Nocturnal enuresis in a 5 year old child. Urinary incontinence in children. Methods of dealing with enuresis, depending on the causes of its occurrence

Nighttime urinary incontinence in children under 5 years of age is considered normal. Unfortunately, there are children who, even at the age of 7-10, sometimes wake up on wet sheets. In addition to the fact that the child is uncomfortable waking up in a wet, cold bed, he is also very ashamed. You can get rid of nighttime troubles only by establishing an accurate diagnosis of the disease that caused nocturnal enuresis.

What can provoke enuresis in children aged 7-10 years

The processes that contribute to urinary incontinence at night (enuresis) in children of primary school age are represented by a physiological and psychological component. A wet bed when waking up causes trouble not only for the child, but for all family members. Most often, bedwetting appears in boys and disappears in them by the beginning. adolescence . This does not mean that the situation that has arisen does not need to be dealt with. If a child pees at night, he feels psychological discomfort, is ashamed and withdraws into himself.

The manifestation of nocturnal enuresis is caused by several reasons.

1. Causes of a psychological nature

By the way, the nervous stress experienced by the baby can provoke bedwetting.

• Change of environment (change of residence or transfer to a new school).
• Family conflicts.
• The loss of a dear person or four-legged pet.
• Exam or test papers at school.

In most of these cases, enuresis resolves without outside intervention, but sometimes the help of medical professionals may be required.

2. Occurred in the work of the central nervous system failure or immaturity

The body does not receive a signal that the bladder is full and that it is time to empty it. This reason is one of the main contributing to the manifestation of enuresis.

3. Hereditary factors

If both mom and dad suffered from the problem of nighttime urination, then the probability of its occurrence in a child is almost 80%, and if one of the parents, then up to 45%.

4. Cold weather

Children are more sensitive to a strong drop in temperature.

5. When the child is often raised to the toilet at night

He can sometimes wake up on his own and a conditioned reflex to urinate will quickly work in him.

6. Malfunctions of the endocrine system

In this case, the child manifests not only enuresis. He noticeably increases sweating, swelling of the face or a tendency to be overweight.

7. Hormonal imbalance

8. Pathological abnormalities in the urination system

9. Infection in the genitourinary system or vaginal infection (in girls)

10. Weakened bladder or kidney function

The problem of enuresis during night sleep at 7-10 years old can be quite prosaic. It's just that the baby has a healthy, sound sleep, or the root cause lies in the large amount of liquid, fruit or cold foods that he consumed before bedtime. Treatment in these cases will consist in the timely control of children.

Which doctor will help children get rid of enuresis

First of all, parents, faced with nocturnal enuresis, turn to the pediatrician. As a rule, the doctor advises to wait a bit, arguing that over time the problem will disappear. At best, he will appoint general analysis blood and ultrasound procedure internal organs.

It is not necessary, on the advice of a doctor, to wake the child more often at night. This can only make the situation worse. Because of the frequent getting up at night, the child may then show symptoms of childhood neurosis.

A good pediatrician should determine what kind of specialist the baby will need and give a referral to a pediatric urologist, psychologist or neurologist. Only a complete examination will help determine what caused urinary incontinence during a night's sleep.

Do not wait for the problem to "resolve" without medical intervention. Consult a doctor at the first manifestations of the disease.

Methods of dealing with enuresis, depending on the causes of its occurrence

After a complete examination and discovery of the causes of the disease, the doctor decides which method to use to solve the problem in a particular case.

Treatment with medications

• One of effective means from children's enuresis drug Adiuretin-SD is recognized which contains desmopressin. It is an analogue of vasopressin, a hormonal agent that normalizes the process of excretion or absorption of free fluid by the body. The drug is released in the form of drops in the nose and is prescribed to children from the age of eight. For a baby who has not reached this age, the doctor reduces the dosage.
• For bedwetting, tranquilizers may be prescribed to improve children's sleep. having a hypnotic effect. (Radedorm or Eunoktin).
• With a neuropathic manifestation of the disease, Rudotel is prescribed, Atarax or Trioxazin (children over 6 years old).
• Neurological bedwetting is treated with amitriptyline. However, its use under 6 years of age is contraindicated.
• To increase the volume of the bladder, prescribe Driptan in tablets.
• To improve the functioning of the brain, prescribe sedatives such as Persen, Nootropil, Novopassit, B vitamins, vitamin A and E. Pantocalcin may be prescribed. With its help, the development of impulses responsible for the assimilation of new skills is stimulated.

You can use these funds only as directed and under the supervision of a physician. In order not to harm the child, strictly adhere to the prescribed dosage.

Non-drug therapy

When the problem of bedwetting is psychological in nature, no medication will help, unless irritating factors are excluded from the life of a student. First of all, you can not scold the child for a wet bed or tease and mock him. This will only make the situation worse.

Fear of punishment or ridicule will provoke the development of the disease. You can’t tell strangers about the problems of your son or daughter, especially in their presence.

Creating a favorable microclimate in the family is the first step to success in the fight against childhood enuresis.

In addition, other factors contribute to the solution of the problem.

