[건강톡톡] Every night without my knowledge, ‘mistake in drawing a map on a blanket’… Why is that?

It’s easy to dismiss the drawing of a map on a blanket as a child’s slight mistake while sleeping at night. However, if it does not get better as it grows and repeats itself, enuresis should be suspected. Enuresis is a symptom that occurs frequently in children, and is a symptom of urinating against one’s will during sleep at least twice a week for at least 3 months, even though normal urination can be controlled at the age of 5 years or older. Let’s solve your questions about ‘enuresis’ with Haidak experts.

Enuresis mainly occurs in children, but can also occur in adultsㅣSource: Getty Image Bank

Q. I don’t drink a lot of water at night, and I go to the bathroom before going to bed, but I pee when I sleep. Why?
A. It is normal for urine to be stored in the bladder when you fall asleep and to hold it until the next day. Urinating before waking up at night is called enuresis.
Types of enuresis are largely divided into primary enuresis and secondary enuresis. Primary nocturnal enuresis is a condition in which a child has never urinated at night since birth. Secondary enuresis is when enuresis occurs again after a period of temporary urination.
In the case of enuresis, the pituitary gland secretes less anti-diuretic hormone (ADH), making more urine than normal people while sleeping at night, so there may be cases of overflow. There are sensitive forms that cause discharge.
-Haidak Urology Counseling Doctor Hyukjun Lee (Purun Urology Clinic)

A. Enuresis is defined as urinary incontinence during sleep in children over the age of 5 years. Enuresis is often found in urinary tract infections, constipation, bladder outlet obstruction or external urethral stricture in boys, spinal cord disorders, sleep apnea, diabetes insipidus, diabetes, and attention deficit hyperactivity disorder, so the presence or absence of these diseases must be determined.
Through a detailed medical examination, the propensity for enuresis is identified, and the pattern of urination is analyzed in advance through a urination diary for diagnosis. In the hospital, the presence or absence of spinal cord deformities and perineal abnormalities are observed through a physical examination along with a urinalysis, blood tests are performed to evaluate antidiuretic hormone and renal function, and radiation X-rays, abdominal ultrasound, and urodynamic tests are performed. It tests bladder function.
-Hydak Urology Counseling Doctor Joo-Nam Kim (Neoyu Women’s Urology Clinic)

Q. If the amount of urine during the night is much higher than during the day, is it severe enuresis?
A. The main cause of enuresis is a functional problem of the bladder. As the amount of urine at night is higher than during the day, it seems to be enuresis accompanied by overactive bladder. Overactive bladder is caused by excessive contraction of the bladder muscles, frequent urination (more than 8 times a day), nocturia (waking up before bed or while sleeping to urinate), urinary urgency that is difficult to hold back urine, and a feeling of not feeling refreshed even after urinating (residual urination). ), and in severe cases, they complain of ‘urgency urinary incontinence’, in which they cannot hold back and urinate while going to the bathroom. Occasionally, you may feel a tingling sensation in your lower abdomen.
The exact cause of overactive bladder is not yet known, but it is known that it is related to incorrect urination habits at a young age, frequent cystitis, stress, sensitive personality, obesity, and genetic factors.
Tests for the diagnosis of overactive bladder mainly include urine tests and bladder function tests (urolith tests or urodynamic tests), and a urination log written by oneself is also essential for diagnosis. Bladder function tests are performed to evaluate the exact condition of the bladder (volume, contractility, amount of residual urine, etc.).
In the case of enuresis accompanied by overactive bladder, unlike general enuresis, it is difficult to expect a cure with drug treatment alone. Therefore, it must be combined with the treatment of overactive bladder. Overactive bladder treatment includes behavioral therapy, drug therapy, and physical therapy (magnetic field therapy), and most of them are rehabilitation therapy in a room. In other words, it is a treatment that increases the flexibility of the bladder muscles to make it a more mature bladder, and requires long-term treatment for more than 3 months. Overactive bladder is not a fatal disease, but it must be treated because it causes extreme stress in daily life and can lead to depression in severe cases.
-Hydak Urology Counseling Doctor Choi Ho-seong (Neoyu Women’s Urology Clinic)

