What Is Enuresis?

Enuresis or Bedwetting is the inability to control the discharge of urine, so that urine comes out accidentally. This condition is generally experienced by children, especially under the age of 7 years. When a person wet the bed during the daytime, it is called Diurnal Enuresis, whereas if bedwetting at night, it is called nocturnal enuresis. Some children generally experience nocturnal enuresis, although they can also experience both.

Urine produced by the kidneys will collect in the bladder. Under normal conditions, the nerves in the bladder wall send a message to the brain if the bladder is full, which the brain responds to by sending a message to the bladder to regulate the bladder emptying, so that people are ready to urinate in the bathroom. But in enuresis, there is a disruption in the process that causes people to wet their bed accidentally.

In children, good control of the bladder so that the child does not wet the bed again, usually reached at around 4 years of age. Control of the bladder during the day is usually achieved first, followed by the control of the bladder at night, however, the age of bladder control can vary for each child.

In addition to bladder control, some medical conditions can also cause enuresis in children. Enuresis can be a shameful experience for children and parents. To overcome this, several efforts can be made so that the child does not wet the bed again.


Enuresis Symptoms
Enuresis can be a symptom of certain conditions that require medical treatment, and is usually characterized by:

• Children are still wet after the age of 7 years.
• Bedwetting followed by pain when urinating.
• Excessive thirst.
• Snoring .
• Urine is pink or red.
• Stool becomes hard.
• The child returns to wet the bed after several months of not wet the bed.

Causes of Enuresis
So far the exact cause of enuresis or bedwetting has not been confirmed. However, several factors play a role in the development of enuresis, including:

• Hormonal disorders. The disorder occurs in the antidiuretic hormone (ADH), which serves to reduce urine production. The ADH hormone in enuresis patients is insufficient so that the body produces more urine, especially at night.
• Bladder problems. The problem can be a bladder that is too small to accommodate a large amount of urine, a bladder muscle that is too tense so it cannot hold back the normal amount of urine, and a nervous system error that controls the bladder so it doesn't warn or can't wake the child who is sleeping when the bladder is full.
• Sleep disturbance. Bedwetting is one sign of a disturbance in sleep apnea , where irritation is disrupted during sleep, one of which is due to enlarged tonsils or adenoid glands. Another sleep disorder occurs when the child sleeps too well so he doesn't wake up when going to urinate.
• Enuresis disorders can be inherited from parents, and usually occur at the same age.
• Consume too much caffeine. This can make frequent urination.
• Medical condition. Some medical conditions that trigger enuresis include diabetes , urinary tract infections, abnormal urinary tract structure, constipation, spinal cord injury, and injuries during exercise or accident.
• Psychological disorder. Stress or psychological stress can also cause In children, stress can be triggered by the death of relatives, adaptation to a new environment, or quarrels in the family. In addition, learning to urinate in the toilet ( toilet training ) that is forced or started at an early age, can also be a factor that plays a role in enuresis.

Although enuresis can occur in men and women, most cases are suffered by men and children with ADHD.

Based on the cause, enuresis can be divided into two, namely primary and secondary enuresis. Primary enuresis shows a nervous system disorder in controlling the bladder so that the child cannot realize the sensation when the bladder is full. While secondary enuresis indicates physical or psychological conditions, such as diabetes, impaired urinary tract structure, or stress.

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Diagnosis of Enuresis
The diagnosis of enuresis is done after a child aged 5-7 years. After discussing the symptoms and doing a physical examination of the patient, the doctor also needs to find conditions that make the patient wet the bed. Searching for these causes can be done by:

• Urine test (urinalysis). This check indicates the occurrence of infection, diabetes, or consumption of drugs that cause side effects of enuresis.
• Scanning with X-ray or MRI to see the condition of the kidneys, bladder and urinary tract structure.

Treatment of Enuresis
Most enuresis sufferers can recover by themselves. But doctors will recommend changes in lifestyle to reduce the frequency of bedwetting. Changes in lifestyle are in the form of:

• Limiting fluid intake at night.
• Encourage children to urinate frequently, at least every two hours, especially before going to bed or if they wake up.

If there are special medical conditions that cause a person to experience enuresis, such as sleep apnea or constipation, then the condition needs to be addressed first before treating bedwetting disorders.

If lifestyle changes have not been able to relieve enuresis, the doctor can do therapy to change behavior. This behavioral therapy can be done by:

• Using an alarm system that can sound when the child wet the bed. This therapy aims to improve the response to the sensation of a full bladder, especially at night. This therapy is quite effective in relieving bedwetting disorders.
• Bladder exercise. In this technique, children are accustomed to urinating in the bathroom with increasing intervals of time so that children are accustomed to holding urine for a longer period of time. This exercise can also help stretch the size of the bladder.
• Rewarding each time the child is successful in controlling the urinary bladder so that it does not wet the bed.
• Technique of imagining a positive image. The technique of imagining or thinking about waking up in a dry state and not wet your bed, can help your child stop wetting.

If these efforts have not been able to improve enuresis disorders, then the doctor can provide medication, including:

• Drugs to reduce urine production at night, for example desmopressin , administration of this drug is not recommended if the child also has fever , diarrhea, or nausea. This drug is given orally and is only intended for children over the age of 5 years.
• Bladder muscle relaxant medication. This drug is given if the child has a small bladder, and serves to reduce the contraction of the bladder wall and increase its capacity. An example of this type of drug is oxybutynin .

Although administration of the drug can relieve bed wetting problems, this disorder can return when the drug has been stopped. On the other hand, consideration of side effects also needs to be considered before giving these drugs to children. Therefore, it is better to administer this drug in combination with behavioral therapy. Giving medication can help behavior therapy until the therapy can show improvement in the condition of the patient.

Most enuresis sufferers can be free from bedwetting disorders as they get older, with spontaneous healing from themselves. Only a few cases of enuresis persist into adulthood.


Complications of Enuresis
Enuresis usually does not cause severe complications in sufferers. The complications can be psychological problems, namely the existence of shame and guilt to reduce self-confidence or lose the opportunity to do activities with other people, such as staying at a friend's house or camping. In addition, because it often wet the bed, the complications that can arise are a rash in the rectum or genitals

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