Nocturnal urinary incontinence in women, men and children

Various urination disorders are quite common, characteristic of both childhood and adulthood. Nocturnal enuresis is especially common: we are talking about a complex problem that affects, among other things, a person’s psychological state.

In medical circles, nocturnal urinary incontinence is called enuresis. A patient who suffers from this disorder does not feel the urge to urinate during sleep at night. Until the age of three, such a lack of control over the urinary process can be considered normal: a child under 3 years of age cannot yet respond correctly and promptly to the urge, since his nervous system is still in the developmental stage. However, the signs of nocturnal urinary incontinence in a child after 4-5 years, or even in adults, cannot be physiological and indicate the presence of pathology. [ 1 ]

Epidemiology

According to statistics, adults rarely suffer from nocturnal enuresis. It is more often diagnosed in childhood:

• in six-year-old children – in 15% of cases;
• in eight-year-old children – in 12% of cases;
• in ten-year-old children - in 7% of cases;
• in twelve-year-old children - in 3% of cases.

About 16% of children recover by adolescence. The rate of spontaneous relapses in many patients remains quite high. [ 2 ]

Boys suffer from bedwetting approximately 1.8 times more often than girls.[ 3 ]

Causes nocturnal urinary incontinence

The occurrence of nocturnal enuresis in adults and children is often associated with the following reasons:

• age-related unpreparedness of the central nervous system and urinary system (usually everything returns to normal by about 5 years of age);
• delayed maturation of the nervous system (sometimes the delaying factors are psychoneurological disorders, behavioral disorders, etc.);
• psychological, stress factors (change of residence, loss of loved ones, family troubles);
• unfavorable heredity;
• impaired production of antidiuretic hormone;
• pathologies and infections of the genitourinary tract (cystitis, prostatitis, etc.).

Less common causes are:

• epileptic seizures at night;
• sleep apnea, incomplete upper respiratory tract obstruction;
• endocrine pathologies (insufficient or excessive thyroid function, diabetes);
• taking certain medications.

Bedwetting and Alcohol

Large amounts of ethyl alcohol are an unbearable burden for the body. Severe intoxication can cause uncontrolled emptying of the urinary organ: this most often happens in patients suffering from chronic alcoholism.

Ethanol has the ability to quickly enter the bloodstream, absorbed in the digestive tract. Alcohol lingers in the tissues for a long time, breaking down into acetaldehyde and acetic acid. The first component of decay is a very strong toxic substance that leads to the death of nerve cells in the brain. As a result, the function of the nervous system is completely disrupted, the transmission of signals responsible for many vital functions is blocked.

Nighttime urinary incontinence after drinking alcohol can also be explained by the fact that ethanol has diuretic properties. In addition, the body's natural response to the ingestion of toxic substances is the need to quickly get rid of them. The work of the renal mechanism accelerates, and urine begins to be produced in greater volumes.

With prolonged use of alcoholic beverages, the tone of the muscles responsible for retaining fluid in the bladder decreases. Over time, atrophic processes develop, leading to chronic incontinence even after stopping drinking alcohol.

Nocturnal enuresis after drinking alcohol usually occurs after falling asleep, against the background of complete loss of consciousness, relaxation of muscles. At the initial stage, the problem may be episodic, but subsequently incontinence is observed more and more often, including during the day. [ 4 ]

Nocturnal urinary incontinence in adenoids

Quite often (especially in childhood) nocturnal enuresis is combined with other diseases or conditions - for example, with allergic processes, hyperactivity syndrome, adenoiditis. It would seem that what could connect childhood enuresis and adenoids? However, an indirect connection exists.

Pronounced adenoid growths interfere with the normal breathing process, especially at night. It is difficult for the child to breathe freely, he snores and sleeps restlessly. Such disorders in some children provoke an increase in pressure. In response, the body's protective reaction is triggered, which stimulates the production of hormones aimed at stabilizing this pressure. At the same time, there is an active removal of excess fluid from the tissues, and the bladder fills faster than usual.

