Enuresis or bedwetting is the inability to control the discharge of urine so that urine comes out involuntarily. This condition is generally experienced by children under the age of 7 years. Even so, enuresis can also occur in adults.
Enuresis is also often referred to as urinary incontinence . Based on the type, enuresis is divided into two, namely primary and secondary enuresis.
Primary enuresis occurs since infancy. This enuresis goes on continuously, every day, and almost without a break. Meanwhile, secondary enuresis is enuresis that recurs 6 months or several years after the patient is able to control his bladder.
Causes of Enuresis
The bladder functions to collect the urine produced by the kidneys. The bladder will enlarge as more urine enters and shrink to push urine out when someone urinates.
Normally, nerves in the bladder wall send signals to the brain when the bladder is full. Next, the brain will send a message to the bladder to hold the urine out, until the person is ready to urinate in the bathroom.
In the condition of enuresis, there is a disturbance in the process of sending the signal. This is what causes a person to wet the bed.
Based on the age of the patient, enuresis can be divided into two types, namely:
Enuresis in children
Children generally begin to be able to control the urge to urinate at the age of 4 years. Initially, children can control the urge to urinate during the day, then able to control the urge to urinate at night. However, the age at which children can control their bladder can vary.
Enuresis in children aged 2-7 years is normal. This condition is usually caused by the following factors:
- The child's inability to hold urine throughout the night
- Small bladder size
- Does not wake up from sleep when the bladder is full at night
- Immature bladder nerve development
- More urine production in the afternoon and at night
- Children's habits to resist the urge to urinate
In addition, enuresis in children can also occur due to physical or psychological conditions that are being experienced. This medical condition depends on the type of enuresis suffered, namely:
1. Causes of primary enuresis:
- Disorders of antidiuretic hormone (ADH), which is a hormone that functions to decrease urine production
- Structural abnormalities of the urinary tract, such as abnormalities in the valves of the outer urinary tract (urethra) or more than two ureters ( ectopic ureters )
- Abnormalities in the nerves of the brain, such as cerebral palsy
2. Causes of secondary enuresis:
- Enuresis disorder inherited from parents
- Sleep apnea
- Sleep too well
- Urinary tract infection
- Constipation or constipation
- Spinal cord injury, for example as a result of exercise or an accident
- Severe stress, one of which is the result of learning to urinate in the toilet ( toilet training ) which is forced or started at too early an age
Enuresis in adults
Depending on the type of enuresis suffered, there are several conditions that can cause enuresis in adults, namely:
1. Causes of primary enuresis
- Disorders of antidiuretic hormone (ADH) so that the kidneys produce more urine
- Blockage in the urethra
- The size of the bladder that is too small to accommodate urine
- Bladder muscles that are too tense to push urine out of the bladder ( overactive bladder )
2. Causes of secondary enuresis
- Use of drugs, including sleeping pills or antipsychotics (such as clozapine or risperidone )
- Drinking too much, especially drinks containing caffeine
- Diabetes mellitus
- A protrusion of the pelvic organs pressing on the bladder
- Urinary tract infection
- Bladder stones
- Prostate enlargement
- Bladder or prostate cancer
- Pinworm infection
- Multiple sclerosis
- Parkinson's disease
Enuresis risk factors
Enuresis can happen to anyone, but there are several factors that can increase the risk of enuresis, namely:
- Experiencing stress or anxiety disorders
- Have family members who have or are currently experiencing enuresis
- Suffers from ADHD
In addition, pregnant women or those who have just given birth can also experience difficulty holding urination which can cause neuresis.
In most children, the ability to control the bladder appears by the age of 5. Only a few children still wet the bed at the age of 5–7 years, and even fewer children over the age of 7 still wet the bed.
The most common symptom of enuresis is repeated wetting of the bed, at least twice a week for about 3 months, accompanied by frequent wet clothing.
In addition, there are other symptoms that can accompany enuresis, among others:
- Urine menetes
- More frequent urination
- Lower abdominal pain
- Pain when urinating
Enuresis can occur at night (nocturnal enuresis) or during the day (diurnal enuresis). Enuresis sufferers usually only wet the bed when sleeping at night. However, some sufferers can also wet the bed during the day, or both times.
