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Nocturnal enuresis is more
common in males than in females (almost 2:1). This male preponderance is particularly true in younger
age groups, cases with milder
severity, and cases involving enuresis occurring only at
night. (9)
Life stressors have, in some
studies, been linked
to bedwetting; however,
for most children with bedwetting, there have not been any major life events. It is reasonable to ask about
any stressors (e.g., new baby in the home,
recent move, loss of a loved one), particularly in children with secondary enuresis (i.e., who were
previously continent at night). More importantly,
physicians should ask about the impact of bedwetting on the child’s quality of life. (10)
SYMPTOMS OF NOCTURNAL ENURESIS:
The main
symptoms of enuresis include repeated bed-wetting, Wetting in the clothes,
Wetting at least twice a week for approximately three months.
Many children
with enuresis sleepwalk or talk in their sleep. A complete physical
examination should include palpation of the abdomen and possibly a rectal
examination after voiding to assess the possibility of a chronically
distended bladder and constipation. (1)
The child with
nocturnal enuresis should be examined carefully for neurologic and spinal
abnormalities. There is an increased incidence of bacteriuria in enuretic
females, and, if found, it should be investigated and treated , although this
does not always lead to resolution of bedwetting. (1)
Other features
of Nocturnal Enuresis can also be : Enuresis can occur during any stage of
sleep, although it most commonly happens during non-rapid eye movement (NREM)
sleep. Children, in general, are most difficult to arouse in the first third
of the night and easiest to wake in the last third. However, enuretic
children are typically more difficult to awaken than those with normal
bladder control. These children are often described as "soaking the
bed." A family history of enuresis is frequently found in enuretic
children, suggesting a genetic predisposition. Additionally, the risk of
enuresis is higher in children with developmental delays,
attention-deficit/hyperactivity disorder (ADHD), or autism spectrum
disorders. (1)
Major two types:
Primary
Nocturnal Enuresis : Enuresis may be primary (estimated 75–90 percentage of
children with enuresis; nocturnal urinary control never achieved).
Secondary
Nocturnal Enuresis : Enuresis in which 10–25 percentage; the child was dry at
night for at least a few months and then enuresis developed. (1)
Diagnostic Criteria’s
The essential feature of
enuresis is repeated voiding of urine during the day or at night into bed or
clothes (Criterion A). Most often the voiding is involuntary, but
occasionally it may be intentional.
To qualify for
a diagnosis of enuresis, the voiding of urine must occur at least twice a
week for at least 3 consecutive months or must cause clinically significant
distress or impairment in social, academic (occupational), or other important
areas of functioning (Criterion B).
The individual must have
reached an age at which continence is
expected (i.e., a
chronological age of at least 5 years or, for children
with developmental delays,
a mental age of at least 5 years).
The urinary incontinence
is not attributable to the physiological effects of
a substance (e.g., a diuretic, an
antipsychotic medication) or another
medical condition (e.g., diabetes, spina bifida, ectopic ureter in a
female,
posterior urethral valves in a male, tethered cord, a seizure
disorder). (9)
HOMOEOPATHY & MENTAL STATES: ADRESSING NOCTURNAL ENURESIS:
A person’s evolution reveals many distinct and vital aspects about
him. Children are impacted by both ‘nature’ that is inherited biological
features and ‘nurture’ that is environmental factors. (11)
Developmental
psychology studies the physical, behavioral, cognitive, and personality
changes that occur from conception to childhood and beyond. A child’s initial
emotional expressions are typically related to physical or biological
demands, such as protection or survival. As children get older, they may
display more complex emotions such as grief, rage, and fear. (11)
These feelings are frequently fleeting, but if they intensify or
endure long enough, they have the potential to develop into emotional
"states" and "moods." At that point, these
"states" may begin to affect how kids view and engage with the
outside world. When these feelings start to dominate the child’s personality,
they serve to be one of the indications for homoeopathic similimum. (11)
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