This problem needs to be solved: first of all, measures need to be taken to facilitate nasal breathing in the child. Treatment is prescribed by a pediatrician after consultation with a pediatric ENT specialist and allergist.

Risk factors

Indirect causes and predisposing factors for the development of nocturnal urinary incontinence are as follows:

• digestive disorders, frequent and prolonged constipation;
• helminthic infestations;
• excess weight;
• hereditary predisposition (the presence of a similar problem in one of the parents);
• complicated childbirth, which could cause the development of neurological problems in the baby;
• difficult psychological and emotional family situation;
• living in unsatisfactory sanitary and hygienic conditions;
• alcohol abuse.

Pathogenesis

A newborn baby cannot control some processes, such as defecation and urination. As the baby grows, the mechanism of voluntary urination improves, and the child begins to visit the toilet independently, including at night: this usually happens around 4 years old, sometimes by 5. If nocturnal enuresis continues in an older child, then it is called pathology.

Bedwetting is a serious problem for both children and adults. It is important to understand that this is a disease, and not a lack of upbringing, stubbornness or a character trait. Incontinence must be treated: specialists such as urologists, neurologists, psychotherapists, therapists and pediatricians can help with this. [ 5 ]

There may be many reasons for the problem. In childhood, primary incontinence is more common - this is a pathology associated with the imperfection of the nervous system. In such a situation, the baby does not feel the fullness of the bladder and the urge to urinate, which ultimately leads to an "accident" during a night's rest.

Secondary incontinence is more often diagnosed in adolescents and adult patients. It develops against the background of other congenital or acquired pathologies and often manifests itself not only at night, but also during the day. [ 6 ]

A great deal of importance in pathogenesis is given to the delay in the maturation of the nervous system and the late development of urinary regulation skills. According to experts, the imperfection of the central nervous system provokes a disorder of the regulatory functions of many systems in the body. In particular, bladder contractions may not be controlled during sleep. Since nocturnal incontinence is a multifactorial pathology, organic and psychogenic disorders, which are often combined, play a significant role in its development.

The problem is also often associated with a number of other medical conditions, such as diabetes, nonoliguric renal failure, genitourinary infections, constipation, neurogenic bladder, urinary tract malformations, sleep apnea, or snoring. [ 7 ]

Independent studies have shown that decreased urine output during nighttime rest is due to increased production of vasopressin. Therefore, some patients with nocturnal incontinence are successfully treated with Desmopressin. However, there are data on cases of impaired renal sensitivity to these hormones, which requires a completely different therapeutic approach. [ 8 ]

Symptoms nocturnal urinary incontinence

The main symptom of nocturnal enuresis is obvious – it is the involuntary emptying of the bladder during the night's rest.

If the problem occurs against the background of other pathologies, then other early signs may also be detected:

• neurological disorders may include hyperactivity, neuroses, tics, depression, and stuttering;
• In infectious and inflammatory lesions of the genitourinary tract, there is an increase in frequency or other changes in diuresis, pain when urinating, abdominal pain, and high body temperature.

Incontinence of urine during sleep with normal daytime urination is called monosympathetic enuresis. Polysympathetic pathology is said to occur if the patient has nocturnal incontinence combined with other urination disorders – this may be urgency, pollakiuria, daytime enuresis, etc. All of the listed symptoms indicate the presence of overactive bladder syndrome.

If the patient experiences incontinence episodes less than three times a week, then they speak of periodic pathology. If "wet" nights occur more often than this indicator, then doctors diagnose stable nocturnal urinary incontinence.

Bedwetting in Children

One of the factors for the occurrence of nocturnal enuresis in children is heredity, another is the instability of the psychological state. Sudden incontinence can appear after a strong fright, a stressful situation, etc. Usually the problem occurs in the deep sleep phase, with sleepwalking or in the presence of night phobias.

