair must participate in treating this condition. If there is no proper treating to the patient in relation with parents, this might lead to a child to a low self-esteem.  Having low self-esteem, the child may not perform well in his daily activities and as well to his school performance. He might have trouble with his social interaction. In this case he might be a problem to the community instead of being a good citizen. Let’s treat our young ones who have having this problem in order for them to cope easily with the stress to avoid any psychological problem in the future.       References: Banerjee S, Srivastav A, Palan BM. Hypnosis and self-hypnosis in the   management of nocturnal enuresis: a comparative study with imipramine therapy. Am J Clin Hypn . 1993;36:113–119. Bed Wetting. American Family Physician 67 (2003) . Egger J, Carter CH, Soothill JF, et al. Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. Clin Pediatr (Phila). 1992;31:302–307. Fletcher,Teresa.Primary Nocturnal Enuresis:A Structural and Strategic Family Systems Approach.Journal of Mental Health Counseling 22 (2000): 32. Harari,Md and Moulden,A. Nocturnal Enuresis:What is Happening? Journal of         Pediatrics & Child Health 36 (2000): 78. Reed WR, Beavers S, Reddy SK, et al. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther. 1994; 17:596–600. Credit:ivythesis.typepad.com

Nocturnal Enuresis

Introduction What is bed wetting? It is a condition where an individual urinates during nighttime unintended. It is co...