How to get out of night enuresis

1. What is night enuresis?

1) the medical definition of night enuresis

Night enuresis means peeing because there is an abnormality in urination control even after the age when the bladder should be controlled. In infancy, the bladder function is incomplete, so it automatically urinates simply by reflection.

2) Urine function with growth

When the bladder volume increases and the regulation of urinary reflex is formed by 6 months of age, the amount of urine once you see increases and the interval between urinating begins to increase. After that, the bladder volume continues to increase around the age of two to three, and the ability to consciously control the bladder and urethral sphincter increases. By the age of four, they have almost the same urination control function as adults. Being unable to cover urine while sleeping after the age of 5 is called night urination. Usually, you have to pee more than twice a week to diagnose night urination. Night urination is divided into primary and secondary (secondary). Primary is when you have never covered your urine since birth, and secondary is when you show symptoms of night urination again after covering your urine for at least 6 months. Most of the night enuresis is primary.

2. Causes of night enuresis

The cause of night enuresis is not yet clear. However, the following factors can be said to work in combination.

1) A hereditary trend

If both parents had night enuresis when they were young, 70% of their children have night enuresis. If one of the parents has night enuresis, 40% of their children have night enuresis. From these results, it seems that genetic factors are involved in night enuresis. Recently, it was discovered that chromosomes related to night enuresis exist in chromosome 13.

2) Delayed maturity of bladder function

It is considered a common cause of night enuresis. This theory is acceptable as most children with night enuresis improve with age.

3) A sleeping element

Previously, it was thought that sleep factors would be involved in most cases of children with night enuresis because they fell into deep sleep and were difficult to wake up. However, recent studies have shown that sleep patterns in children with night enuresis are not much different from those of normal children.

4) An increase in urine emissions during sleep

Recently, an increase in urine emissions during sleep has been identified as one of the causes of night enuresis. Normally, anti-diuretic hormones that inhibit urine production increase during sleep, reducing the amount of urine and sleeping without urine. However, after measuring the antidiuretic hormone in some children with night enuresis, the hormone level did not increase even during sleep and remained similar to daytime. As a result, urine is made at night, just like during the day, and night enuresis occurs as it exceeds the volume of your bladder. However, these antidiuretic hormone secretion abnormalities were not found in all children. Therefore, this alone cannot explain the cause of night enuresis. However, if urine is made more than your bladder volume during sleep, you must urinate in either form, whether you wake up and go to the bathroom or wrap it in a blanket. Therefore, you can think of night enuresis as determined by the correlation between urine production and your bladder volume during the night.

5) The relationship between mental causes

Previously, it was said that night enuresis and mental abnormalities were correlated. Recently, however, it is generally accepted that night urination is not caused by mental causes. However, if night enuresis persists, it can have a secondary impact on mental growth such as inferiority complex, lack of confidence due to shame, and maladjustment to social life.

6) A urological disease

In very few cases, night urination can be associated with actual urinary tract diseases. If you have stenosis at the urethral exit or urethra, you urinate regardless of night and day. If you can't control your urine even during the day and pee in your pants, you should check for symptoms that notify you of urethral obstruction (bladder wall thickening, receipt, residual urine, etc.) through ultrasound.

7) Hydration:

In particular, night enuresis can occur if you drink too much water until bedtime. Reducing water intake in the evening and before bed can help relieve symptoms.

8) Medical condition:

Certain medical conditions can cause night enuresis, including urinary tract infections, irritable bladder, prostate problems, and kidney disease. Treatment of underlying medical conditions can help relieve symptoms.

9) Drugs:

Some medications, such as diuretics and blood pressure medications, can cause nightly anemia. Adjusting the dosage or switching to another drug can help relieve symptoms.

10) Aging:

With age, the body produces fewer urine-concentrating hormones, increasing urine production at night. Aging can also weaken bladder muscles and cause night enuresis.

11) Sleep disorders:

Sleep apnea and other sleep disorders can interfere with sleep and increase body fluid production, leading to night urination.

12) Lifestyle factors:

Certain lifestyle factors, including caffeine and alcohol consumption, smoking, overweight or obesity, can contribute to nightly anemia.

3. Symptoms of night enuresis

The symptom of night enuresis is that even after the age of five, you can't cover your urine while sleeping. There are no other symptoms.

