Nighttime incontinence also is known as nocturnal enuresis or bed wetting is a common disorder to be found in children and young teenagers. Enuresis means to void urine and it can be classified as primary or secondary enuresis. Primary enuresis is labeled when a patient has never been dry and bed wetting is consistent whereas secondary enuresis is labeled when a patient has been dry for at least six months before the starting of episodes of bed wetting.
Is Nighttime Incontinence A Serious Condition?
Nighttime incontinence is not a very serious disorder and is a self-limiting disease. Even if no treatment is given for this condition then also it shows the cure rate as 15% per year. The common age group affected is between 4 to 9 years. The cause of this disorder is immature nervous system and the pathways regulating the urinary incontinence which develop completely till the age of 4 years. It is diagnosed after a child does not stop bed wetting till the age of 5 years and only a few cases reach till the age of adolescence while continuing with the disorder.
In the epidemiological data collection, it has been found that only 25% of the children continue to bed wet after the age of 4 years and this number falls between 5 to 10% at the age of 7 years and only less than 5% of children bed wet after the age of 10 years. It is more commonly found in males as compared to females but there is no racial, ethnic or geographical predominance. Most of the patients recover by itself without any medical treatment and recurrence rate is almost nil. Mortality due to nighttime incontinence is not found but can be attributed to secondary abuse suffered by the children from their parents or guardians.
Can It Be Reversed?
It is a very much reversible condition and the mainstay of treatment is resolving the psychological issues of the child because, in most cases, the cause is also psychological. Before starting any therapy it must be ensured that the cause is psychological and not physical. It is done by reducing the anxiety and embarrassment of a child along with the reduction in frustration of the parents. Behavior modification therapy and positive reinforcement are the first lines of treatment for this disorder. This treatment alone can reverse the condition in most of the cases.
Bed alarm therapy has shown immense success in the trials as well as routine application in this disorder. An alarm is set for a fixed time period according to the history of the patient and when the alarm rings, the child is told to go for voiding the urine. The alarm system is used for at least three months continuously to eliminate the disorder. It develops the habit of nocturnal urine voiding and reverses the bed wetting. Medical therapy is not started usually before the age of 7 to 8 years and only in persistent cases. There is no need for surgical intervention until the disorder is resistant to medical therapy.
Nighttime bed-wetting is a common phenomenon found in the children but is considered as a disorder if it continues even after the age of 4 years when the pathway for micturition matures completely. It is not a serious condition to be considered altogether but has a negative impact on the psychology of the child and can even lead to facing the abuse from elders due to this habit.
It is a completely reversible condition and can occur naturally over the period of time with a successful reversal rate of 15% per year. Its reversal can be augmented by the use of behavioral therapies and bed alarm systems. Even if the cases become resistant to psychological therapies, medical treatment is sufficient to reverse the condition in a small period of time.
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