When to see a doctor
Although generally not requiring medical treatment, bedwetting the bed can indicate other, more serious conditions. Therefore, do an examination to the doctor if enuresis:
- Happens during the day
- Followed by pain when urine comes out
- Occurs after the age of 7 years or after several months of not wetting the bed
- Accompanied by other complaints, such as snoring , excessive thirst, hard stools, and reddish urine color
As explained above, the child's ability to control the bladder generally appears after the age of 5 years. Therefore, the diagnosis of enuresis is only made when girls are 5 years old and boys are 6 years old.
Diagnosis begins with questions and answers related to symptoms experienced, lifestyle, and medical history. After that, the doctor will perform a thorough physical examination, to detect other conditions that may be causing the enuresis.
To confirm the diagnosis, the doctor can also carry out supporting examinations, such as:
- Urine test (urinalysis), to check whether the enuresis is caused by infection, diabetes, or a side effect of medication
- Scanning with X-rays , ultrasound, or MRI, to see the condition of the kidneys, bladder, and urinary tract structures
Treatment of Enuresis
In most cases, people with enuresis resolve on their own. However, to reduce the frequency of bedwetting, the doctor will suggest lifestyle changes, namely by:
- Limit fluid intake at night
- Encourage the child to urinate more often, at least every 2 hours, especially before bedtime or when awakened from sleep
- Avoid consuming caffeinated foods or drinks
If the independent steps above have not been able to relieve enuresis, the doctor will carry out therapy to change the patient's behavior. Behavioral therapy is done by:
Using an alarm system that can sound when a child wets the bed
This therapy aims to increase the body's response when the bladder is full, especially at night. This therapy is quite effective in reducing the frequency of bedwetting.
Bladder training ( bladder training )
In this technique, the child is scheduled to urinate in the bathroom with longer intervals which will be further enhanced. The goal is to help stretch the size of the bladder, as well as to get the child used to holding urine for a longer period of time.
Doctors can advise parents to reward their child every time the child manages to control the bladder and does not wet the bed.
Imagining a positive image
The patient will be taught to imagine or think that he will wake up dry and not wet his bed. This technique can help to stop wetting the bed.
If these efforts have not been able to improve the enuresis disorder, the doctor will give drugs, such as:
- Medications to decrease urine production at night, such as desmopressin . These drugs are given orally and are only for children over the age of 5 years. However, this drug is not recommended in children who also have diarrhea, fever , or nausea.
- Bladder muscle relaxants, to be given to children who have small bladders. This drug serves to reduce the contraction of the bladder wall and increase its capacity. An example of this type of drug is oxybutynin .
Please note, although the above drugs can relieve bed-wetting disorders, this disorder can recur once the drug consumption has been stopped. On the other hand, consideration of the risk of side effects also needs to be considered before giving these drugs to children.
Giving the drug above can also be combined with behavioral therapy. In some cases, the combination of the two methods has proven effective in treating enuresis.
Most people with enuresis can get rid of bed-wetting disorders with age. Only a few cases of enuresis persist into adulthood.
If the enuresis is caused by sleep apnea or constipation , the doctor will treat those conditions first before treating the enuresis. Meanwhile, if enuresis is caused by an abnormality in the structure of the urinary tract, the doctor will perform surgery.
Enuresis generally does not cause severe complications in the sufferer. Complications that usually arise include:
- Psychological problems, namely the emergence of shame and guilt that reduce self-confidence
- Missing opportunities to do activities with other people, such as sleepovers at friends' houses or camping
- The appearance of a rash on the anus or genitals
Not all cases of enuresis can be prevented, especially if the enuresis is caused by structural abnormalities of the urinary tract. In these conditions, the best thing that can be done is to see a doctor as soon as symptoms appear so that the cause of enuresis can be treated immediately.
In addition, the role of parents is also very important in teaching children to urinate. Parents are advised to be positive and patient in teaching their children . This is to prevent the emergence of negative behavior that may appear in children when urinating.