Dr. Komarovsky on the treatment of enuresis in children

The problem of enuresis, or bedwetting, affects a lot of families, particularly those with young children. Parents and children may find it stressful, but Dr. Komarovsky provides helpful guidance that can help ease the process. The first step in solving the issue is realizing why it occurs.

Dr. Komarovsky asserts that enuresis isn’t always reason for concern. Usually, it’s a normal aspect of a child’s growth and will go away on its own with time. Nonetheless, there are methods by which parents can assist their child and hasten the process of getting over it.

This piece will examine Dr. Komarovsky’s suggestions for treating enuresis with tolerance, compassion, and a few useful techniques. Families can foster a nurturing environment that gives kids more self-assurance and comfort by heeding his advice.

About the problem

Enuresis, as it is known in medicine, is a form of recurrent urinary incontinence that primarily happens at night while a patient is sleeping.

Approximately 5% of teenagers and up to 20% of five-year-olds and fifteen percent of seven-year-olds, respectively, have been reported to wet their beds while they sleep. Boys are more likely than girls to experience incontinence during sleep; of all children affected, roughly 60% are young members of the stronger sex.

Pediatrician Evgeny Komarovsky argues that enuresis is not always a disease. It is typically a sign of immaturity of the central nervous system and specific receptors that regulate the urination process in childhood.

Disappointing statistics show that up to 30% of Russian parents chastise and punish their kids for having nocturnal enuresis episodes. And according to Komarovsky, this is far worse than enuresis itself.

Punishment or pedagogy cannot solve an issue that is unrelated to the child’s conscious actions. Since what occurs at night is uncontrollable and occurs naturally, the child is not at fault for anything. However, nocturnal enuresis cannot be ignored; parents can help their infant manage this uncomfortable condition by taking the appropriate steps.

Types

You must respond to the question of what kind of enuresis the baby has in order to comprehend the gravity of the situation.

Incontinence can be classified as primary or secondary.

• primary the problem is called if it has always occurred, almost from birth;
• secondary enuresis is a condition that occurs after some traumatic events, illness, after at least a six-month break in night "incidents".

Eight out of ten children typically have the primary form. Furthermore, enuresis can be polysymptomatic, meaning the child has frequent urges to urinate during the day, or monosymptomatic, meaning the only sign is wet sheets and pajamas in the morning. The polysymptomatic form affects approximately 15% of infants.

There are three types of enuresis: combined, daytime, and nighttime. The majority of kids (at least 85–90%) only have nighttime incontinence.

Causes

According to Dr. Komarovsky, the central nervous system’s immaturity is the primary cause of children’s nocturnal enuresis, and it is very difficult to affect this system’s maturation process. But eventually, as the nervous system develops, the issue won’t even be noticeable. In this scenario, 85% of children experience everything.

• Doctors have long noticed that children whose parents wet themselves in their sleep will also suffer from enuresis with a probability of 50 to 75%. But even if the parents have never suffered from this, even at a very tender age, the risk of developing incontinence is still 15 to 20%. Komarovsky emphasizes that this can happen to absolutely anyone.
• As an accompanying symptom, enuresis can occur with various diseases of the nervous system, with problems with hormones and the health of the urinary system, and also with some mental disorders.
• Neurotic enuresis can be a response of the nervous system to stress, psychological trauma (occurs in about 5% of cases), endocrinopathic enuresis is a consequence of hormonal imbalance, for example, it is more common in children with severe obesity, as well as with diabetes mellitus. Epileptic enuresis is one of the symptoms of epilepsy.
• Enuresis can develop after serious illnesses, after inflammatory diseases of the urinary tract (for example, after cystitis or pyelonephritis). The causes of "night troubles" can be a neurogenic bladder and some anomalies in the structure of the urinary system.

Komarovsky stresses that the frequency of manifestations is unaffected by the child’s tendency to uncover himself while sleeping or by the presence of any specific food in the diet.

According to official statistics, up to 95% of enuresis cases do not have the pathological causes we have listed. Examining the child reveals no abnormalities, supporting the theory that the age-related nervous system characteristics remain the primary cause.

Dr. Komarovsky responds that it is normal for a child to continue wetting the bed at night until they are between the ages of five and seven. By the time a child turns four, daytime enuresis usually goes away. But the standards are highly subjective.

Dr. Komarovsky highlights that children’s enuresis is frequently a normal developmental phase and not a severe medical issue. He advises concentrating on comprehending the child’s emotional condition, offering assistance, and fostering a happy atmosphere. Patience, appropriate sleep schedules, and refraining from punishing the child are all part of treatment. While medical advice may be required in certain situations, most children outgrow enuresis with time.

How it manifests?

Enuresis most commonly presents as one or more nighttime urinations. Even though a child might not wet the bed every night, dynamics—specifically, the number of dry nights a month at three, four, and beyond—seem to be significant factors, according to Komarovsky. The dynamics should typically exist and be in a positive way. Children most frequently wet the bed during the first half of the night, during the deep sleep phase. Once the bladder is empty, they remain unconscious.

When a child has complex enuresis, daytime issues are added to nighttime urination: the baby has a weak urine stream and frequently or infrequently visits the toilet to relieve himself. Children frequently exhibit elevated levels of anxiety and excitement, as well as nightmares or other sleep disorders. Stuttering, tics, and delays in speech development can be seen in a form resembling neurosis.

How to find the cause?

Parents should put aside their false shame and speak with a pediatrician about their child’s issue, suggests Evgeny Komarovsky. A pediatrician can consult with specialized doctors such as urologists, neurologists, endocrinologists, or child psychiatrists as needed.

The doctor’s ability to determine the actual cause of the child’s urination will be greatly aided by a parental diary. It is advised to store it for a few months at the very least.

You must record the number of dry and wet nights, the total number of urinations per day, and the circumstances in a special notebook. You might have gone to the circus or contracted the flu on this particular day, which exposed you to a lot of novel experiences.

Among the diagnostic instruments and techniques, a urine culture, a clinical blood test, and a general urine test will be helpful and instructive. A kidney, ureter, and bladder ultrasound is performed to rule out anatomical issues. Sphincterometry and cystometry are two more techniques that may be recommended. Urinary tract or cystoscopy, along with a bladder x-ray, may be recommended for specific indications.

Dr. Komarovsky highlights that children’s enuresis is a common problem that usually goes away with time. Parents must be understanding and patient because stress and punishment can exacerbate the situation.

He suggests concentrating on doable strategies like cutting back on liquids before bed, creating a consistent sleep schedule, and taking care of any underlying emotional issues. A medical examination can rule out underlying medical conditions if necessary.

Above all, it’s critical to provide your child with support and assurance, emphasizing that many kids go through similar phases before eventually overcoming them.

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