• Daily regime. It is necessary to properly organize the time of rest and study of a teenager. He should avoid heavy loads that lead to overwork, and increase the duration of sleep. The last meal should be 2.5-3 hours before bedtime. In the evening, you need to limit the intake of liquids, especially juices, dairy and sour-milk products.
• Bladder training. The procedure begins at the age of seven. The child is taught to delay the process of urination. Track when the baby goes to the toilet, offer him to be patient a little more. Slowly increase the delay time. This will help develop bladder control.
• motivational therapy. The method is highly effective, allowing to solve the problem of nocturnal enuresis in 80% of children. The best doctor in this case is the child himself. The essence of the method is very simple - encouraging children for every dry night. One child needs simple praise, another needs a new toy, a bike or skates. Hang a calendar over your son's or daughter's bed, marking all the dry nights on it. Agree with the child that with a certain number of dry nights per week or per month, the baby will receive a long-awaited gift. If he fulfills his part of the agreement, you must, without any excuses, fulfill yours.
• Physiotherapy. The procedures contribute to the improved functioning of the nervous system, brain and bladder. As medical procedures, to ensure a dry bed for the crumbs, electrophoresis, acupuncture, magnetotherapy are used, electrosleep, circular showers and therapeutic exercises are used.
• Psychotherapy. The specialist teaches the child self-hypnosis and relaxation techniques. In the process of training, the reflex connection between the bladder and the nervous system, weakened for various reasons, is restored. With severe neurotic enuresis, therapy is used for depressive mood shift - tearfulness, fear, irritability or anxiety. An important role in this is played by family psychotherapy, that is, the creation of a favorable climate in the family and the comprehensive support of the child.

Folk methods of dealing with bedwetting

Traditional medicine with its recipes can also become an assistant in the fight against the disease.

1. A tablespoon of dill seeds brew a glass of boiling water and insist 1 hour. Up to 10 years old, drink half a glass in the morning on an empty stomach.
2. A decoction of St. John's wort leaves is added to the compote of lingonberry berries, and give the child to drink several times a day. The tool helps well with incontinence, which is caused by psychological factors.
3. One liter of boiling water pour 2 tablespoons of rose hips and let it brew. You need to drink infusion several times a day, replacing them with tea or compote. Rosehip not only helps to cope with enuresis, but also has a general strengthening effect on the entire body.

Traditional medicine offers great amount prescriptions for enuresis. But, before using them, do not forget to consult with your doctor.

For treatment to work, family members must be the moral support for the child. Praise him for every dry night, do not scold him if the bed suddenly turns out to be wet again.

It is necessary to reassure the beloved man, to inspire him that all this can be got rid of and that he is able to cope with the problem that has arisen. Feeling the full support of loved ones, the baby will quickly cope with such an unpleasant phenomenon as nocturnal enuresis.

All parents are faced with the problem of bedwetting in children, but not everyone knows that you really need to start worrying when this happens after 5 years. Illness means the inability of the bladder to hold the contents. When a person sleeps, the muscles relax, so involuntary urination occurs.

If the "trouble" happened to a small child, then there is nothing to worry about. It is worth sounding the alarm to the parents of those children who have crossed the five-year milestone and continue to write in bedFactors contributing to the onset of the disease

Up to a certain age, urination in babies is not regulated due to the fact that from the moment of birth they adapt to new conditions, the formation of all life processes and skills to meet their physiological needs. If by the age of 4 these processes have not returned to normal, then parents need to ask themselves the question about the causes of the pathology.

According to the famous pediatrician Komarovsky E.O., enuresis does not mean the presence of serious pathologies in the body, so its treatment can quickly help get rid of involuntary urination during sleep, if it is properly organized. The main thing is that parents should remember the need for a gentle attitude towards the child, even if the treatment is delayed. The activity of all organs in the body is carried out through the brain, which is connected to them by nerves through the central nervous system, so the problem of urinary incontinence at night is not only physiological and medical in nature, but also psychological.

Anything can become an irritating factor: quarrels, divorce of parents, appearance in the family small child who receives more attention, fear, attitudes in the classroom. Along with classes with a psychologist, parents need to create a favorable environment in the family that minimizes the occurrence of stress: no punishments, ridicule, disclosure of the problem.

About the causes of the disease

In newborns, the nervous system is still underdeveloped, so urination occurs uncontrollably - up to 20 times a day. As the baby matures, nerve endings develop, children begin to control urges and learn to go to the toilet.

Full formation of the reflex should occur on average by 4 years, but depending on individual characteristics organism, can happen a year earlier or after reaching 5 years. The alarm should be beaten if at the age of 6, 7, 8, 10, 11 years old, involuntary urination in a child occurs during daytime and nighttime sleep. Causes of enuresis:

• complications during pregnancy or childbirth, as a result of which the child was found to have perinatal hypoxic damage to the nervous system;
• hereditary predisposition - this means that a gene is passed from parents to a child that increases the level of substances that reduce the reaction of bladder cells to antidiuretic hormone in the blood;
• the presence of an infection in the urinary tract or urological disease;
• stressful situations, unfavorable atmosphere in the environment, psychological trauma;
• insufficient capacity of the bladder - such a symptom must be borne in mind if the child had previously had pyelonephritis;
• congenital or acquired diseases of the brain or spinal cord;
• diabetes;
• allergic reaction.

The cause of urinary incontinence can be a psychological trauma received by the child. The nervous system of babies is unstable, so even a quarrel in the family sometimes turns into health problems

Enuresis in children can occur as a result of the action of several factors at the same time, one cause can give rise to another. A very simple reason for involuntary urination at night can be, in the absence of pathologies, a sound sleep or an excessive amount of liquid, fruits, cold foods taken immediately before bedtime, hypothermia of the body. Do not throw off the scales psychological factors that contribute to the development of urinary incontinence: quarrels, night terrors, jealousy, etc.

Which specialist to contact?

The doctor who deals with the primary diagnosis and treatment of all childhood diseases is a pediatrician. Despite the fact that the disease is associated with the urinary organs, it is worth starting with a visit to this particular specialist. A qualified doctor must identify a narrow specialist who will be required for a more accurate diagnosis and refer the parents with the child for a full examination.

Given that enuresis is a disease that can be caused by a number of factors of a different nature, it is appropriate to undergo an examination with several specialists:

• a neuropathologist prescribes electroencephalography, which should reveal the state of the nervous system;
• the psychologist finds out if there were any stressful situations, how the child develops, using special techniques, reveals the emotional background in the family, gives recommendations to parents;
• the urologist prescribes an ultrasound of the kidneys and bladder, a urine test, then medication.

