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Night Enuresis: Heroes in Pajamas!

Night Enuresis: Heroes in Pajamas!

Bed wetting, called nocturnal enuresis, consists of uncontrolled emptying of the bladder during sleep. Peeing in bed while sleeping is a more common situation than you think but it is not a warning sign.

The rhythm and maturation of urinary sphincters differ from child to child. This pace must be respected. No one is guilty, much less the child!



It is a common condition in children, with approximately 5–10% of 7-year-olds still regularly wetting their beds, and the problem may even persist until adolescence or adulthood. In children aged 5 years and over, enuresis is considered unusual.

This article aims to provide support and advice to parents, educators and children who want to know more about nocturnal enuresis.



Above all, both the physical well-being of the child must be ensured using (adequate and comfortable incontinence products) as well as psychological well-being (showing understanding and comfort). The child is not to blame in the process!

Here are some tips for managing enuresis:


Fluid intake

Reduce fluid intake at the end of the day, and to compensate it increases it early in the day.


Bathroom program

Take the child to the bathroom at night, at a regular urine time (every two to three hours) and before bedtime. There are also those who argue that this procedure should not occur and that disturbs the sleep of the child. Here you should test if your child is disturbed by sleep interruption.


Bedtime Routine

Always lay the child at the same time and establish a routine that includes going to the bathroom before going to bed.


Encouragement

Make the child feel good about progress by consistently rewarding successes.


Take an open and calm attitude

Keeping calm and talking about the situation often in an open and honest manner will make your child feel more comfortable. It is very important to know how your child feels and if you have questions or concerns. Take it easy… kids recognize impatience!


Eliminate bladder stimulants and irritants

At night, eliminate caffeine, chocolate or cocoa milk, coke and, if that doesn't work, eliminate citrus juices, artificial flavors, colorings (especially red) and sweeteners. Many parents are unaware that they can irritate a child's bladder.


Avoid excess thirst

Nowadays schools allow children to bring their bottle or canteen to school. Encourage your child to drink during the day to avoid excessive thirst after school and especially at night. The hydration of the child is of utmost importance!


Reward

Create a reward system with small symbolic prizes for each night when the child does not wet the bed (dry nights).


Punishment for peeing in bed? Never

Showing anger to your child does not help him learn. Conflict does not benefit the process.


Constipation can be a factor

The rectum lies behind the bladder, difficulties with constipation can have consequences on the bladder, especially at night. This affects about one third of children who pee in bed. Children are unlikely to identify or share information about constipation. Be aware!


Normalize the situation

Your child may feel worried and think that something is wrong with him. So it is good to comfort him, to tell him that it is not his fault and that other children feel the same way. Explain that there are probably one or two more children in your classroom who are going through the same situation and probably don't talk about it because they are shy. It's good to underline that you don't have to be ashamed! If one of the child's parents or siblings has experienced a similar situation, tell them. Thus the child realizes that other people have experienced the same and that it is only a temporary phase. Give the children hope!


Shame

A child should never be defined or described as someone with nocturnal enuresis. Doing so will reinforce the negativity of the issue. Instead, make sure your child understands that it is a situation you are not to blame, or something you have no control over. It is good to help your child understand that there are good products and good solutions available to help manage his or her incontinence.


Salty foods at night is a crime!

Avoid very salty foods, especially at night, as they give more thirst.


Daytime Urination

Encourage the habit of peeing every three hours throughout the day.


Always have a spare bed change available

Have alternate bedding, pajamas and a duvet available in your child's room for overnight changes. This will help when you are awake at night.


Neutralize the smell of urine in the room

The smell of urine in the room can make the child feel insecure and ashamed. Modern incontinence products now feature odor neutralizers to make children feel comfortable even after an accident. Be careful to ventilate the room and preferably scent it with natural products such as burning eucalyptus or mint leaves.


Urine Alarms In Bed

There are alarms on the market designed to assist in the process of acquiring sphincter control that have been shown to be effective. Ask the pediatrician for advice.


Each child is unique! There are a number of factors that influence your incontinence, so if you have questions or concerns, it is best to talk to your doctor or healthcare professional. The specialist will also help rule out other problems such as urinary tract infection and even sleep apnea.



Children love to understand how the human body works. A child with enuresis benefits even more from understanding how the body and bladder works by feeling safer. You will better understand what is happening to your body.

You can go with her to the library and even order the book to take home, thus providing visual support that makes it easier to understand what you are explaining to them. You can also search for simple images and videos on the internet.


For younger children, you might even try to make up a story about the situation to make it even more understandable.