Q. When I dream of peeing, I always excuse myself on the futon. Could it be related to enuresis?
A. There are many causes of enuresis. It can be caused by psychological reasons, sleep disorders, abnormal secretion of hormones, bladder dysfunction (overactive bladder), and drugs. Effective treatment is possible only when the root cause is identified.
When psychological factors are determined to be the cause, an evaluation of the psychological background is required. If you dream of urinating while sleeping, it seems that you have such a dream because you have to urinate or are bored.
Bedwetting in children is based on drug treatment for several months, and if the treatment is ineffective, treatment with an enuresis alarm can increase the treatment effect.
It has already passed the age of 5, and if it has suddenly gotten worse recently, it may be a temporary phenomenon, so I think we need to keep an eye on it. When a urine mistake occurs, stabilizing the psychological state through conversation is helpful in overcoming it.
-Hydak Urology Counseling Doctor Choi Ho-seong (Neoyu Women’s Urology Clinic)

Q. Can enuresis occur even after becoming an adult?
A. In the case of bedwetting in adults, a diagnosis can be made if there is an average of 2 or more times a year. Causes of enuresis in adults include psychological problems, sleep disorders, abnormal secretion of hormones, bladder dysfunction (overactive bladder), and drug use. You should find out whether you urinate frequently, whether you urinate in a hurry, and whether you wake up at night because you need to urinate. If you have one or more of these, you should suspect bladder dysfunction. In addition, the influence of changes in the surrounding environment and psychological effects can also have a significant effect. Adult enuresis is closely related to sleep disorders. If you are suffering from a sleep disorder such as chronic insomnia, the incidence of enuresis is more than twice as high as that of people who sleep normally.
-Hydak Urology Counseling Doctor Choi Ho-seong (Neoyu Women’s Urology Clinic)

A. Enuresis requires a distinction between waking up and urinating at night due to the need to urinate and leaking urine without being aware of urination. Strictly speaking, enuresis is the latter, but if you feel the need to urinate during sleep, it can be caused by various lower urinary tract diseases such as prostatitis, enlarged prostate, overactive bladder, bacterial bladder, and interstitial cystitis.
However, enuresis is a very rare phenomenon in adults who have been trained to urinate, but it mainly occurs in children when the urination function has not yet been completed, as it can be affected by abnormal nerve function or emotional state. If you are an adult male enuresis, you should first check whether there are any diseases that can affect the urination function, and continue to take medications such as TCA, anticholinergic, and beta-blocker alpha blocker to see if the symptoms are alleviated.
-Hydak Urology Counseling Doctor Lee Woo-seung (Eurojin Urology Clinic (Wonju Branch))

A. Bedwetting can occur even as an adult. The exact cause of enuresis is not known, but delaying treatment can make symptoms worse. In addition to visiting a urologist, the following lifestyle modifications are also necessary.
– First of all, reduce salt and water intake at dinner.
-Don’t eat a lot of soup or water at dinner, and avoid eating fruit after dinner.
– You must urinate before going to bed.
It seems that it will be helpful to first try lifestyle correction such as sufficient rest and exercise, and to combine medication and behavioral therapy after visiting the hospital.
-Hydak Urology Counseling Doctor Youngjin Lee (Daegu Cornell Urology Clinic)

* This article has been reconstructed from a Haidak expert’s answer.

Help = Haidak Counseling Doctor Choi Ho-seong (Neoyu Women’s Urology Clinic Urology Specialist), Haidak Counseling Doctor Lee Hyuk-jun (Purun Urology Clinic Urology Specialist), Haidak Counseling Doctor Kim Joo-nam (Neoyu Women’s Urology Clinic Urology Specialist) , Haidaq Counseling Doctor, Director Lee Young-jin (Daegu Cornell Urology Clinic Urology Specialist)

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