Each specialist works in turn, looking for the causes of the disease in his area.

If in doubt about determining the cause, the council can send the baby for examination to other specialists - a nephrologist, an endocrinologist. The main circle of narrow specialists is usually enough to make a diagnosis with confidence and prescribe such treatment that will help save the child from involuntary urination at night.

How to treat enuresis?

There is no single prescription for the treatment of bedwetting in children, as the appointment depends on the causes of its occurrence. Each specific case requires an individual approach. Ways drug treatment are prescribed according to the results of diagnosing the condition of the muscles of the bladder, the content of the hormone vasopressin, which regulates the level of fluid, as well as the state of its receptors:

1. Minirin - is produced on the basis of vasopressin in the form of nasal drops, instilled before bedtime;
2. Driptan - with an increase in the tone of the bladder;
3. Minirin in combination with Prozerin - with hypotension of the bladder in the form of injections;
4. Nootropil, Persen in the form of tablets, B vitamins - are treated for nocturnal enuresis of neurotic origin.

All medicines are used only after examination, identification of causes and appointment by a narrow specialist with strict adherence to the rules of administration and dosage. Alternatively, patients may be referred to a homeopathic doctor who will prescribe alternative remedies:

1. Pulsatilla - in the presence of infectious diseases of the urinary tract, also for emotionally excitable children;
2. Gelsemium - with symptoms of relaxation of the muscles of the bladder as a result of stressful situations;
3. preparations containing Phosphorus are given to children who drink much cold water;
4. Sepia - with urinary incontinence when coughing, laughing at any time, also in the first 3 hours after falling asleep.

Modern homeopathic medicines are guaranteed to cure enuresis, provided that the diagnosis is correctly made. Alternative methods may be prescribed if drugs do not have the desired effect and enuresis in children is not curable.

Diseases of nervous origin are often treated with traditional medicines. Persen is considered one of the safest sedative properates. About non-drug methods

Medications will not have the necessary effect on the cure of enuresis if the cause of its occurrence is in the psychological plane. Other factors contributing to the normalization of the urination process:

• Organization of the daily routine. Proper regulation of all processes during the day will accustom the body to internal discipline (eating at strictly defined hours, walking, daytime rest, sleep, entertainment) and will gradually nullify enuresis in children. It is necessary to teach the child to stop eating 3 hours before bedtime. To fulfill this difficult condition, the parents themselves must be the best example.
• Training exercises for the bladder. It is necessary to learn to control the process of urination. To do this, you need to learn how to briefly delay the desire to go to the toilet.
• Creating a motive Motivational therapy is a powerful psychotherapeutic tool that is applied to children suffering from enuresis. It is used only in cases where the cause of the disease is psychological factors. The motivation should be to reward the child for "dry" nights. What will be the subject of promotion and for how many successful nights is an individual decision, but the technique works in 70% of cases.
• Physiotherapy treatment. Physiotherapy in the form of electrophoresis, acupuncture, magnetotherapy, electric sleep, circular shower, therapeutic exercises is designed to improve the functioning of the brain, nerve endings.
• Psychotherapeutic help. With special techniques, the specialist teaches the child the methods of self-hypnosis. As a result, the reflex connection between the central nervous system and the muscles of the bladder should be restored. If the neurotic nature of bedwetting is pronounced, then psychologists use their tools to shift depressive states. The main role in psychotherapy should be played by the creation of a favorable positive atmosphere in the family.

In some cases, therapeutic exercises can help the child, which stimulates the nerve endings and strengthens the nervous system. Traditional medicine in the fight against the disease.

Traditional medicine is a pantry of healing methods for all kinds of diseases, so do not neglect the effective home recipes that came from the depths of centuries. They have been tested in practice by many generations of people, they contain only natural ingredients:

• For children under 10 years old, brew a tablespoon of dill in a glass of boiling water and insist for an hour. Drink in the morning on an empty stomach for half a glass.
• Cook lingonberry compote with the addition of 2 tablespoons of wild rose, insist. The infusion can be drunk several times a day, it has a calming effect on the nervous system.
• Rosehip 2 tablespoons pour one liter of boiling water, insist. Replacing tea, drink throughout the day. Rosehip strengthens nerve cells well.
• Berries and leaves of lingonberries, St. John's wort in an arbitrary small amount bring to a boil in ½ liter of water. Infuse for 30 minutes, strain, cool and take throughout the day.
• Boil 30 g of crushed plantain leaf in 350 ml of hot water, let it brew, take 10 g 4 times a day.
• Collection of herbs mint, St. John's wort, birch leaves, chamomile flowers in equal parts grind and mix. Pour 50 g of the mixture into 1 liter of hot water in a thermos, insist for 8 hours. Take half an hour before meals for 100g. In order for the child to drink the infusion with pleasure, you can add honey to it. After 3 months, you need to take a break for 2 weeks, then continue taking the remedy.
• The collection of knotweed, yarrow, St. John's wort, blackberry leaves will alleviate the symptoms of enuresis. All ingredients must be chopped and mixed in equal parts. Ready 10 g of the mixture pour 300 ml of boiling water, insist in a thermos for 2 hours. The infusion should be taken 5 times a day before meals.

Folk remedies will have the desired effect if taken under the supervision of the attending physician. Herbal medicines are an addition to the main treatment, it should not be a complete replacement for it. In addition, herbal preparations can have a good effect in the prevention of enuresis.

Reading time: 5 min.

Enuresis is persistent bedwetting, involuntary nocturnal urination that does not correspond to psychological age child. Enuresis in children may be associated with organic causes, and may be psychogenic.

The disease is considered primary if nocturnal involuntary urination is observed regularly, and secondary when the child has already had a "dry period" - the disappearance of symptoms of incontinence for 6 or more months.

