Natural Enuresis Treatment
99 Ways To Stop Bedwetting
53 Minutes From Now, You'll Know Exactly How To Stop Your Child From Wetting The Bed...Without Drama Or Discipline. It's one of the hardest problems families face and can be very tough on a child's self esteem. When one of your children is a bed wetter, it can be a very sensitive topic. Even though it's a normal part of growing up, siblings can still give them a hard time.
Specific questions will often help clarify the type of incontinence distressing the patient. Women with stress urinary incontinence (SUI), or urine loss associated with exertion, report urine loss with coughing, sneezing, or laughing. Urine loss during physical activity that increases intraabdominal pressure, such as running and sit-ups, also occurs frequently. Women with urge urinary incontinence (UUI), or urine loss associated with uninhibited detrusor muscle contractions,will typically also complain of urinary urgency, nocturia, and symptoms of frequency. These patients often report an urgency to void that occurs with little warning and cannot be repressed, with leakage often occurring on the way to the toilet. They should be asked how many daytime and nocturnal voids they average. More than eight voids per day and two voids per night is considered abnormal. Episodes of enuresis should be specifically elicited. Urge incontinence will often have triggers such as running water,...
The patient is a 40-year-old G2P1 woman with a 4-year history of stress urinary incontinence (SUI) and fecal incontinence (FI) that began with the vaginal delivery of her now 4-year-old daughter complicated by a fourth degree laceration. Since that time, she has had progressively worsening FI to both liquid and solid stools, as well as an inability to control flatus. Her urinary incontinence is stress related with no significant urgency, frequency, enuresis, or nocturia. She voids with a normal flow. In addition, she complains of dyspareunia and vaginal dryness. Her symptoms have caused significant quality-of-life impairment.
Imipramine is used to treat depression however, it can paradoxically aggravate the anxiety sometimes associated with depression. Imipramine also produces an anticholinergic effect and is therefore approved by the Food and Drug Administration (FDA) for the treatment of enuresis (bedwetting) in children.
Medication (imipramine or desmopressin) is often used to treat bedwetting. Although this treatment produces a better outcome than no treatment, the gains are lost on follow-up and barely exceed the spontaneous remission rate.(33 Desmopressin acetate, a synthetic form of vasopressin, is also used, this has an effect on the kidneys to reduce the volume of urine produced at night, but it is only effective when being used. Relapse occurs as soon as medication is stopped Behavioural therapy using an enuresis alarm or bell and pad is the most effective treatment a treatment period of 8 to 12 weeks produces a success rate of 75 to 90 per cent in the short term, with 45 per cent showing a lasting cure.(33) A second shorter course of treatment will manage any relapse and further courses are seldom required. The effectiveness of the approach depends on the motivation of the parents and child to follow the demanding procedures correctly and to maintain the treatment programme. Over the course of...
Scott, M.A., Barclay, D.R., and Houts, A.A. (1990) Childhood enuresis etiology, assessment and current behavioural treatment. In Progress in behavior modification (ed. M. Hersen, R.M. Eisler, and P.M. Miller), pp. 83-117. Sage, Beverly Hills, CA. 25. Doleys, D.M. (1989) Enuresis and encopresis. In Handbook of child psychopathology (2nd edn) (ed. T.H. Ollendick and M. Hersen), pp. 291-314. Plenum, New York. 26. Mellon, M.N. and Houts, A.C. (1998). Home based treatment for primary enuresis. In Handbook of parent training (2nd edn) (ed. J.M. Briesmeister and C.E. Schaefer), pp. 384-418. Wiley, New York. 28. Norgaard, J.P., Hansen, J.H., Wildshiotz, G., Sorensen, S., Rittig, S., and Djurhuus, J.C. (1989). Sleep cystometries in children with nocturnal enuresis. Journal of Urology, 141, 1156-9. 33. Houts, A.C., Berman, J.S., and Abramson, H.A. (1994). The effectiveness of psychological and pharmacological treatment for nocturnal enuresis. Journal of Consulting and Clinical Psychology, 62,...
Some sleep behaviours which are developmentally usual in children are abnormal in adults and require investigation. Examples are nocturnal enuresis and repeated napping. Certain sleep disorders are seen exclusively in children (e.g. sleeplessness caused by infantile colic). Others, such as settling problems and confusional arousals, occur primarily in children (see later).
Children need information, reassurance, an opportunity to express their feelings, and adults with whom they can do so. As children lack the vocabulary of adults they may often exhibit their distress by behavioural changes, for example bedwetting, difficulty sleeping, and school refusal. Children and their siblings faced with death need clear, simple, and truthful explanations. They should not be pushed to talk nor frightened with excessive medical detail. (,35
Tricyclic antidepressants, such as clomipramine, amitriptyline, and imipramine, have powerful or moderate effects on serotonin neurones, and have been demonstrated to have some beneficial effects in certain disorders with childhood or adolescent onset. These include enuresis, separation anxiety disorder, school phobia, and obsessive-compulsive disorder. Studies using these drugs to treat depression have yielded equivocal results. Desipramine, a tricyclic antidepressant without clear serotonergic effects, has been tested in attention disorders. The new serotonergic drugs, such as fluoxetine, sertraline, and fluvoxamine, are supported by limited child and adolescent data in selective mutism, obsessive-compulsive disorder, and other syndromes listed under anxiety disorders in the DSM-IV.
