Enuresis is a condition in which children older than five years old have a night or day involuntary urination. Enuresis in children is widespread enough, this disease is often consulted by specialists.
The fact that the signs of enuresis are clearly expressed, and the diagnosis is easy to establish, sometimes gives the impression that the disease can be easily and quickly cured. However, in fact, such a violation requires an individual approach to treatment, because in each case, the disease can provoke other reasons. Therefore, parents and children should realize that the treatment of enuresis lasts a rather long period, and for its successful completion requires a lot of effort and patience from all family members. Attempts at unsystematic treatment often become unsuccessful.
Types of Enuresis
Today it is customary to distinguish between enuresis primary and secondary, as well as day and night. Primary enuresis is a condition in which a child is observed from birth urinary incontinence. Therefore, if such manifestations occur only during the day, then we are talking about daily primary enuresis. With bedwetting, one should talk about nocturnal primary enuresis. Such conditions can be combined.
Secondary enuresis it is diagnosed if the child was “dry” for a certain period of at least six months, after which he again began to suffer from urinary incontinence. As in the first case, secondary enuresis in boys and girls is day, night or two of these forms are combined.
At daytime enuresis Incontinence is caused by disorders in the functioning of the muscles of the bladder. If these muscles are excessively excited, then the child determines hyperreflex or neurogenic bladder. If the excitation of the muscles is insufficient, then we are talking about hyporeflex the bladder.
At nocturnal enuresis nighttime urinary incontinence occurs due to delayed maturation of certain centers of the brain that are responsible for controlling the function of the bladder. Today, night enuresis is more common among children. In the case of primary nocturnal enuresis, spontaneous independent cure very often occurs.
Features of enuresis
This disease has described Avicenna in his work "Canon of Medicine". Today this disease is common enough: according to statistics, about 15-20% of children at the age of five, about 10% at seven years of age, 5% of ten-year-old children and 3% of twelve-year-olds cannot control the bladder. In addition, enuresis also occurs in adults: according to various sources, from 1% to 3% of adults suffer from this disease.Enuresis in boys is approximately two times more common than in girls.
If the child develops normally, then gradually he gains the ability to control his own bladder, and as early as 2-3 years old children learn to consciously control urination. However, in many children this process may be delayed, which is considered a variant of the norm. Consequently, parents may not sound the alarm until the child is five years old. However, if in the sixth year of life the child cannot control this process, then in this case you should already visit a doctor.
Causes of Enuresis
All types of enuresis described above in children arise under the influence of various reasons. The most important factor that affects the occurrence of daytime and secondary enuresis is considered emotional stress. At the same time, the manifestation of primary nocturnal enuresis, as a rule, occurs due to a delay in the maturation of the centers of the brain or shortages vasopressin.
It should also be noted that the genetic factor is a common factor affecting the occurrence of all types of enuresis. About seventy percent of patients with this disease have relatives who also suffered from enuresis.
Daytime enuresis, as well as secondary nocturnal enuresis in boys and girls, manifests itself as a result of a certain imbalance in the activity of the nervous system. This disease develops under the influence of emotional stress: initially, the child has an imbalance in the functioning of the nervous system, which causes a disturbance in the functioning of the bladder. There are many points that can become a source of great stress for a child: this is the death of loved ones, the divorce of parents, and the appearance of another child in the family.
Another reason for the occurrence of daytime enuresis, experts consider the wrong approach to accustoming the child to the potty. In some cases, this process begins in the family too early, perhaps the parents show excessive severity or approach the issue inconsistently.
In addition, the causes of these types of enuresis can be a child’s behavioral problems, as well as a small volume of the bladder (congenital problem).
Primary nocturnal enuresis in children is manifested as a consequence of a delay in the maturation of the centers of the brain, which are responsible for controlling the functioning of the bladder. Due to this delay, the child has a very sound sleep and impaired ability to wake up to urinate on her own. Impulses from the bladder do not reach the brain of a sick child. As a result, there is no signal to wake up.
Another reason for nocturnal enuresis is the insufficient production of vasopressin in the body of the child. Urine is produced in the body constantly, around the clock. So that at night a person does not have a need to get up to the toilet several times, the body produces hormone of the posterior lobe pituitary gland - vasopressin. Under its influence, urine production stops at night. In children with enuresis, sometimes this hormone is not produced in the right amount. As a result, during the night they must empty the bladder with the same frequency as during the day. Most often, enuresis in children occurs as a result of the presence of several factors.
In more rare cases, the presence of enuresis may indicate the development of an organic disease in the child's body. It can be defects of the lumbar vertebrae, congenital or acquired lesion of the lower spinal cord, sleep apnea syndrome, epilepsy, sugar or diabetes insipidus. To exclude these diseases, it is necessary to visit a specialist who will prescribe all the necessary examinations in a particular case. After finding out the cause of enuresis, the doctor will prescribe the correct and effective therapy for the disease.
In addition, disorders of a urological nature sometimes become a cause of urinary incontinence: illness, as well as abnormalities in the structure of the organs of the urinary system.
