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Dx Bed Wetting Treatments: Read More...


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Observation:
Bed Wetting

The Merck Manual states:
"Urinary incontinence (enuresis) is defined as the involuntary release of urine occurring two or more times per month after toilet training. Incontinence may be present during the day (daytime incontinence), at night (nighttime incontinence or nocturnal enuresis), or both (combined incontinence). The duration of the process of toilet training, or the age at which children achieve urinary continence, varies greatly. However, more than 90% of children achieve daytime urinary continence by age 5. Nighttime continence may take longer to achieve. Bed-wetting or nighttime incontinence affects about 30% of children at age 4, 10% at age 7, 3% at age 12, and 1% at age 18. About 0.5% of adults continue to have nighttime incontinence. Doctors take these time lines into account when diagnosing urinary incontinence. Because the duration of the process of toilet training varies, young children are usually not considered to have daytime incontinence if they are under age 5 or 6 or nighttime incontinence if they are under age 7.
  Daytime incontinence is more common among girls. Bed-wetting is more common among boys and among children who have a family history of nighttime incontinence. Both daytime and nighttime incontinence are symptoms—not diagnoses—and doctors look for an underlying cause.

Causes
Causes vary depending on whether incontinence occurs in the daytime or mainly at night.
  In nighttime incontinence (nocturnal enuresis), most cases do not involve a medical disorder but result from a combination of factors, including:
*Developmental delay
*Uncompleted toilet training
*A bladder that contracts before it is completely full
*Drinking too much before bedtime
*Problems waking up from sleep (for example, being a very deep sleeper)

*Family history (if one parent had nighttime incontinence, there is a 30% chance offspring will have it, increasing to 70% if both parents had it)

For daytime incontinence (diurnal enuresis), common causes include:
*A bladder that is irritated because of a urinary tract infection or because something is pressing on it (such as a full rectum caused by constipation)
*An overactive bladder
*Urethrovaginal reflux (also called vaginal voiding), which can occur in girls who urinate in an incorrect position or who have extra skin folds, and can cause urine to back up into the vagina and then leak out when they stand up
*Anatomic abnormalities (for example, a misplaced ureter in girls or a congenital urinary tract obstruction)
*Weakness of the urinary sphincter, which controls the flow of urine out of the bladder (for example, because of a spinal cord abnormality) In both types of incontinence, stress, attention-deficit/hyperactivity,
*or urinary tract infection can increase the risk of incontinence.

Medications Used in Treatment:
1. Tricylic Antidepressants: Tofranil®
2. Vasopressins: Ddvap®

Suggested Links:
*  N.H.S. Choice
* Medscape

*[Editor] Good common sense answers

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