The atmosphere within the family – regular scandals, misunderstandings between parents, divorce, the birth of a second child, a change of residence – often influences the development of nocturnal enuresis.

Another common factor is urological problems. Characteristic symptoms include frequent urination, urinary disorders, etc. The source of the problem should be sought in the condition of the genitourinary organs.

If fetal hypoxia was recorded during pregnancy, or there was a birth injury, then this may subsequently affect the health of the child's brain. Neurological pathologies often manifest as nocturnal enuresis.

It turns out that there are quite a few reasons for the appearance of such a problem in children. Therefore, each child must be carefully examined, excluding not only urological, but also neurological and somatic factors. [ 9 ]

Bedwetting in adolescents

When talking about bedwetting, most often we mean small children. However, this problem can also manifest itself in adolescence. Here is a list of the main causes of the problem:

• overactive bladder syndrome;
• inflammatory processes in the genitourinary system;
• hereditary predisposition;
• features of nervous regulation, etc.

Psychological factors have an indirect influence on the development of nocturnal enuresis:

• overprotection (an overprotected teenager continues to feel like a baby, and therefore behaves accordingly);
• lack of attention (the teenager unconsciously performs actions that allow him to, in one way or another, attract attention);
• stress, psychotraumatic situations (urinary incontinence can be a specific reaction to parental quarrels, loss of loved ones, etc.).

Often, nocturnal enuresis is combined with daytime enuresis. Such a complex problem requires a special approach to treatment, with a mandatory visit to a psychologist.

Bedwetting in adults

The causes of nocturnal enuresis in adults are completely different from those in children. The disorder may indicate a change in hormonal function, kidney problems, diseases of internal organs, the nervous system, or be the result of taking certain medications. In general, the causes of the problem in adults are divided into the following categories:

• neurological (caused by previous injuries, strokes, etc.);
• genitourinary (overactive bladder, urge or stress incontinence).

Nocturnal urinary incontinence in women is especially common during hormonal changes, particularly during menopause. It is also noted that female incontinence occurs more often than male incontinence. Other factors that can cause this problem in women include difficult childbirth, abortions, and neurological disorders.

But nocturnal urinary incontinence in men is more often of the urgent type - that is, it is associated with urinary neurogenicity. There are several reasons for this problem:

• traumatic spinal injury;
• head injuries (TBI);
• suffered a stroke.

In most cases, urge incontinence affects older men, who experience the following additional painful symptoms:

• frequent uncontrollable urge to urinate;
• leakage of urine (incontinence).

Nocturnal urinary incontinence in the elderly is not always related to neurogenic bladder. The problem can be caused by infectious lesions of the urinary system (inflammation of the prostate, cystitis, etc.), tumor processes of various origins (including adenoma or cancer of the prostate gland).

Stress enuresis is often caused by urethral or bladder insufficiency causing increased mobility of the urethra or sphincter insufficiency.

If the problem is related to overfilling of the bladder, then incontinence is more often caused by obstruction of the urethral canal or improper contraction of the bladder. There are also less common causes:

• urethral stricture;
• taking antiallergic and diuretic medications;
• diabetes mellitus;
• multiple sclerosis.

In some cases, doctors diagnose idiopathic nocturnal incontinence, a term that means the underlying cause of the disorder cannot be determined.

Forms

What types of bedwetting do experts usually talk about?

• Imperative (aka urgent, imperative) incontinence is manifested by the inability to hold urine at the peak point of the urge to urinate. Such a malfunction is usually caused by increased activity of the bladder wall muscles due to pathologies of the brain or spinal cord, hormonal disorders, inflammatory or other damaging processes in the bladder.
• Stress incontinence at night can manifest itself at the moment of coughing, sneezing - that is, with a sudden increase in pressure in the abdominal cavity. The problem is explained by a sphincter disorder due to hormonal, anatomical or nervous disorders.
• Unconscious (aka reflex) incontinence is explained by incorrect conduction of the nerve signal to the bladder: a person does not feel the desire to go to the toilet even with a full bladder. As a result, this leads to a reflex emptying of the organ.
• Continuous leakage of urine in the form of leaks is explained by a disorder of nerve conduction or incomplete closure of the sphincters. Sometimes the muscles of the bladder lose the ability to contract adequately: as a result, too much fluid accumulates in the organ, which begins to leak.
• Nocturnal urinary incontinence is any type of involuntary urination that occurs during nighttime sleep in adult patients or in children over 5 years of age. This pathology can be primary (occur from birth) or secondary (appear against the background of a correctly formed urinary reflex).

