Enuresis. What it is? Urologists and nephrologists believe that this is involuntary urination at night, and the term "daytime enuresis" is not entirely correct. The term itself means “to urinate” in Greek. The ICD-10 defines enuresis as: involuntary persistent daytime and/or nighttime urination beyond age.
Enuresis - a disease that manifests itself in a dream. This becomes a problem when a child reaches 5 years old, and it is so important that even the International Children's Continence Society (ICCS) was created.
What is enuresis according to the ICCS definition? This is inappropriate time and place for urination in a child after 5 years. In other words, enuresis is a nocturnal phenomenon. But the age of 5 years is conditional, because the development of a child is always individual and can vary as early as 3-6 years. Therefore, it is correct to diagnose enuresis in a child when he himself began to understand the unacceptability of involuntary urination, to show concern about this and an interest in eliminating these episodes.
Whatwhat is enuresis, and what is its significance? Pathology is important not only in terms of treatment, but also in social and psychological aspects: such children often face intolerance from adults and peers, all kinds of humiliating censure. Often they withdraw into themselves due to pronounced psychological discomfort and difficulties in social adaptation. 94.5% of enuretics are children; 4.5% are teenagers and only 1% are adults. In general, enuresis affects half a percent of the world's population. In boys, this phenomenon occurs 2 times more often, and the same preponderance persists in adults.
Provoking factors
What is enuresis in an adult? The causes are degenerative changes in the genitourinary system, brain, anomalies of the urethra or the bladder itself, urolithiasis. But that's not all. The cause of enuresis in adult women is the extinction of estrogen production in menopause with degenerative changes in the muscles of the small pelvis. Rarer causes: its appearance with sleep apnea, especially in overweight people, all types of diabetes, thyroid disorders, taking certain sleeping pills that give deep sleep.
Reasons in men
In adults, the causes of enuresis and treatment are: the postoperative condition of the prostate, as well as hormonal age-related changes in this organ, when the pelvic muscles weaken. It affects the development of pathology and Parkinson's disease, as well as MS (remitting CNS disease), stress, alcohol.
Causes of illness in a child
Children's enuresis can be caused by:
- Immaturity of CNS and urinary tract regulation. The biological circuit for the transmission of a nerve impulse to emptying has not yet been formed.
- Psychosomatics of enuresis - psychological causes include mental trauma, nervous strain, fear, sleep disturbances during the age crisis (at 3 and 7 years old) against the background of asthenia, excessively strict upbringing, neuropsychiatric disorders. Also, the cause is attention deficit hyperactivity disorder, tics, hysterical reactions.
- Causes of childhood enuresis - delayed psychomotor and neurological development: cerebral palsy, anomalies in the development of the central nervous system, pathology at the chromosome level, organic pathology that developed after injuries and infections, intoxications. In such children, psychomotor skills in general suffer, they begin to walk and talk later than their peers.
- Psychosocial factors: children from low-income families, in boarding schools, with alcoholic parents, etc. It is noted that these children often have increased production of the hormone vasopressin, which increases urine production.
- Hereditary burden, especially in the male line. If one of the parents suffered, the risk of enuresis increases by 3 times, if both - by 5 times.
- Impaired production of antidiuretic hormone (ADH). If it is not enough at night, the volume of urine increases greatly.
- Congenital and acquired anomalies of the genitourinary system: narrowness of the urethra or foreskin in men, insufficient bladder capacity, etc.
- Kidney infections.
- Enuresis can be a manifestation of epilepsy, because in this case it is included inepileptic structure.
Classification
Enuresis is divided into primary and secondary. In the first case, there are no so-called dry nights. Pathology occurs independently and is expressed in the absence of a wake-up signal to empty the bladder.
Secondary enuresis is a consequence of congenital and acquired diseases. It is preceded by a period of normal urination, when the nights were dry for more than six months, the child already woke up on his own to go to the toilet. There is also a mixed version - a combination of immaturity and provoking factors.
Enuresis is also divided into combined and isolated, mono- and polysymptomatic. Only nocturnal enuresis is called isolated enuresis. When combined - both at night and during the day. Monosymptomatic enuresis - the absence of other comorbidities.
For reference: young men with enuresis are not accepted into the army.
Main symptoms
Symptoms of enuresis are manifested in sleep disturbances (superficial sleep, very deep, difficult awakening, etc.), delayed physical and mental development, nocturnal episodes of urinary incontinence, nervousness and increased excitability of the child, shyness. Episodes may be infrequent but persistent, with varying frequency.
More often this is typical for the first half of the night, in the phase of deep sleep. At the same time, a wet child does not wake up.
Some children with enuresis have constipation or fecal incontinence, emotional lability, increased anxiety and sensitivity, withdrawal, stuttering,tics, fears.
Treatment of enuresis in children and adults
Treatment of pathology is determined by the cause. It is divided into medicinal and non-traditional. This includes regime, psychotherapeutic, physiotherapeutic methods, etc. But any type of therapy excludes self-treatment.