1. Prevalence

In general, boys suffer from the disease 1.5-2 times more often than girls. Among those children whose parents were also diagnosed with enuresis, the probability of its occurrence increases to 70%. The frequency of involuntary nocturnal urination is higher in dysfunctional families.

Cystectomy, transurethral resection and other types of bladder surgery

2. Causes of bedwetting

The proven causes of enuresis in children are:

1. 1 Hereditary predisposition. If one of the parents suffered from the disease, then the probability of its occurrence in a child is about 40%, if both parents, then the risk of the disease increases to 70%. Currently, specialists distinguish several types of pathology caused at the gene level: type 1 (*600631, 13q13–q14.3, ENUR1 gene, В) and type 2 (*600808, 12q13–q21, ENUR2 gene, В).
2. 2 Urinary tract infection. According to studies, the frequency of asymptomatic urinary tract infections in five-year-old girls is 1%, and in enuresis - 5%.
3. 3 Stress. If a child experiences a strong emotional shock at the age of 3-4 years, then the likelihood of pathology doubles. Typical stressful conditions for babies are separation from their mother for more than 1 month, divorce of parents, moving, the birth of a second baby, accidents, hospitalization, sexual abuse, etc.
4. 4 Social disadvantage. This is living in orphanages, a cramped apartment, education in socially disadvantaged families.
5. 5Delay of neuropsychic development. Enuresis in a group of children with a delay speech development and motility, observed 2 times more often.
6. 6 Late potty training.
7. 7 Kidney insensitivity to antidiuretic hormone (ADH) at night.

Unlikely causes of enuresis include structural anomalies in the development of the urinary tract, a decrease in the functional capacity of the bladder, sound sleep, and epilepsy.

Secondary enuresis can be one of the symptoms of diseases:

1. 1 Developmental anomalies, injuries and tumors of the spinal cord - spina bifida, myelomeningocele, etc.
2. 2 Epilepsy - against the background of ongoing antiepileptic therapy or during minor seizures.
3. 3Attention deficit hyperactivity disorder.
4. 4Neurosis and neurosis-like states.
5. 5Intellectual deficiency, mental retardation.
6. 6 Taking medications used in neurology - phenytoin, valproate, diazepam, baclofen, botulinum toxin, thioridazine, etc.
7. 7 Food allergies.
8. 8 Malabsorption syndrome, intolerance to certain products - gluten, lactose.

Urinary incontinence in women - causes, diagnosis, treatment methods

3. Criteria for making a diagnosis

According to the International Classification of Diseases of the 10th revision (ICD), there are 5 main criteria for making a diagnosis.

Table 1 - Diagnostic criteria for enuresis

Causes, symptoms, treatment tactics and the main groups of antibiotics prescribed for cystitis in children

4. Features of pathogenesis

The physiological formation of urination control in a child takes place in several stages:

1. 1Infantile bladder. It is observed in the first months of life after birth. The bladder fills and then empties under the action of the parasympathetic nervous system. This process is not controlled by consciousness.
2. 2 Immature bladder. At the age of 1-2 years, impulses from the bladder, when it is filled, are sent to the cerebral cortex, so the child already partially controls urination on his own. First disappears involuntary urination during the day, and then at night.
3. 3 The bladder usually becomes mature by 3-4 years, less often by 5-6 years. By this time, its volume increases, the baby is able to actively contract the muscles of the pelvic floor and the sphincter of the urethra, as well as suppress the hyperactivity of the detrusor.

With enuresis, the maturity of the bladder is not observed. In some children, the maturation process is completed by the age of 6-7, less often by adolescence, after which spontaneous healing occurs.

5. Pathogenetic mechanisms

Whatever the causes of enuresis, the mechanisms of the development of the disease can be reduced to 3 main ones:

1. 1 Violation of the correspondence between the volume of the bladder and the amount of urine.
2. 2 Increased detrusor activity at night.
3. 3 Violation of awakening processes.

Violation of the correspondence between the volume of the bubble and the amount of content can cause:

1. 1 Anomalies in the structure of the genitourinary system, initially accompanied by a decrease in the volume of the bladder, etc.
2. 2 Violation of the production of hormones that reduce the formation of urine at night - vasopressin (ADH), etc.
3. 3 The habit of drinking at night.
4. 4Renal insensitivity to the action of antidiuretic hormone.
5. 5 Diabetes or diabetes insipidus.
6. 6Snoring, apnea episodes.
7. 7 Pathologies of the nervous system, leading to an increase in detrusor tone and weakness of the sphincters.

5.1. Increased detrusor activity at night

The detrusor is the main muscle of the bladder, responsible for its contraction and expulsion of urine.

With its increased activity, uncontrolled urgent urination is observed at any time of the day, including at night, so the overactive bladder syndrome is often accompanied by enuresis.

5.2. Violation of awakening processes

It is currently believed that deep sleep alone does not contribute to bedwetting. Most often, awakening processes are disturbed: the child does not wake up, despite the fact that the bladder is full.

This is partly due to insufficient interaction between the structures of the brain stem - the blue spot, which is responsible for awakening, and the center of urination. Currently, research in this direction is actively ongoing.

6. Classification and types of enuresis

The classification of the disease is presented in the form of table 2.

Table 2 - Classification and types of enuresis

Table 3 - Forms of enuresis based on EEG and clinical observations

6.1. neurotic form

The neurotic form of enuresis differs from others in that children are not at all indifferent to the fact that they have episodes of bedwetting.

Children can experience a variety of emotions, ranging from simple interest in what is happening to painful experiences. As a rule, psychotrauma plays an important role in the occurrence of the neurotic form of enuresis.

