Nighttime incontinence is found in nearly one-fourth of the patients and it is a self-limiting disorder with very good prognosis. No need for medical therapy arises in most of the cases and only psychological evaluation and behavior therapy is sufficient to treat it.
Prognosis For Night Time Incontinence
Although the disease carries a good prognosis of it and has no mortality even then the children suffering from it are likely to be abused and mutilated by the elders.
Sometimes even fatal abuse and mortality has been reported for this disorder because there is very less awareness among the parents about it. It is generally considered that the child is doing hit purposefully and is punished for the same. It also significantly increases the morbidity among children with bruised self-esteem and a huge psychological impact on the mentality.
On the note of physical symptoms, due to continuous wet area around the groin, it can lead to rashes in the genital and perianal area with skin discontinuation and cutaneous infections. If the treatment is inadequate or stopped suddenly, then it will lead to relapse of the condition in many cases which is an unfavorable prognosis occurring due to lack of compliance by the guardians.
Lifestyle Changes For Night Time Incontinence
Nighttime incontinence is a common disorder upcoming naturally till the age of 5 years and there is no need for the diagnosis to be made for the abnormality. No lifestyle changes are recommended before the age of 5 years. After the patient has achieved the age of 5 years and continues to suffer from the disorder, it is necessary to differentiate the persistent or intermittent nature of the disorder. In every 15% of the cases, it undergoes spontaneous remission with every year of growing age.
If the symptoms remain intermittent occurring at a very low frequency or once in a while then the behavioral therapy and psychological support are sufficient enough to cure disorder because the commonest cause seen responsible for it is low self-esteem and psychological problems. The patients recover usually within 6 months when their low self-esteem is boosted with various psychological supports.
If the disorder remains persistent and regular then a bed alarm therapy could be applied for forming the habit of night time micturition. The alarm is set according to the time period around which the patient micturates and is prompted to go to the washroom. This therapy is usually curative when applied for at least three months without any missed period. It can be stretched to 6 months or longer if the symptoms continue to appear.
Punishment has no role in the treatment of this disorder and should be avoided because it may precipitate the cause of low self-esteem and delay the cure of the disease. Even after lifestyle modifications, if the patient continued to suffer then the medical therapy can be sought in the form of antidepressants, desmopressin, etc. which help to mature the neurogenic pathway responsible for micturition reflex.
Direct prognosis of the night time incontinence disorder is very good with a very low failure rate and only a few cases go till the age of adolescence but the associated mortality or morbidity is due to the abusive behavior by the guardians either due to an awareness of the disorder or lack of compassion with the child. As thought by the elders, that the punishment will create a fear in the mind of child and it would refrain the child from bed wetting but it is reverse because of its association with poor self-esteem and psychological insecurity of the child.
Lifestyle modifications are recommended on the basis of severity, duration and most importantly the age of the patient. It is considered normal till the age of 5 years and the cure is sought only after it. Medical therapy can be needed in later stages due to non-compliance or persistence of the disease.
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