04/06/2021 at 6:25 PM CEST
Enuresis refers to all those urine leaks that occur exclusively at night in children with an age in which voluntary continence of urination would already be expected (five years of age).
Who knows a lot about this is Elena Taborga (Madrid, 1978), a specialist in Pediatrics who currently works at the Villalegre-La Luz health center (Avilés). He has dedicated his doctoral thesis to these involuntary urination. To do this, he surveyed 2011 children between the ages of 6 and 13. Conclusion of the work, referring to Asturias but, without a doubt, very indicative about what can happen in any other territory: «Enuresis affects 5.5 percent of the school population».
Boys wet the bed more than girls: for every three boys with enuresis there is one girl with leaks
The specialist clarifies in this regard: «When we analyze the data according to the latest published diagnostic criteria, which establish a minimum age of five years for diagnosis and a minimum frequency of two escapes a week, the prevalence drops to 2.8 percent . Most (86%) had a primary enuresis and 65% a non-monosymptomatic enuresis ».
Another fact: boys wet the bed more than girls. «In almost all published epidemiological studies on enuresis, and also in ours, it is children who have the highest prevalence. In Asturias, according to our data, for every three children with enuresis there is a girl with leaks. This can be explained, in part, because boys acquire voluntary continence control a few months later than girls.
The main thing, according to Taborga, is to differentiate monosymptomatic enuresis from non-monosymptomatic ones, since their origin and treatment differ. «For this we need to carry out an adequate and complete medical history with certain key questions about the type of enuresis that is present, symptoms suggestive of bladder dysfunction, presence of encopresis or constipation, quality of sleep (presence of nocturnal apneas) and quantity and type of ingested fluids throughout the day, among others. The physical examination of a child with enuresis must be complete and it must be normal, “he explains. In addition, he adds, in all cases it is necessary to make a calendar of dry / wet nights, a voiding diary and a stool log. The rest of the complementary tests, in the opinion of Taborga, should be based on the data obtained with the clinical interview, physical examination and calendars, diaries and records.
To the specialist
«In the event that our son has enuresis, either because he has not achieved continence (primary enuresis) or because he has lost it (secondary enuresis), we should consult our primary care pediatrician. It will be the person who studies the type and degree of enuresis that the child presents, ruling out the possibility that it is a symptom of another disease or condition (diabetes mellitus or insipidus, hidden spinal dysraphism, hypothyroidism, chronic kidney disease & mldr; even abuse or sexual abuse) », underlines the specialist. The expert will also assess certain items that may cause resistance to treatment. «Most of the children will be treated successfully from Primary Care. Few cases will need to be referred to the specialist, among them are children with enuresis refractory to adequate treatment, non-monosymptomatic enuresis and organic diseases that present enuresis as one of their symptoms, “he clarifies.
There are two main lines of treatment for monosymptomatic enuresis: alarm and desmopressin. In the case of non-monosymptomatic patients, there are anticholinergics, among others. «All this must be supported by a behavioral therapy where the child is the protagonist, must follow some routines, complete his calendar of dry / wet nights and control the intake of liquids before going to bed, always maintaining a positive attitude avoiding punishments and fights », Elena Taborga specifies. But the choice of one or the other treatment, he emphasizes, must always be individualized, adapting to the family and the patient. «In addition to assessing the type of enuresis when choosing it, we must take into account the involvement in the treatment of both the child and the family. If the family is not involved, the alarm treatment would fail from the start, “he warns.
Taborga advises families not to rush when it comes to removing their children’s diapers. “They have to be ready to do it, and when that time comes, we must teach them to do it.” Some premises that should be taken into account are: «Detect those postures that the child adopts to retain urine and postpone the moment of urination, that they cannot resist the urge to urinate, that urination can be programmed (for example, one before each one of the five meals of the day and before going to bed) and encourage the voiding stream to always be continuous, preventing the child from cutting him off when he is urinating, since they empty the bladder completely every time they go to the bathroom ».
Enuresis and pandemic
Elena Taborga considers that some forms of enuresis with a high emotional component may have increased as a result of the new coronavirus pandemic. But the specialist goes further: «As in other entities with chronic evolution, diagnoses have been lost and their control has worsened. This results in them wetting the bed longer and evolving more into complicated shapes. Both to identify this problem and to solve it, the face-to-face relationship is key: the telephone is not worth it, “concludes the pediatrician avilesina.