| Bed Wetting -------------------------------------------------------------------------------- Definition Bed wetting or enuresis is defined as frequent wetting the bed in children greater than 5 years of life. Bed wetting or enuresis is a very common problem that can on occasion actually persist into adult life. During infancy the bladder is automatic so as the bladder fills up the muscle in the bladder wall stretches, the pressure then builds up until the bladder wall muscle can automatically contract emptying the bladder. Around 2 years of age the infants are potty trained during the day and some children are dry both day and night by the age of 3 years. However we do not actually know how infants learn to control their bladder or to wake up during the night when the bladder fills up, so equally we do not know why some children do not learn to control their bladders at night (primary enuresis), or have learnt and then become wet again (secondary enuresis). As we do not know the underlying cause the treatment is aimed at trying to control the problem rather than alter the root cause. Incidence Although bed-wetting is defined as wetting persistently after 5 years of age around 1 in 10 still wet the bed at this age. This reduces to about 1 in 20 at age 10 but even by 15 years of age it is thought that around 1 in 100 may still wet the bed. -------------------------------------------------------------------------------- Cause The cause of bed wetting is unknown but it can recur after a �life event� such as moving school, moving house or a death of sometimes a pet or even a family member. Often it has no cause. Treatment The treatment of bed-wetting can be undertaken by a GP, a hospital doctor or a specialist enuresis clinic that is usually run by specialist nurses and held in local health centres. Under the age of 5 years, although it may be difficult for the family, treatment is not usually offered as bed wetting is considered normal. Between 5 and 7 years the initial treatment is with encouragement, for example with star charts when a child colours in a star each morning after a dry night. This gives a visual record of improvement. If this does not work a buzzer device may be used which alarms when the bedclothes become damp. This is meant to wake the child up along with sensation of a full bladder. The child then gets up and wees in the loo. Eventually the idea is that the sensation of a full bladder will wake the child up rather than the alarm. Many children respond well to this initially but a few relapse when the buzzer is taken away. Finally drugs may be used. The usual one is called desmopressin, which is a natural hormone that reduces the volume of urine produced at night. This is frequently very successful when used but some children may relapse when the drug treatment is stopped. By the time the spots have stopped forming and are dried over and the temperature has fallen back to normal, the child is no longer infectious. Usually this takes about a week, until then they should remain off playgroup or school. Chickenpox does not usually make children very ill, and for most the main problem is the itchiness. Your doctor will not normally need to see the child, but you should let him know that the child has had it. Occasionally more serious complications can occur, and if a child does not appear to be following the above course it is worth speaking to your doctor. Once you have had chickenpox you are immune, and cannot catch it again. The virus particles remain dormant in your nervous system, however, and can, at a later stage, cause shingles. As a result of the large numbers of people who catch chickenpox as children, 90% of adults are immune. -------------------------------------------------------------------------------- Treatment Many people find that calamine lotion helps to soothe the itch, and paracetamol liquid helps to ease any aches and pains and also keep down the temperature. -------------------------------------------------------------------------------- Prevention People with chickenpox or shingles should stay away from others who have not had chickenpox until their rashes have dried up. This especially applies to staying away from people who have depleted immune systems (eg people on: steroids; cancer drugs; on immunosuppressant drugs for transplants; with AIDS; etc.). These people are said to be "immunocompromised" and cannot fight off an infection as well as the rest of us. Another group who are at higher risk is pregnant women, and newborn babies. There is now a chickenpox (varicella) vaccine. This is not used in all countries. It can be given as a protective measure to immunocompromised people, especially children with leukaemia or organ transplants. If people at high risk are exposed For people who are not immune and who are exposed to the virus, there is a way of using the antibodies that someone else has made against an infection. This is called passive immunisation. An injection is made up from the protein in people's blood which fight off infections (immunoglobulin). In the case of chickenpox, it is made from pooled serum from blood donors who have recently had chickenpox or shingles. In the UK it is standard practice for all blood donors to be tested for, and be clear of HIV, Hepatitis B, and Hepatitis C. This product is known as Human Varicella-Zoster Immunoglobulin (VZIG). Its supplies are limited, as a result of the small number of suitable donors, and thus it can only be given to those at greatest risk, and in whom it has been shown that it is likely to be effective. VZIG is recommended for use in people who fit into all three of the following groups: A clinical condition that increases the risks of developing a severe response to the varicella virus. eg Immunocompromised Newborn babies Pregnant women No antibodies to varicella-zoster virus. Significant exposure to chickenpox or shingles. If any of these people develop chickenpox, it is likely that the doctor will arrange hospital admission, or at least, ask a specialist to see them. In such infections, anti-viral drugs may be used. Measles Bed Wetting Crying Babies Chicken Pox Nappy Rash Whooping Cough Vasectomy Testicular Cancer Breast Awareness |
 |
 |
 |
 |
 |
 |
 |