Complications and consequences

Experts say there is a certain connection between nocturnal enuresis in boys and subsequent problems with potency in adult men. For girls, urinary incontinence in childhood can eventually result in frequent infections of the genitourinary system, in particular cystitis.

Many children suffering from enuresis experience a significant deterioration in their quality of life: their personal development is disrupted, and severe neuroses develop. Lack of self-confidence and low self-esteem can transform into a disorder and cause social disorientation. According to questionnaire data from patients who have had to deal with nocturnal enuresis, the disorder has had an extremely negative impact on their lives.

Urinary incontinence is a psychological stress for both the patients themselves and their environment. It becomes difficult for a person to communicate with friends and colleagues, it is difficult to go on a trip or even visit. For a child suffering from enuresis, a trip to a children's camp or an excursion becomes a problem. Strangers, and sometimes even close people, are often very cruel to patients, resorting not only to ridicule, but also to punishment. Patients (especially children) are under an oppressive feeling of shame, fear, which over time develops into an inferiority complex, depressive states develop.

Diagnostics nocturnal urinary incontinence

Any diagnostic measures begin with collecting the patient's complaints. The doctor specifies the possible causes of the disorder, the degree and frequency of nocturnal enuresis, listens to the accompanying complaints. In addition, it is advisable to ask the patient's relatives about similar painful symptoms in order to exclude the hereditary origin of the disease.

Some specialists offer patients to fill out a so-called "questionnaire" - a list of questions related to the problem of urinary incontinence. A standard "questionnaire" includes the following items:

• For what period of time has the patient been experiencing signs of incontinence?
• Are there any changes in the amount of urine excreted?
• Are cases of bedwetting becoming more frequent?
• What does the patient himself associate with the occurrence of episodes of enuresis (physical activity, coughing, running, laughing or sneezing, carrying heavy objects, changing the position of the body, the sound of splashing water, stress, hypothermia, etc.)?
• Are there any other urinary problems?
• Do you often have to hold back the urge to urinate?
• Do you experience urinary leakage (with or without urge)?
• Does the patient wake up to go to the toilet at night?
• Does bedwetting affect the quality of your daily life?

In addition, the doctor often initiates the patient to keep a special diary. In it, the patient must make daily notes on the amount of liquid drunk, the frequency and volume of urination, the quality of the urge, and episodes of urinary incontinence (night and day). [ 10 ]

Women suffering from nocturnal urinary incontinence additionally undergo a vaginal examination – first of all, to exclude background diseases. Such pathologies as atrophy of the vaginal mucosa, prolapse of the pelvic organs, etc. can directly influence the appearance of the problem.

Also during the examination, a cough test is performed (when coughing, the release of urine from the urethra is noted).

Urine tests are always prescribed for any diseases related to the urinary system. To collect a general analysis, you need:

• Before collecting biomaterial, thoroughly wash (cleanse) the external genitalia;
• Collect urine during the first morning visit to the toilet (collect from the middle portion of the stream).

Instrumental diagnostics usually include MRI and ultrasound of the pelvic organs. Additionally, urodynamic diagnostics is prescribed to help determine the type of incontinence. [ 11 ]

Differential diagnosis

Differential diagnostics is primarily carried out with nocturnal epileptic seizures. In addition, nocturnal incontinence is often a sign of sleep apnea syndrome with incomplete obstruction of the upper respiratory tract. Some endocrine diseases (diabetes, hypothyroidism, endemic goiter) are often combined with genitourinary disorders. Presumably, nocturnal incontinence against the background of endocrine problems occurs as a result of impaired bladder autonomic innervation. Increased excitability of the urinary organ is observed in allergic processes. Food allergies are an exception.