Types of neurotic form:

1. 1Asthenoneurotic. It develops after a psychotrauma in weakened, emotionally vulnerable, quiet and shy kids only at certain times. age periods associated with critical age (3, 5, 7 years). They are very sensitive to their defect, which leads to a feeling of inferiority. Sleep is restless, a psychotraumatic situation may be dreaming. No changes were observed on the EEG.
2. 2 Hysteroid. It is more common in artistic, mobile, sociable girls with a lively temperament and rich facial expressions. EEG changes are not observed.
3. 3Reactive. With this form, enuresis itself serves as a psychotrauma and causes a severe emotional state (up to committing suicidal attempts). If the symptoms persist, then it is fraught with persistent personality changes even after the disease disappears at an older age.

7. Treatment

Treatment of bedwetting in children is complex, including the use of psychotherapeutic techniques, drug therapy, and lifestyle changes.

7.1. Mode optimization

It should be aimed at fixing the conditioned urination reflex or its development. Includes:

1. 1Psychologically comfortable mode - exclusion of stress, prolonged TV viewing, overwork, etc.
2. 2Maintaining the optimal temperature of the body and the surrounding space (avoid hypothermia, warm bed).
3. 3Wake the child until fully awake at the same time for a conscious visit to the toilet.

7.2. Diet correction

Eat dinner no later than 3 hours before bedtime. Exclude in the evening meal foods that increase urination: strong tea, coffee, cucumbers, apples, watermelons, milk, kefir.

For dinner, you can give dry crumbly cereals, cheese, an egg, a sandwich with jam, butter.

7.3. Attitude of family members

The family needs to create a warm and cozy atmosphere. The attitude towards the child should be even, calm. He should not be punished for involuntary urination, so as not to increase guilt and anxiety. After each case, it is necessary to change bed linen and wet clothes, the baby should not be left in a wet bed until morning.

7.4. Self-control training

Regular performance of special exercises contributes to the development and consolidation of mechanisms for self-control of urination. Important aspects are the strengthening of faith in one's own strengths, elements role playing, behavioral psychotherapy, alarm therapy (urinary "alarm clocks").

7.5. Physiotherapy

Exercises are prescribed to strengthen the muscles of the abdomen, pelvic floor. Skating, skiing, cycling, swimming are quite effective.

7.6. Medical therapy

As a rule, the treatment of primary enuresis begins with the appointment of an analogue of the antidiuretic hormone - desmopressin, minirin. According to the recommendations of WHO and the European Society for the Study of Enuresis, these are the drugs of choice # 1, which have proven their effectiveness.

The dose of desmopressin is selected individually, starting with 0.2 mg. The course of treatment is 3 months. Then a week-long break is taken, and if the episodes recur, then a repeated three-month course is carried out with an adequate dosage of the drug (up to 0.4 mg).

The effectiveness of desmopressin reaches 80-90%, therefore, in foreign clinics, treatment begins with it. Desmopressin can be combined with many antibacterial agents.

In case of intolerance to desmopressin, drugs of other groups are prescribed. The choice of a specific tool depends on clinical picture and the suspected nature of urinary incontinence.

A fairly common problem in preschool and school age considered nocturnal enuresis in children. This is an uncontrolled separation of urine in small or more at night time. This problem needs an urgent solution, because over time, in the absence of proper treatment, it can develop into a permanent condition. Why does enuresis occur and how to treat bedwetting in children?

A “wet bed” in growing children does not happen rarely, but this phenomenon should not be treated as temporary, letting it take its course.

Types of enuresis

There are two main types of bedwetting:

1. Primary enuresis - occurs in a child for the first time and is manifested by uncontrolled urination at night. This type of enuresis has a mild form of leakage and it is not necessary to apply a specific method of treatment to it.
2. Secondary - occurs under the influence of some factors (it may either appear or disappear again).

Types of enuresis depending on the form of leakage:

1. uncomplicated - there are symptoms related only to uncontrolled urination, otherwise everything is fine with health;
2. complicated - the malaise is expressed not only by characteristic symptoms, but also affects internal organs, provoking an inflammatory process and some deviations in the development of the child.

Secondary types of incontinence in children:

1. Neurotic enuresis - appears in children who are ashamed and somewhat afraid of their condition. Such children have disturbed sleep, as they are afraid that they may wake up "wet".
2. Neurosis-like enuresis - incontinence appears in overly nervous and hysterical children. Before adolescence they do not worry about their condition, and then, starting to understand that this is bad, they withdraw into themselves and are alienated from society.

Enuresis - nocturnal urination, is a common disease in children 4-7 years old. Preschool children often pee at night. At first, parents do not consider this a problem. But we must not postpone and miss the time of treatment of this not only physiological, but also emotional illness.

Both children and parents are ashamed to admit the disease and consult a doctor. If your child wakes up in a wet bed, this is not normal and should be a concern.

A delicate problem should be carefully discussed with the child. He already suffers, and should not feel shame or fear of his parents, should not hush up or hide traces of a night incident from adults. Your child must fully trust you and agree to examination and treatment by a doctor. Often the wrong position of adults leads to psychological trauma, sleep disturbance and the formation of an inferiority complex.

The ability to control the process of urination matures in the head. This happens at different times for different children. But by the age of five, 80% of children can sleep through the night and go to the toilet when they wake up in the morning. Daytime incontinence in preschool children is rare. We will not talk about him. Nocturnal enuresis is often a disease that requires a referral to a urologist. Enuresis is several times more common in boys.

• Primary enuresis- when the child does not wake up in order to pee at night.
• Secondary enuresis- a consequence of severe mental or physiological trauma. In this case, involuntary urination can be both at night and during the day.

The child learns to control the process of urination along with other skills and life processes. At the age of one and a half years, babies feel the filling of the bladder and express anxiety when the moment of emptying comes.

The relationship between the brain and the center of regulation of urination is formed by 4-5 years. The muscles of the bladder in children, when contracted, push out the accumulated fluid, and the muscles of the entrance relax. Young children cannot control the relaxation of this muscle, the process occurs involuntarily.

