Nocturnal urination (enuresis nocturna)

Enuresis is a common problem. This problem has turned not only the sheets, but also the lives of many families into a nightmare. Today it is argued that enuresis can be almost completely prevented. Why and how do children learn micturition control?”.
Emission Control: Enuresis is the frequent voiding of urine under inappropriate conditions at an expected age. Lifelong wetting is called primary enuresis; cases of wetting that begins after a period of controlled micturition
Daytime wetting (diurnal enuresis) is less common than nighttime wetting (nocturnal enuresis), but the two can also occur in combination.Many children with nocturnal enuresis alone have learned daytime bladder control after the age of two or three.
Just as some healthy children learn to walk slowly or quickly, others learn to control their micturition slowly or quickly, and such abilities continue to develop for some time.
A baby’s kidneys constantly secrete urine, but the baby is constantly passing urine. It does not wet, and the time to hold the urine accumulated in the bladder gradually increases. It is essential that the necessary mechanisms in the central nervous system (CNS) develop in order for this to be possible in a few years. This development takes place sometimes at the age of one year, more often at the age of 2-3 years, sometimes at the age of 4 or even 5 years. After the age of five, developmental delay is very rarely thought to be a factor in nocturnal enuresis, but there are many other factors. Thus, micturition control is a behavior that occurs with the development of the CNS, but its occurrence may be disrupted.
Some factors affecting the initiation of micturition control:
1. Growing up: The role played by upbringing can be demonstrated first by comparing the frequency of enuresis in different countries (although some nations give more importance to this problem). Non-Western countries are not included in this article, except for some parts of Africa, where 10% of pre-puberty children are affected. The breakdown of micturition control in four-year-olds is as follows: Sweden 92%, England 88%, USA (white) 71%, Australia 61%.
2.Family: Enuresis is often “inherited”. Familial factors can be genetic (factors affecting developmental time) or environmental (eg, “problem families”). In a troubled family, enuresis is more likely to persist if the child is deprived of a parent or not well cared for. Conversely, it is possible for micturition control to develop earlier in the setting of good family relationships.
3. Anxiety: If toilet training is applied with pressure or if these efforts are undertaken in an environment of anxiety and tension, micturition control may be delayed. In a peaceful home atmosphere, this development accelerates. For example, in a 4-year-old boy, due to the slow development of CNS, current enuresis may cause some concerns in the family, which may delay micturition control even after development has taken place. Other anxiety factors, such as a death in the family or a new birth, can have the same effect. Although the cause changes, the symptom remains the same.
When enuresis is secondary to organic disease, it is usually “secondary enuresis”, yet anxiety is by far the most common cause of secondary enuresis. Small bladder is not a causative agent of enuresis, it is secondary to enuresis. The finding of spina bifida occulta is not important without CNS symptoms.
A child who wets the bed does not urinate much at night. Does he sleep too deeply to be awakened by a urination stimulus? While this is partially accepted, it is now being re-examined and evaluated.
It is important to examine the child in terms of family environment and accept that bedwetting is frequently encountered in children of families with the disorder. Enuresis was once believed to be a psychiatric disorder in its own right, but this view was later questioned. There is modern evidence today that enuresis is related to an emotional or behavioral disorder. A secondary anxiety appears to be present in some enuretic children. However, many of these children are psychiatrically normal. An emotional disorder may also be temporary; however, if the “sensitive period” (approximately 2-4 years of age) is encountered in terms of learning, it may delay bladder control.
Thus, anxiety may play an important role in primary or secondary enuresis, or in relapsing cases that are apparently cured.
Acupuncture; By providing regulation of the limbic system, it relieves anxiety as well as contributes to the development of micturition control in the CNS, thereby eliminating the problem.