Nocturnal urinary incontinence is detected after hypothermia, as well as with cold allergy, cryotrauma. To exclude certain diseases and conditions, a thorough examination of the entire body is carried out, in particular the pelvic area. [ 12 ]

Treatment nocturnal urinary incontinence

Although some patients (especially children) experience bedwetting that resolves over time even without any treatment, there are no clear guarantees about this. That is why treatment is prescribed in any case if there is episodic but persistent incontinence.

The treatment regimen is determined depending on the etiological factor of a specific case of the disease. In general, therapeutic methods can be as follows:

• medicinal (using medications);
• non-drug (psychotherapeutic, physiotherapeutic, etc.);
• regime, etc.

Many people practice the method of night "wake-ups". This method consists of waking up a patient with nocturnal urinary incontinence every hour after midnight. After about a week, the frequency of "wakes" is reduced, choosing the most optimal regime. If episodes recur, the cycle is repeated.

Diet therapy also plays a significant role in the treatment. The diet is changed, starting with limiting liquids (drinks and liquid dishes). There is also a specific Krasnogorsky diet, which helps to increase the osmotic pressure of the blood and retain moisture in the tissues, which generally causes a decrease in the volume of urine. [ 13 ]

All regime activities consist of the following:

• Liquid consumption is extremely limited in the second half of the day. After dinner, drinking is completely prohibited.
• The bed for night sleep should not be too soft.
• If the patient sleeps too deeply, it is advisable to turn him over several times during his sleep.
• The patient should be protected from stress, psycho-emotional overstrain, fatigue, and hypothermia.
• During the day, you should avoid foods and dishes with caffeine, carbonated drinks, juicy fruits and berries.

Medicines that a doctor may prescribe

If nocturnal urinary incontinence is associated with infectious processes in the urinary tract, the patient is prescribed a full course of antibiotic therapy under the control of urine parameters (the sensitivity of microflora to antibacterial and uroseptic drugs is also taken into account).

If necessary, tranquilizers with a hypnotic effect are prescribed to stabilize the depth of sleep (Eunoktin, Radedorm). If resistance to these drugs develops against the background of a neurosis-like form of the disease, then stimulants (Sidnocarb) or thymoleptics (Milepramine, Amitriptyline) are used shortly before sleep.

Amitriptyline is usually taken in a dosage of 12.5 to 25 mg up to three times a day (tablet form of release of 10, 25 or 50 mg). During the use of the drug, side effects such as increased intraocular pressure, increased heart rate, mydriasis, constipation may occur.

If incontinence is not associated with inflammatory processes, then it is optimal to prescribe Imipramine. It is used to treat adults and children over six years of age (dosage from 0.01 to 0.05 g per day). Some specialists practice the following therapeutic regimen: an hour before bedtime, the patient is given 25 mg of the drug, but if the desired effect is not achieved, then after 4 weeks the dosage is doubled. Then the amount of the drug is gradually reduced and discontinued. Possible side effects during treatment: dizziness, increased sweating, dry mouth, accommodation disorder. [ 14 ]

If we are talking about neurotic enuresis, then the patient is prescribed tranquilizers:

• Hydroxyzine in tablets of 0.01-0.025 g, or in syrup (5 ml corresponds to 0.01 g);
• Medazepam in tablets of 0.01 g or in capsules of 0.005 or 0.001 g;
• Trimetosin in tablets of 0.3 g;
• Meprobamate in tablets of 0.2 g, in a course lasting 1 month. [ 15 ]

Considering that the occurrence of the problem in children in many cases is associated with the imperfection of the child's nervous system, nootropic drugs such as Glycesed, Nootropil, Phenibut, Instenon, etc. are used for treatment. Such drugs are prescribed for long-term use - for 1-2 months, in combination with other types of therapy.