Diagnosis of enuresis
In the case of nocturnal enuresis, the diagnosis is made mainly guided by the complaints of the patients, and an anamnesis is also being studied, both individual and family. To date, there are studies confirming that if episodes of enuresis occurred in the father or mother, the risk of developing the disease in the child increases by about three times.
In the process of collecting an anamnesis, it is necessary to understand how the child is brought up and how he develops neatness skills. In this case, the doctor takes into account the incidence of urinary incontinence, what type of enuresis, ascertains the nature of urination, checks whether the child has had any urinary tract infections, or if encopres or constipation. In addition, it is important to determine the presence or absence of nocturnal apnea, epilepsy attacks, food allergies or drugs, urticaria, bronchial asthma, allergic rhinitis. All these diseases affect the condition of the bladder, making it more excitable.
Some drugs, mostly tranquilizers and anticonvulsantsmay have a side effect of urinary incontinence, so it’s important to find out if their child has taken it before.
Also, in the process of diagnosis, the doctor conducts a physical examination, paying attention to the structure of the abdominal cavity organs, endocrine glands, and urogenital system. It is also important to assess adequately the physical development of the child and his neuropsychiatric status.
To exclude the pathology of the genitourinary system, laboratory tests of urine, ultrasound of the bladder and kidneys are performed. In some cases, the doctor prescribes other additional studies.
There are also a number of conditions with which to differentiate enuresis in children. These are epileptic seizures, some types of allergies, some endocrine diseases, nocturnal apnea, side effects as a result of taking medications.
To date, the treatment of enuresis is carried out by doctors who work in various fields of medicine. A comprehensive approach to the treatment of the disease is important in order to effectively address all the causes that lead to enuresis in children.
As methods of treatment of daytime and secondary enuresis, as a rule, methods aimed at training the muscles of the bladder, as well as psychological assistance, are used. Sometimes children are prescribed preparations -anticholinergic blockers.
For the treatment of nocturnal enuresis, both the help of a psychologist and the effect of the special “night alarm” apparatus, which stimulates the brain to train to wake up at night, are used. As medications prescribed desmopressin, in rarer cases, apply tricyclic antidepressants.
Medications also have a versatile effect. Anticholinergics reduce the tone of the bladder, while the frequency of urges to urinate decreases. Tricyclic antidepressants have a different effect: they relax the muscles of the bladder and make sleep less deep. Imipramine must be taken at night, it begins to act after a week. This drug is used for three months, and gradually its amount decreases. But very often after taking this drug, enuresis appears in the child again. In addition, imipramine can adversely affect a child’s heart condition. Therefore, it is important to constantly monitor its condition, conducting electrocardiograms.
Desmopressin take those children in whom nocturnal enuresis occurs as a result of a lack of vasopressin in the body. This drug is its synthetic counterpart. The drug acts after about thirty minutes, the effect lasts about 8-12 hours. After taking the remedy, the disease often resumes.
Thus, therapy with medications often only temporarily eliminates the manifestations of the disease, it does not lead to a complete recovery. It is recommended to use medications situationally, for example, on days of long trips, etc.
However, very often doctors, taking into account the large number of cases of arbitrary cure of enuresis in children, advise not to treat those children who calmly perceive this problem. It is necessary to treat nocturnal enuresis when children are very worried about this problem. The course of treatment for enuresis, as a rule, lasts from two to six months and is repeated twice.
Training methods for enuresis patients are used to teach a child to control his own bladder. Special exercises that teach you to hold urine longer, interrupt urination with Kegel exercises, gradually help to demonstrate to the child how to influence this process.
In addition, doctors often recommend trying a special technique of night awakenings. During the week, the child should be awakened at night at the same time - after midnight every hour. Later, the child must be woken up several times during the night at a certain time, trying to pick up this watch so that the child does not have time to urinate. If after this repeated cases of enuresis are observed, then the course is carried out again.
In addition, some specialists practice the appointment of other treatment methods related to alternative therapy. It could be acupuncture, magnetotherapy, music therapy and etc.
In the process of treatment, parents should pay attention to features diets a child. It is important to significantly limit the intake of fluids, as well as those foods that contribute to frequent urination. After dinner, before bedtime, fluid intake should be limited to the maximum. Also, special attention should be paid to the control of the use of products that contain caffeine - they have a pronounced diuretic effect.
In addition, it is important to follow some general rules that will help you deal with the problem faster. Parents and other family members should be as calm and tolerant as possible towards a sick child. Children should not be punished for failures, while it is important to constantly instill in them the belief that they will be able to cope with the problem.
A child suffering from enuresis should not experience severe stress and situations that are emotional from an emotional point of view. No need to allow severe hypothermia of the child. Before going to bed, the child must go to the toilet.
Prevention of enuresis in children
There are some preventive measures aimed at avoiding nocturnal enuresis in children. Experts advise in time to abandon diapers, both reusable and disposable. As a rule, the optimal time for giving up the diaper is the two-year-old age of the child. Given the time of year and air temperature, parents should control how much fluid the child consumes. In addition, parents are required to pay special attention to the sanitary-hygienic education of children, teaching them the rules for caring for the external genital organs, etc.