Medicated treatment
How to treat nocturnal enuresis by a neurologist? The approach is only individual and complex. Includes:
- Restoration or development of the awakening reflex when urinating - in children it occurs already with a volume of urine of 100 ml.
- Stimulation of the metabolism in the CNS for the maturation of all levels of the biological circuit that regulates urination.
- In case of neurosis - its correction (appointment of tranquilizers, for example, "Atarax").
In other cases, nootropics, the most effective drugs for enuresis, have received the most use. What they give:
- stimulate metabolic processes and improve cerebral blood flow;
- increase glucose utilization and microcirculation;
- are neuroprotective for brain damage;
- in case of hypoxia and intoxication, they improve the integrative activity of the brain;
- have antiplatelet and antioxidant effects;
- reduce the tone of cerebral vessels;
- reduce tension, anxiety, fear;
- increase efficiency;
- improve memory and attention;
- reduce vasovegetative manifestations in the form of headache, irritability, emotional lability.
At the same time, they are of low toxicity.
The most popular nootropics are hopantenic acid and its derivatives ("Pantogam", "Pantocalcin", "Gopantam"), "Glycine", "Piracetam", "Phenibut", "Pikamilon", "Nootropil", "Encephabol" "," Pyritinol ". Less commonly prescribed are "Semax", "Instenon", "Gliatilin", "Cortexin", "Cerebrolysin", "Actovegin", "Cogitum", "Aminalon". They are taken in courses up to six months as directed by a doctor. Can be combined with vitamins and sedatives. But polypharmacy is not welcome, a lot of drugs is not always good.
If insufficient bladder capacity is the cause, antispasmodics and anticholinergics are prescribed. The most famous and often prescribed due to its effectiveness is Driptan (oxybutynin hydrochloride). "Driptan" is a medicine for enuresis of an antispasmodic nature. Taking it will relax the bladder by relieving detrusor spasm. This increases its volume, which in turn reduces the number of contractions of the specified muscle and prevents the bladder from emptying uncontrollably. Urine is kept in such a bladder longer. The drug has many analogues, the most famous is Spazmeks. Good for teenagers. Enhances its effect when combined with amitriptyline and anticholinergic drugs. Helps with enuresis and ADH. It has already been noted that ADH normalizes the rhythm of urine production, reduces its excessive formation at night.
"Minirin" - syntheticanalogue of vasopressin. Used for children over 6 years of age, diabetes insipidus, nocturia, etc.
"Adiuretin" from the same group. Available in tablets and nasal drops.
"Imipramine" is effective only in half of the cases, and its result is unstable, often giving relapses. Is an antidepressant. Dangerous for its cardiotoxic effects. Today it is hardly used.
Phytotherapy
National treatment of enuresis in children is not welcomed by everyone, although it is widespread. Opponents of it believe that the effectiveness of folk remedies has not been clinically proven, and there is no information about its safety. Herbs are selected empirically, and it is a mistake to believe in the benefits of such a natural treatment. But, nevertheless, with the permission of a doctor, herbs such as chicory, strawberry flowers, fragrant violet, lemon balm, peppermint, centaury, knotweed, birch leaves, chamomile, burdock, couch grass roots can be used for enuresis.
Physiotherapy
In physiotherapy, the doctor takes into account the cause of enuresis and the type of impaired bladder functions. They can be hypo- and hypertonic. The latter form is more common and uses antispasmodic techniques to relax the spasmodic detrusor:
- Electrophoresis of anticholinergics ("Atropine", "Platifillin", "Eufillin", etc.), antispasmodics, paraffin therapy in the form of applications on the lower back or bladder area, paravertebral ultrasound on the area of 2 and 3 lumbar vertebrae. They restore the normal conduction of signals todetrusor.
- In hyporeflex neurogenic dysfunction, with hypotension of the detrusor, its stimulation (myostimulators) is effective. These include diadynamic currents (DDT), SMT therapy (sinus modulated currents), electrophoresis of cholinomimetics (with "Prozerin", "Galantamine") on the bladder zone.
- IRT, segmental massage of the lower back, legs and soles - this stimulates their work. All this can be used in the treatment of enuresis. Of the sedative methods for neurotic disorders, electrophoresis with sedatives, electrosleep, and a galvanic collar according to Shcherbak are widely used.
- Balneotherapy - coniferous s alt, valerian, oxygen, pearl baths at a temperature of 35-37 °C.
- Mud therapy (peloid therapy) in the form of applications.
Regime measures - the answer to the question of how to cure enuresis at home. This is a whole set of rules that parents of babies should apply:
- moderately hard and flat bed;
- when a child is deep asleep, he needs to be turned over several times during the night to different sides;
- eliminate hypothermia and drafts in the bedroom;
- ventilate the room just before going to bed;
- before going to bed, the child should go to the toilet;
- wake up to develop a reflex to urinate 1-2 times at night until fully awake;
- a night light should be lit in the bedroom so that the child is not afraid of the dark.
Advice to parents with enuresis in a child
What parents should do:
- The atmosphere in the family should always be calm to the maximum,especially in the evenings. All exciting and activating games, TV shows, computers are excluded.