If nocturnal urinary incontinence is caused by unstable bladder function, neurogenic disorders, or idiopathic detrusor disorders, the patient may be prescribed Oxybutynin hydrochloride in the form of 0.005 g tablets (can be used in children over five years of age).

The most successfully used is Desmopressin, an artificial analogue of the hormone Vasopressin, a regulator of the excretion and absorption of free fluid in the body. The most common such drug is called Adiuretin SD, which is available in drops. The drug is dripped into the nose (in the area of the nasal septum) 2-3 drops per day for a week. After achieving nights without "accidents", the treatment is continued for another 3 months, after which the drops are discontinued. If a positive effect is not observed, the dosage is increased by one drop per week until the result is achieved. Children over eight years old are dripped up to 12 drops per day. [ 16 ]

Vitamins

Despite the fact that vitamin deficiency in the body does not directly affect the occurrence of nocturnal enuresis, the introduction of vitamin preparations into the body often helps to cope with this disorder. Thus, in 2018, scientists conducted a study in which they offered children suffering from enuresis certain doses of vitamins. After a thorough analysis of the results, the following conclusions were made:

• Supplements containing vitamin D and fish oil help prevent bedwetting in children (ages 7 to 15);
• The optimal dosage for children is 1000 IU/day of vitamin D and 1000 mg/day of fish oil.

In some cases, the dosage may be increased, which should be controlled by the attending pediatrician. Fish oil is allowed to be taken both in pure form and in capsules or chewable lozenges, which is not of fundamental importance.

Physiotherapy treatment

Among additional treatment methods, physiotherapy is quite common, represented by the following procedures:

• acupuncture (reflexotherapy, which provokes the appearance of bioelectric currents in the body, which have a positive effect on the functioning of the bladder);
• magnetic therapy (a method based on the influence of low-frequency magnetic fields with variable or constant impact on the painful area of the body);
• laser treatment (involves exposing the body to a concentrated beam of light);
• music therapy (a specific music psychotherapeutic method), etc.

The effectiveness of such methods depends on the characteristics of the body, the causes of nocturnal enuresis, as well as the age and presence of other diseases in the patient. Physiotherapy is always prescribed in combination with medication and other types of treatment.

Folk remedies

Traditional healers offer their own, sometimes unconventional, methods of correcting urinary function. For example, in case of nocturnal enuresis, the following procedure is recommended: immerse the patient's feet in very cold (literally ice-cold) water for a short period of time, then dry them thoroughly with a soft towel and quickly warm them up.

In addition, other methods of retaining fluid in the body are recommended for patients with enuresis to prevent its elimination. For example, before going to bed, the patient is given a piece of salted herring or black bread with salt. The most important condition is that such a "dinner" cannot be washed down with any liquid.

Some experts recommend using honey instead of salt – about 1 teaspoon daily before going to bed, for a long time. How exactly honey works in this case is unknown. However, many patients note a significant improvement in their well-being and relief of painful symptoms associated with nocturnal enuresis.

Herbal treatment

To eliminate nocturnal enuresis, infusions and decoctions based on St. John's wort and dill are successfully used.

• 1 tbsp. of dill seed is brewed in 200 ml of boiling water, infused under a lid for 2.5 hours. Taken internally a little at a time, so that the entire volume is drunk during the day. The treatment continues daily for 7-10 days.
• 40 g of dry St. John's wort raw material is poured into a thermos and 1 liter of boiling water is added. Infuse for 2.5 hours. Drink throughout the day instead of tea.

The dominant volume of any liquid, including various infusions, should be drunk in the first half of the day. A few hours before going to bed, liquid intake should be stopped.