By the age of three, the size of the bladder increases, the brain gives a command to keep the muscles in a tense state, as a result of which the process slows down. A kid of 2-3 years old is already asking for a “little way”. During the day, the excretory system turns on 7-8 times, and at night the bladder does not disturb the urge. The "adult" urination pattern develops completely by the age of four. Prior to this, night "swimming" in children is not a pathology.

Causes of enuresis

The causes of enuresis in girls and boys are not the same. The development of the body and behavior patterns in each child are individual. Conditions of upbringing, habits, hereditary traits can affect the formation of health.

How factors can cause enuresis in children?

State of development of the brain. The slowdown in the development of the central nervous system entails a lack of ability to control the process of urination. The reason for the slow development may be a dysfunctional pregnancy or a difficult birth. Children with this feature are easily excitable, nervous, and concentrate poorly. A calm environment and hardening of the baby's body will help to avoid enuresis.

Daily routine with periods of sleep and wakefulness. is one of the most common causes of nighttime urination. This is restless shallow sleep or deep sleep (when the child does not remember when he is woken up at night).

Extremes in the system of raising children. If the baby is allowed everything, they are not accustomed to cleanliness and personal hygiene, then he does not pay attention to wet panties or the bed. Or, on the contrary, if the child is too strictly scolded for every little thing, he is afraid to remind himself once again and ask to go to the toilet.

Causes of the disease:

• psychological situation at home;
• heredity. If there are cases of neuropathic diseases, enuresis in the family, this can be the cause of the disease;
• anomalies in the formation of the genitourinary system. Insufficient bladder capacity;
• inflammatory processes, consequences of injuries and operations;
• wrong organization bed child. The bed should be hard and warm. The lower back and legs should always be wrapped tightly, put on warm pajamas for the night and socks.

Another reason is the abuse of diapers, which may be convenient for the mother. The child is warm and does not need to be constantly planted on the potty. But this leads to the fact that three-year-old children do not know the potty and empty themselves into panties. Potty training should be done at the age of one year.

He must understand that the discomfort from wet sliders or diapers comes after urination. At the level of conditioned reflexes, the need to stay dry is formed. The child begins to worry at the appointed time, showing that it is time for the potty. By the nursery, the child should be able to do without diapers during the wakefulness period. Even up to a year, you should not keep the child in a diaper all the time. Only during a walk, a trip to visit or a clinic.

Nocturnal enuresis in boys

Boys always strive to establish themselves, they want to seem strong, independent. Not everyone succeeds. If such a child lacks confidence, determination, he begins to feel flawed. He develops complexes, he becomes nervous.

This character most often develops when a child is under strong pressure from adults. If a mother orders to do something, often unreasonably forbids doing things that are pleasant for the child, the baby cannot openly express dissatisfaction. Enuresis in such cases occurs as a reaction to rudeness or protest against prohibitions.

By changing the way you communicate with your child, you can eliminate the psychological cause of the disease. The child needs a warm attitude, protection of loved ones, their support.

Enuresis should be spoken of as a painful condition if the boy urinates frequently during the day. Accompanying symptoms are slow pulse, inhibited mental condition, pale legs and arms, low temperature. The behavior of the child is characterized by extreme states. He is quick-tempered and impulsive, then closed and depressed.

The boy behaves timidly, insecurely, attention is scattered. Neurosis-like enuresis is successfully treated with complex therapy - sedatives, diet. Hypnosis, physiotherapy, reflexology, acupuncture are also used.

Enuresis can be a consequence surgical intervention. The most frequent operations in boys are removal of the inguinal or, circumcision and others. In any case, the sooner the disease is detected and treatment begins, the more effective it will be.

The upbringing of the boy should be harmonious. Both parents should stick to the same line in this matter. Disagreements and contradictions between them lead to inadequate behavior of the child. He takes the side of the parent, who allows everything and does not scold under any circumstances. Therefore, a demanding mom or dad, who teaches to restrain himself when urged and run to the toilet to stay clean, seems to the baby angry and unfriendly.

Protesting against their demands, he pees in his pants. He begins to like to annoy and annoy the "right" adults. A full-fledged upbringing consists in an attentive attitude to the child, his needs, requirements. You need to establish contact and trust with him. The kid needs to feel that he is loved. Then he will want to respond in kind, to be good.

Enuresis in girls can also be associated with psychological problems.

Character change in a child with enuresis

To begin treatment, it is necessary to persuade the child, who is ashamed, to admit his trouble even to his mother, to go to the doctor. Children morally suffer greatly from enuresis, great importance has delicacy and patience loving parents. If the child feels ridicule or irritation, he will withdraw, will avoid peers, will consider himself inferior.

Treatment. How can you help your child cope with illness?

• Follow the instructions of the doctor, monitor sleep and nutrition.
• The child should fall asleep and wake up at the same time. Before going to bed, it is advisable to take a walk in the fresh air.
• Active games, TV and computer in the evening should be excluded. They can be replaced with calm board games, by reading.
• The foot of the bed should be slightly raised.
• Do not scold the baby if the bed is wet again in the morning. Support him with a joke, cheer him up. Tell him that soon the disease will pass.
• Limit drinking in the evening. Kefir, milk, fruits have a diuretic effect. They can be replaced with salted nuts, a piece of cheese. Salt helps retain water in the body.
• Do not deny your child travel, travel, visits. Sometimes in a different environment, the child stays dry at night.

A few practical tips:

• if it is difficult for a child to go without drinking for 3-4 hours before bedtime, do not focus on this, do not prohibit drinking, just reduce portions;
• sometimes children do not get up at night because they are afraid of the dark. Place a pot next to the crib and leave the night light on in the nursery at night;
• if you wake the child up at night to go to the toilet, bring him fully conscious. Otherwise, the enuresis reflex will only strengthen;
• do not wear diapers at night;
• if the child is old enough, treat him like an adult. Let him himself, preferably without witnesses, make his wet bed, take a shower himself;
• start a diary with your child in which you will mark dry and wet nights (draw a sun or a cloud there, if there are more and more “sunny” nights, praise him). The diary will prove to be very useful for the doctor when choosing treatment methods.