- You can't scold and punish a pissed baby, it won't do anything except complexes.
- Please note that the oilcloth placed under the child is completely covered with a sheet. The bedroom should be warm, but without stuffiness. Avoid drafts. It is better to teach the child to sleep on his back, and the foot end of the bed can be slightly raised to somehow restrain urination.
- Going to bed at the same time is important.
- Eat and drink better 3 hours before bedtime. At the same time, products with a diuretic effect are excluded (milk, strong tea, coffee; juicy fruits - watermelon, melon, apples, strawberries). For dinner - boiled egg whites, stewed fish or meat, weak, slightly sweetened tea. Some adults on the Krasnogorsky diet eat something s alty at night to wake up at night (a piece of s alted herring, bread with s alt, cheese). It is better for a child not to use this.
Does the baby need to wake up at night to empty the bladder?
The child should be awakened at night, and he should know about it so that there is no negative reaction. Some parents put their still sleepy child on the pot, but then the reflex is not developed. The kid should not only wake up, but also go to the potty or the toilet himself and come back himself. Out of pity, carrying a sleepy baby to the toilet and back is pointless. There will be no reflex, and in the morning the child will not even remember that he was worn on a potty at night. If the baby has already pissed, be sure to wake him up and change clothes.
Forschoolchildren use "scheduled wake-up":
- The first week the baby is awakened every hour after falling asleep.
- In the following days, the sleep interval is gradually increased (waking up after 2 hours, then after 3, then only once at night).
- This treatment lasts a month. If necessary, repeat the course.
Children endure such an awakening hard, they do not get enough sleep and fall asleep during the lessons. Therefore, it is better to do such treatment during the holidays.
Alarm therapy has long been a method of awakening. This is the use of an enuresis alarm clock. There are no side effects. Efficiency is 80%, and only 30% of children have relapses. Urinary alarms interrupt sleep as soon as the first drops of urine appear. There is a sensor in the shorts that gives an alarm signal. Then the child can immediately get up and run to the toilet. He turns off the alarm clock. A self-awakening reflex will gradually form with a filled bubble.
Efficiency in children - 90%, adults - 50%. Like specialized sheets, mattress covers, adult diapers, urinary alarm clocks. You can buy them on specialized sites. This makes life comfortable and the patient does not feel inferior. He can go to visit with an overnight stay, to a camp, etc.
Method - bladder training
Helps moderately. If the child wants to pee, he is invited to wait a minute, then go. Gradually the bladder trains.
Psychotherapy
Psychotherapy for neuroticdisorders are carried out by child psychotherapists. Use suggestive and corrective behavior approaches. From the age of 10, the use of affirmations is effective. The child, before going to bed, for 10 minutes, repeats the “formulas” of self-awakening several times when the urge to urinate in the form of a whole biological chain. He says: “I always want to wake up in a dry bed. While I sleep, the urine is tightly locked in my bladder. When I feel like writing, I will wake up on my own.”
Family Therapy
Parents must be tolerant and abide by the rules:
- Child should not be shamed or punished.
- His daily routine should be rational.
- Children should avoid worry, positive or negative.
- He can't watch horror movies, run and play noisy games before bed.
- You need to set the child up for recovery and inspire him to believe in his own strength.
Motivational Therapy
It is quite effective (80%), but is applicable after the age of 6-7 years in babies with intact intelligence. Parents introduce a system of rewarding the child for "dry" nights in the form of toys and prizes. This is done according to the wishes of the child. In such cases, the child can keep his urinary diary, where he depicts dry nights as the sun, and enuresis as rain.
It is useful to instill in the baby the skill of making his own bed and changing underwear after he has peed. This creates a reflex to the comfort of a dry bed. The negative relationship in this case is reversed. The kid is tryingavoid enuresis.
How to potty train a child
This can be practiced after 6 months, when the baby has already learned to sit. First, he stays on the potty for 1-5 minutes, and at the same time he must be encouraged with the idiomatic expressions "pee-pee" and "ah-ah" in order to develop a conditioned reflex. And then the children themselves pronounce these sounds, asking for a potty. When the child has safely emptied, be sure to praise him. Children under 2 years of age cannot be scolded for wet pants. Even older children only need to be gently told that it is better to ask for a potty.
Enuresis prevention
Preventive measures:
- do not use diapers after 2 years;
- to instill in your child the habit of evening dress;
- don't drink plenty before bed;
- treat urinary tract infections in a timely manner.
So, what to do with enuresis to the parents of the baby? It is important to achieve an awakening reflex, activate the maturation of urination regulation using nootropics and other drugs, and correct neurotic manifestations with psychotherapy.
Feedback on the treatment of enuresis is as follows: children are well helped by "Pikamilon", a sheet with a battery, psychotherapy and homeopathy, hypnosis, bladder training. Some parents report that nothing worked until they moved out, were in their teens, and then went away without any treatment. Among adults, good reviews received at appointment"Ovestin", "Pikamilona", "Minirina", "Driptana".