Many recipes for bedwetting include plantain, or more precisely, the plant's seeds. It turns out that they don't need to be prepared in advance. It's enough to simply take ½ g of seeds three times a day with water. The duration of such treatment is one month. If there are no seeds, it is permissible to use an infusion of the plant's leaves: drink 1 tbsp. four times a day.

Homeopathy

Among the various methods of alternative treatment of nocturnal enuresis, specialists most of all recommend homeopathy. This type of therapy is actively used in both pediatric and adult practice. However, independent selection of drugs is not welcomed: they are selected by a specialist, taking into account not only the symptoms, but also the individual characteristics of the body. For example, for stress incontinence, many patients are recommended the drug Gelsemium, but the doctor prescribes the dosage individually.

For whiny, capricious natures who require increased attention, the remedy Pulsatilla is suitable. If nighttime incontinence is associated with any phobias, Argentum nitricum is prescribed.

Incontinence due to family troubles requires the prescription of Natrium muriaticum or Causticum.

It is important to remember that nocturnal enuresis can be of both functional and organic origin. Only a specialist can understand the causes. Therefore, you should not self-medicate. It is better to immediately, without wasting time, contact a doctor who will select the most optimal treatment regimen, having previously determined the origin of the problem.

Surgical treatment

Surgery for nocturnal enuresis is a serious procedure with possible complications. The effectiveness of such operations is estimated at approximately 80%.

Most often, surgeons offer the following interventions:

• suspension (sling) operation;
• vaginal plastic surgery;
• placement of a sphincter implant;
• injection of volume-forming drugs into the periurethral area.

Indications for surgical intervention are:

• acquired stress enuresis;
• combined urinary leakage with a dominant stress component;
• rapid progression of the disorder;
• lack of effectiveness of drug treatment.

Each of the operations has its own additional indications and contraindications. Before deciding on such a radical step, it is necessary to carefully weigh all possible risks, conduct a full diagnostic examination, and consult with a number of medical specialists.

Prevention

Preventive measures to prevent the occurrence of nocturnal enuresis are based on the following actions:

• maintaining personal hygiene, learning basic neatness skills;
• control of the volume of liquid drunk according to the average consumption rate;
• timely treatment of infectious urological and other diseases;
• preventing moral pressure on a person, eliminating stress, fighting phobias.

If the patient has already had cases of nocturnal enuresis, then it is necessary to take measures to prevent recurrence of this problem:

• establish a drinking regimen, limiting the consumption of any drinks in the afternoon and especially in the evening;
• be patient with the patient, avoid ridicule, rudeness, never punish or focus on the problem;
• limit not only drinking liquids, but also eating liquid foods (soups, smoothies, juicy vegetables and fruits);
• provide access to fresh air in the sleeping room;
• avoid stress, psycho-emotional tense situations, excessive fatigue;
• avoid hypothermia;
• Do not consume foods and dishes that have diuretic properties (coffee, cocoa, chocolate, watermelon, etc.).

Children suffering from bedwetting are recommended to be awakened approximately 3 hours after going to bed to go to the toilet and empty the bladder. [ 17 ]

Forecast

Nocturnal enuresis may disappear on its own, but this scenario is typical only for mild, non-gross pathologies of the nervous system and spinal cord. Such childhood problems often go away by the age of 12-14. If you start treatment in a timely manner, recovery will come much earlier.

With timely and competent medical care, the prognosis for the disease is quite good: after just a couple of therapeutic courses, the child is completely cured. [ 18 ]

Another issue is that if there is a person in the family suffering from nocturnal enuresis, this problem affects all its members. Almost all patients, especially children, begin to face considerable psychological problems. We are talking about a constant feeling of guilt, shame, fear of night sleep. Sleep becomes restless, superficial, and the patient himself becomes quick-tempered, irritable, capricious, and insecure. Often, patients withdraw into themselves, fall into depression, which further aggravates the situation. If a person does not receive the necessary medical care for a long time, then nocturnal enuresis can become a problem for life. Therefore, it is very important to visit a doctor at the first unpleasant "alarm bells" and treat the problem.