One another issue often frequented during the childhood and usually underestimated problem is urination disorders. it may occur in very often various shapes urine incontinence during the day time and at night, difficult and painful urination, holding the urine for long time, going to the urinate very often require very detailed and careful urological examination. It can generally be cured as a result of the examination for the reason however one of the cases can be difficult and can last long time

If the urination disorders are under estimated and neglected, they may cause come dangerous results such as serious kidney infections, organ losses even sometimes kidney failures. Urinating at night in bed is medically called as Enuresis Nocturne and it is treatable. It is seen often at the children. We can mention about the presence of this disease at the children who urinates in bed more than one or two times in a month after 5 years old age. It is commonly believed that the diseases are related to the deepness of the sleep and bladder capacity. Also psychological factors also have role in the apparition of the disease. It is seen more often at boys than the girls

It is not difficult to understand the difficulty of a child who sees his bed wet every morning. As this case is not accepted as a disease by the parents, the child is continuously seen guilty and even sometimes he is punished. However it is the child himself who is the most affected side of this story and he wants to get rid of this. Especially when he needs to spend the night at a stranger place or when he stays away from home for camping or for holiday, he feels an intense shame. There is a wrong belief in our society which is that urinate in bed is a temporary condition. It is even believed that it will end when circumcised, in the puberty or when he joins the arms. Actually for some cases with the age it is treated on its own. However it is wrong to let the child wait the end of something without knowing the final point of a condition as it will affect his mental condition

If the child urinates in bed at night is older than 5 years old the parents should look for treatment. There are quite positive solutions in the treatment of this disease. Some gradual programs are used and drugs are also used for treatment. In the society it is believed that some drugs causes infertility which is wrong. The drugs used for the children who has enuresis nocturne do not cause infertility. This wrong and scientifically irrelevant information is just not anything

TREATMENT AND MOTIVATION TECHNIQUES

Recording and Awarding

For the treatment of Enuresis, keep record and awarding have important motivating factors and also responsibility giving factors. The child marks the wet and dry nights on a calendar. Illiterate ones can mark with sun and rain signs the ones knowing writing can use writing. This calendar must be filled by the child and if the dry days are more than the wet ones, he must be awarded.

Liquid Restriction, Urinating Before Sleeping and Waking Up At Night
Getting liquid (including tea, fruit) after the dinner must be restricted and responsibility should be given to the child fort his subject. The child must definitely go to urinate before sleeping he should be woken up 1-1.5 hours after sleeping. Instead of waking him up as half sleeping, he should be completely waken up for urinating.

BLADDER EXERCISES

Bladder training exercises

Urinating frequency and discharged urine amount must be observed for a few days and if the urination frequency is more than 7 per day and if the urine volume is less than 30 cc for each age, it must be considered that the bladder capacity is low and every day at a specific time two glasses of water must be drunk and this must be done with a little of waiting. This method is quite successful with the children with smaller bladder.

Sphincter training exercises

While urinating the children are asked to stop and redo the urination. So that sphincter muscles are aimed to be reinforced

Conditioning (alarm device)

When the child starts to urinate, the alarm starts ringing. The child wakes up and closes the alarm and gets up to empty his bladder. There are researches proving the efficacy of the alarm method than the other methods. At least 2 months are required to complete the treatment. But the noise of the alarm may cause some parasomnia such as night fear or it may increase the current ones.

Drug treatment

Drug treatment s generally started with the children who did not responds the behavioral treatments. Basic aims are two:
1. Decrease the deepness of the sleep of the child
2. Decrease the urine production at night
Drugs are recommended to be used maximum for 6 months. After stopping the drugs, enuresis may repeat. Tricyclic, antidepressants, İbuprofen, diclofenac, anticholinergic, antidiuretic hormones may be used for the drug treatment.