Treatment of enuresis with medications

The question of prescribing drugs can only be decided pediatrician. He will determine the cause of the disease and choose drugs for treatment - adaptogens, antidepressants, nootropics .

Children do not like injections and pills. The medicine Adiuretin-SD is available in the form of drops in the nose. It reduces the amount of urine and allows you to keep it until the morning. It is indicated for children in whom the rhythm of urine accumulation is disturbed. During the daytime it is less than at night.

Medications are prescribed in courses. After the end of the reception, the problem may return. The doctor recommends the duration and frequency of courses. Such a remedy must be taken by the child when he is among strangers, in a children's camp or trip. He will feel more confident.

It is impossible to choose a medicine for the treatment of enuresis. The reason may be an inflammatory process, a cold, an infection, which should be treated not with nootropics, but with antibiotics. Self-treatment of enuresis is prohibited!

If the nervous regulation of the bladder is disturbed, and it is in good shape, then Driptan is used. It relaxes the walls of the bladder, thereby increasing its volume. This drug is combined with Minirin.

To activate the muscle tone of the bladder, the doctor prescribes Minirin + Prazerin.

To activate the processes in the brain, it is recommended to take Nootropil, Picamilon, Persen, Novopassit and a complex of vitamins.

Other treatments

Physiotherapeutic procedures consist in exposing the bladder to ultrasound, currents, and heat treatment (paraffin or ozocerite).

Folk remedies for enuresis

Herbal infusions:

• mix hawthorn, horsetail, mint, St. John's wort in a ratio of 4:1:2:2. 3 art. l. collection pour 0.5 liters. boiling water and insist. Take 100 g 5 times a day;
• equally mix knotweed, St. John's wort, chamomile, mint, yarrow. Brew in the manner described above;
• useful for making infusions are lingonberry leaves, dill, thyme.

A set of special exercises

Exercises are aimed at developing control over the process of urination. The child must learn to restrain himself when necessary. To find out the volume of the bladder, the child is asked to delay the process when he urges. Then measure the amount of urine. This will be the volume of the bubble. In the evening, ask your child to imagine that the bladder is full and he wants to go to the toilet. Then send him to urinate.

It is better to accompany all procedures with jokes and perform, if possible, in a playful manner. If something does not work out or the child refuses to do the exercise, do not insist. Return to him when the patient is in the mood.

Treating nocturnal enuresis in a child requires a lot of love and patience. Help your child cope with a serious illness for him. A positive attitude will speed up healing. And eliminate the obvious causes of the disease.

Useful video about the treatment of nocturnal enuresis in children

Answers

Urinary incontinence is a common problem in children. By the age of 5 years, about 15% of children do not always hold urine. Most of these children have isolated or monosymptomatic urinary incontinence - nocturnal enuresis.

Monosymptomatic, nocturnal enuresis is divided into primary and secondary forms:

Primary is the form of enuresis, in which the child did not have a history of a period of "dry" nights. Children who have a history of "dry nights" lasting more than 6 months have a form called "secondary" enuresis.

Primary monosymptomatic nocturnal enuresis has a high rate of spontaneous resolution and is thought to be due to one or a combination of the following:

Secondary nocturnal enuresis is often thought to be caused by a high level of stress (divorce of parents, the birth of another child in the family, etc.) during a vulnerable period in the development of the child's bladder control system. However, the exact cause of the development of secondary enuresis remains unknown.

Treatment of secondary nocturnal enuresis involves finding the underlying stressor if it can be found, although most children with secondary enuresis have no obvious reason and are treated in the same way as for primary enuresis.

Fluid control

This method consists in having parents monitor fluid intake throughout the day. For those patients who are found to consume a disproportionate amount of fluid during the evening hours, restrictions on various regimens may be recommended. Some authors recommend that patients consume 40% of the daily volume in the morning (from 7 am to 12 pm), 40% in the afternoon (from 12 pm to 5 pm) and only 20% in the evening (after 5 pm), and drinks consumed in the evening should not contain caffeine.

Such a scheme is fundamentally different from the complete ban on drinking in the evening, usually practiced by parents, to prevent enuresis. Complete restriction of evening and night drinking, without compensation in the morning and afternoon hours, can be harmful to the child and usually does not achieve the desired goal.

In contrast, the proposed fluid intake program allows the child to drink as much as he wants during the day. Sufficient fluid intake in the morning and afternoon reduces the child's need for fluids in the evening. In addition, it increases daily urine volume and may promote bladder exercise.

Treatment of enuresis with "urinary signaling"

This method is the most effective in the treatment of nocturnal enuresis. A special device is used. The "alarm" is activated when a sensor placed in underwear or under sheets comes into contact with moisture. The wake-up mechanism is usually an alarm clock and/or a vibrating belt or pager.

The method works through the creation of a conditioned reflex: the patient learns to either wake up to empty the bladder at night, or delay urination at night. When performing this method, sometimes the child is not able to wake up from the sound signal or vibration of the device, in which case, the parents must wake the child themselves at the sound of the signal.

The family should be instructed that the child is solely responsible for the alarm device. Every night before going to bed, he personally checks the device, repeats the sequence of actions at night if the device works. This sequence is as follows: the child turns off the signal, gets up, empties the bladder to the end in the toilet

NB! Only the child should turn off the device.

He returns to the bedroom, wipes the humidity sensor with a wet, then with a dry cloth (or replaces it, if provided by the design), reboots the device and prepares for further sleep. Clean bedding and underwear should be prepared in advance by the bed. If necessary, parents should help the child with the change of bed linen. Must keep a diary of dry and wet nights. The system of rewarding the success of the child should be applied in the same way as described in the previous methods.