4. Diagnosis

Most of the cases of night enuresis are simple night enuresis, which does not show urinary incontinence or urinary disorders during the day. Since it is extremely rare for such simple night urination to have organic abnormalities, you only need to see an outpatient clinic and have a urine test. However, if a basic urinary examination or physical examination finds abnormalities, severe urinary disorders during the day, If you don't urinate too often, if your urine stem is weak or breaks on the way, if you have chronic constipation, If you can't cover your feces, the case of urinary tract infection in the past is called complex night urinary tract. In this case, there is a high possibility of an organic lesion. Complicated night urinary tract reflux, obstructive disease, unstable bladder, In order to distinguish urethral abnormalities, detailed tests such as ultrasound, bladder urethral imaging during urination, and urinary tract examination should be performed.

5. First aid

If you experience night enuresis, you can take some emergency measures to help relieve your symptoms.

1) Restriction on water intake:

Reducing water intake in the evening and before bed can help relieve symptoms of night enuresis.

2) Empty your bladder before bed:

Empty your bladder before going to bed can reduce the need to urinate at night.

3) Use the restroom immediately when you need to pee:

It is important to go to the bathroom immediately when you have to pee. Holding back urine can worsen night enuresis symptoms.

4) Create a safe route to the bathroom:

If you need to wake up to use the bathroom at night, make sure that there are no obstacles to the route and the lights are bright to reduce the risk of falling.

5) Store bedside urinals or toilets:

If you have difficulty getting out of bed and using the bathroom, having a bedside urinal or toilet can help relieve symptoms of night enuresis.

6) Symptom management of underlying diseases:

If night urination is caused by underlying conditions such as prostate enlargement or urinary tract infection, managing symptoms of underlying conditions can help relieve nightly frequent urination symptoms.

6. Treatment of night enuresis

The treatment period for night enuresis is good after the age of 5 or before entering elementary school. Even if most of them are not treated, about 15% of the symptoms disappear naturally every year. However, while waiting, it is recommended to treat night urinary children as they may develop personality-forming disorders that lack confidence due to shame, guilt, and failure. Treatment methods for night urination include medication, behavioral therapy, and mental therapy. Basically, you should limit your water intake after dinner, and you should pee and let it sleep before going to bed. Do not punish or criticize during treatment.

1) medication

(1) Imipramine, an antidepressant drug

The exact mechanism is unknown. It is estimated that the therapeutic effect appears due to weak anticholinergic action, relaxation on urinary muscles, and increase in bladder volume. Treatment effects are seen in 60-70% of all patients. However, if you stop taking the medicine, 60% of the time will recur.

(2) Desmopressin acetate, an antidiuretic hormone analog

It is a drug that is consistent with the logic that the amount of urine increases due to the lack of proper secretion of antidiuretic hormones at night, resulting in night urination. Treatment is effective in 60-80% of all patients. However, if you stop taking the medicine, it often recurs.

(3) Parasympathetic nerve inhibitor Oxybutynin

Not for simple night urination. It is prescribed during the day if you have urgent urination, frequent urination, or urinary incontinence. Side effects can include dry mouth, flushing, constipation, and dizziness.

2) Behavioral therapy

(1) A night alarms

It's a behavioral therapy, a kind of conditioned reflex therapy. If you pee while sleeping with a humidity-sensitive sensor attached to your yo, the alarm goes off. At first, wake the child up during or after urination to go to the bathroom. Repeated behavior results in a conditioned reflex that requires you to hold your urine and wake up when your bladder is full, that is, when the alarm goes off. Then later, you feel your bladder is full, and you wake up on your own and go to the bathroom. It is mainly effective for children over the age of seven. If you treat it for about six months, the treatment effect is about 80%. The recurrence rate is 30%, which has a higher treatment effect and a lower recurrence rate than drug therapy. However, compared to other drug treatments, the first 1-2 months should not be expected to be effective. It also has the disadvantage of having to wake up as soon as the alarm goes off, causing the whole family to suffer at night.

(2) Synchronous therapy

Motivation therapy is to motivate people with positive reinforcement, such as encouraging them with words of praise or buying them a gift they like on a day when they don't pee. Through this, children feel responsible for their actions and actively participate in the treatment program. This approach is also known as responsibility training. On days when the blanket is not wet, we sometimes use a golden star sticker on the calendar. These treatments also require a long time to be effective.

7. Progress / Complications

Even if it is not treated, night urination naturally improves by 15% every year after the age of five.