For example:

“Ms. Bladder is still learning her job and getting to know all her neighbors. Soon everyone will get along. ” Read more basic information about the bladder, urinary system and causes of urinary incontinence and make up the story of Mrs. Bladder.


Simple directions to explain to the child how to

The fluids our body does not need are accumulated in the bladder, which is like a balloon that fills up.

The bladder (the balloon) has a "tap" called the urethra that warns our brain (through the central nervous system) when the balloon is full and we must empty it.

Normally, we control this faucet by day (like you) and also by night and are able to tell the faucet to hold on and not open until we get to the toilet.

But in many cases, like yours, at night, while you sleep, you do not notice the tap warning. So don't wake up, the faucet turns on by itself and you pee in bed.




In this section we present some facts and figures about childhood incontinence.

Regarding age, in general:

  • Nocturnal enuresis is the most common form of childhood incontinence, with daytime enuresis affecting 5-10% of children between the ages of five and seven.
  • By the age of three, about three out of four children already know how to use the bathroom.
  • At age five, about one in 10 children still suffer from nocturnal enuresis.
  • At age 10, about one in 15 children still suffer from nocturnal enuresis.


Enuresis vs heavy sleep. Any relationship?

There are children who do not wake up at night and parents wonder if their children will have very deep sleep.

Effectively, children who urinate in bed are unable to wake up at night. Recent studies have contradicted the belief that children pee in bed for having too much sleep. Children who are bed wetting are now known to have poor sleep quality and many awakenings. They also appear to have "periodic limb movements" during sleep, a sign that may be related to attempts to wake up.


Enuresis vs genetics. Any relationship?

Bed wetting is clearly a hereditary disease (genetic disposition). In approximately 70% of cases there is another family member who also has, or had this problem in childhood. For example, if the mother as a child peed in bed, there is a 7 times greater risk of her children suffering from enuresis. The specific gene responsible for enuresis has not yet been identified.


Enuresis vs psychological disturbances. Any relationship?

In general, enuresis is not directly caused by psychological disturbances. In the reverse of the medal, suffering from enuresis can cause psychological problems, which particularly affect quality of life and self-esteem. These psychological changes normalize after effective treatment of enuresis. Enuresis vs most common cause. Any relationship? The two most common causes for bed wetting are increased urine output at night (nocturnal polyuria) and reduced functional bladder capacity at night. Both causes can occur simultaneously.


Enuresis vs most common causes. Any relationship?

The two most common causes for bed wetting are increased urine output at night (nocturnal polyuria) and reduced functional bladder capacity at night. Both causes can occur simultaneously.


Enuresis vs related problems. Any relationship?

Although most bed-wetting infants from childhood have no underlying disease, either in the nervous system that controls bladder function or in the urinary tract anatomy, these assumptions should only be ruled out after consulting a doctor. Additionally, the doctor will determine if enuresis is the only problem or if there are other associated issues that need to be addressed as well. These include diurnal enuresis, signs of "overactive bladder" (frequent and strong voiding sensation), fecal incontinence and constipation, and recurrent urinary tract infections. If these conditions are present they should be treated before any treatment for enuresis is started.




Why does nocturnal enuresis happen?

Nocturnal enuresis is caused by several physiological or psychological factors, or a mixture of both:

  • Late maturation
  • Defrag not complete
  • Small bladder functional capacity (actually, the bladder is not small, but contracts before it is full)
  • Increased nocturnal urinary volume
  • Low level of antidiuretic hormone (ADH) during sleep
  • Difficulty waking up from sleep
  • Genetic factors / family history (if one parent has nocturnal enuresis, the possibility of the child also having 30%; the probability increases to 70% if both parents are affected)
  • Organic conditions that increase urinary volume (eg diabetes mellitus, diabetes insipidus, chronic renal failure, excessive water intake, sickle cell disease, sickle cell anemia heterozygote [hypostenuria])
  • Constipation
  • Conditions of bladder irritability (eg, UTI - urinary tract infection, rectal and sigmoid bladder pressure caused by constipation)
  • Structural abnormalities (eg ectopic ureter, which may cause nocturnal or daytime urinary incontinence)
  • Abnormally weak sphincter (eg, spina bifida, which may cause nocturnal and daytime incontinence)
  • Anxiety


On the subject, videos for children explaining how the urinary system works:

https://www.youtube.com/watch?v=5lcmJGVtl0s

https://www.youtube.com/watch?v=EszH_DVuA3E

Adult enuresis video:

https://www.youtube.com/watch?v=d-y_1960JqE

Catarina Vilela (nurse)