Figure 8 Nine-year-old girl with symptoms of urine dripping and enuresis. T2-weighted MR urography visualizes an ectopic ureter on the right side. The sagittal plane shows that the ureter (arrowheads) does not join the urinary bladder (arrow). After injection of furosemide, leakage of fluid into the vagina is detected (open arrow), indicating the presence of an ectopic ureteral orifice. The dysplastic right kidney is not seen on the MR urogram. Abbreviation MR, magnetic resonance.
Behavioral problems, learning difficulty, nocturnal enuresis No difference prior to puberty The daytime behavior is an important difference between adults and children with SDB. The abnormal daytime sleepiness may be recognized more often by schoolteachers than by parents of young children. An increase in total sleep time or an extra-long nap may be considered as normal by parents. Nonspecific behavioral difficulties are mentioned to the pediatrician such as abnormal shyness, hyperactivity, developmental delays, rebellious or aggressive behavior (45). Chervin et al. found conduct problems and hyperactivity are frequent among children referred for SDB during sleep. They surveyed parents of children aged 2 to 14 years at two general clinics between 1998 and 2000. Parents of 872 children completed the surveys. Bullying and other specific aggressive behaviors were generally two to three times more frequent among children at high risk for SDB (46). Other daytime symptoms may include speech...
A child may not be able to give a history and the parent or other caregiver may note snoring, labored or obstructed breathing, or both during the child's sleep. There are a number of witnessed sleep events that may indicate OSA, which include paradoxical inward rib cage motion during inspiration, movement arousals, sweating, or neck hyperextension. In addition, the parent or caregiver may note that the child is excessive sleepy during the day, has hyperactivity or aggressive behavior, has a slow rate of growth, has morning headaches and or enuresis. This is confirmed by a PSG
There are other factors correlated with urinary dysfunction, including chronic obstructive lung diseases,27 smoking,28 diabetes,3 constipation, fecal incontinence,25 impaired function of levator muscles, genital prolapse,29 previous gynecologic surgery, perineal suturing,30 and history of childhood enuresis.31
New-onset enuresis in a child can indicate a sleep disorder like sleep apnea. Occasionally, a child is recognized with a sleep disorder during a family vacation when there is greater opportunity for parents to observe children while sharing hotel rooms. Home-video footage both of waking and sleep behaviors can also provide invaluable information, if available.
Various sleep problems, including panic attacks, have been described in anxious children in general including those with panic disorders. Similarly, many types of sleep problem (including nightmares and other disturbed nocturnal episodes, excessive daytime sleepiness, and bedwetting) have been reported to be particularly
Propantheline (Pro-Banthine), oxybutynin, dicyclo-mine, and several other agents have been used for uninhibited bladder syndrome, bladder spasm, enuresis, and urge incontinence. Tolterodine (Detrol), a nonselective muscarinic antagonist, exhibits functional specificity for blocking muscarinic receptors in the bladder, with fewer side effects than oxybutynin. However, total prevention of involuntary bladder contractions is difficult to achieve. The participation of noncholinergic, nonadren-ergic nerves in bladder contraction may explain this apparent resistance to muscarinic blocking agents.
Indirect Cholinergic Local Retinal detachment, cataract, myopia, intense miosis, angle closure, increase bleeding post surgery, punctal stenosis, increase formation of posterior synechiae in chronic uveitis. Systemic Diarrhea, abdominal cramps, enuresis, increases effect of succinylcholine.
Detrusor instability (urge incontinence) is defined as the involuntary loss of urine associated with a sudden and strong desire to void (urgency). Spontaneous uninhibited detrusor overactivity results in detrusor contractions. Patients with this condition complain of an inability to control voiding and experience a sudden urgency to void, which is sometimes unsuppressible. These patients report urinary frequency ( 7 times day), nocturia ( 1 time night), enuresis, and pelvic pain. Although detrusor instability is most often iatrogenic, secondary causes include urinary tract infection, anti-incontinence surgery, bladder stones or foreign bodies, and bladder cancer. Childhood nocturnal enuresis
DSM-IV defines enuresis as involuntary or intentional wetting Wetting may be diurnal, nocturnal, or both. It can be primary (existed from birth) or secondary (follows a period of continence that has lasted for at least 1 year). Children with diurnal enuresis often have a higher incidence of urinary tract infections and abnormal urodynamics, often requiring combined medical evaluation, than children who have nocturnal enuresis (bedwetting).
Nocturnal enuresis(48) is very common, affecting about 5 per cent of 7-year-olds at least once a week. Delayed maturation often seems to be the explanation, but physical or psychological factors may be involved especially where previous bladder control is lost. Behavioural treatment can be very effective. The term nightmare is sometimes used misleadingly for any form of dramatic parasomnia. True nightmares (frightening dreams) are common.(49) If frequent and associated with intense bedtime fears, they may indicate an anxiety disorder and their content may suggest the cause.
Antidepressants have been reported to be effective in many other disorders including substance abuse, alcoholism, and smoking cessation. (52) In children with enuresis a dose of imipramine as low as 25 mg has been seen to be safe and effective. In both children and adults, imipramine, desipramine, and nortriptyline have been effective in the treatment of attention-deficient disorder. (53) Antidepressants have found use in the treatment of premenstrual disorders,(54,5.5) and they are also useful in the treatment of several neurological disorders.(5 57 and