The device should be used continuously until 21 to 28 consecutive dry nights have been achieved. This usually occurs between 12 and 16 weeks with a range of 5 to 24 weeks. The child should be examined by a doctor one to two weeks after the start of using the device and at the end of 8 weeks of use. If necessary, urinary alarm therapy may be restarted (more than 2 episodes of nocturnal enuresis within 2 weeks).

Approximately 30% of patients discontinue urinary alarm therapy for a variety of reasons, such as skin irritation, anxiety from other family members, and/or parents refusing to get up for their child at night.

Children who, due to an increase in episodes of enuresis after the end of alarm therapy, are forced to use the device again, have much higher success rates of the second course of such therapy, due to the creation of an initial effect by the first course.

alarm clocks

It is also possible to train the child for planned nighttime urination using an alarm clock. The conducted studies showed sufficient effectiveness of this simple method, which allowed the authors of the study to recommend the method as a therapy option.

Drug treatment of enuresis in children

Self-medication and errors in the dosages of drugs are unacceptable and can cause serious harm to the child, up to a threat to life.

So. There are two main groups of drugs used for nocturnal enuresis.

1. Desmopressin preparations (minirin, etc.). It is a synthetic analogue of the antidiuretic hormone, and through a number of mechanisms reduces urine production for several hours after administration. Introduced only inside

IMPORTANT: In 2007, the FDA banned the administration of intranasal desmopressin due to rare but extremely serious complications of this drug when administered in the intranasal form.

Important! While taking the drug, the child must certainly limit fluid intake in the evening (see below)

Desmopressin preparations are very expensive and many families will simply not be able to afford.

In addition, sufficient bladder capacity is required for their effectiveness (i.e., exercises aimed at increasing bladder capacity should be applied before prescribing the drug). The drug must be carefully "titrated", that is, increase the dose individually, starting with small ones and choosing the dose that is optimal for a particular child. The dose is changed by the doctor about once every 10 days, the full selection of the dose takes about a month.

If a child, say, is planning a trip to a children's camp, and the problem with nocturnal enuresis is acute, parents should consult a doctor (pediatric urologist) at least 6 weeks in advance, so that the right dose is correctly selected and has the maximum effect.

What is the effectiveness of the drug? With the correct selection of the dose, 25% of patients at the time of admission completely get rid of episodes of nocturnal enuresis, 50% significantly reduce its frequency. However, as with tricyclic antidepressant therapy, discontinuation of the drug causes a return to the previous frequency of enuresis in 70% of patients.

Side effects of proper desmopressin therapy are rare. The most serious side effect is dilutive hyponatremia, which occurs when a child takes a lot of fluids before bed. Therefore, the child should take no more than 240 ml of water per evening and not take liquid at night. If the child forgot, or for objective reasons, took a large amount of water in the evening (SARS, intestinal infection ...), then treatment with desmopressin must be interrupted.

2. Tricyclic antidepressants. (imipramine, amitriptyline, etc.)

The mechanism of action of these drugs is:

• reduced sleep time
• stimulate the secretion of vasopressin (antidiuretic hormone)
• relaxation of the detrusor (muscles of the bladder, which slightly increases the "working" volume of the bladder)

The dose of the drug is selected by the doctor, gradually. This may also take 4-6 weeks. If after the selection of an adequate dose (or the maximum age dose) within three weeks no clinical improvement is visible, the drug is canceled.

What is the effectiveness of TAD therapy?

Varies in different studies. Approximately 20% of children have a complete clinical improvement (estimated as 14 or more dry nights in a row), the rest of the children have a decrease in the frequency of episodes by an average of 1 "wet" night per week. After discontinuation of the course of TAD therapy in 75% of patients, the symptoms return to the initial level.

Side effects of this therapy?

• Approximately 5% of children treated with TAD have neurological side effects: irritability, personality changes and sleep disturbances.
• These drugs are under special scrutiny by the FDA because of their ability to increase the risk of suicide, especially in teenagers with depressive moods.
• The most severe side effects may develop from of cardio-vascular system: violation of contractility and conduction of the heart muscle, especially in case of overdose.

The advantage of this therapy is its relatively inexpensive cost.

Much less effective and less evidence-based

other methods of drug therapy:

3. Indomethacin in suppositories.

One small randomized controlled trial showed that indomethacin suppositories increased the number of dry nights in children over six years of age with primary nocturnal enuresis after a three-week course of treatment. No side effects were identified in the study. Proposed mechanism of action: the drug removes the physiological inhibitory effect of prostaglandins on the production of vasopressin and improves bladder function.

Complementary and Alternative Treatments for Enuresis

Research on complementary and alternative treatments for primary nocturnal enuresis, such as hypnosis, psychotherapy, and acupuncture, shows that a positive effect is observed in a very limited number of cases.

CONCLUSIONS:

Monosymptomatic nocturnal enuresis is a common pediatric problem with a high spontaneous cure rate. Most cases do not require initiation of therapy before the age of 7 years.

Various therapies are available, but none used alone is effective (reflecting the multifactorial nature of pathogenesis). Any therapy must begin with the child's willingness to participate and the parents' awareness that bedwetting episodes are completely unconscious and unintentional on the part of the child. Treatment should be designed so that its potential harm does not exceed the expected benefit.

Simple behavioral methods (such as motivational therapy, bladder training) are usually used first, but more serious methods need to be applied when the child is under social pressure and his sense of self-esteem suffers.

Urinary alarm therapy is the most effective and long-term method. Control of fluid intake and bladder training may be useful complementary methods. Drug therapy may be effective for a short-term effect by allowing the child to schedule social interactions with peers, such as visiting children's camp or a slumber party with friends.

The above recommendations apply to the treatment of children with primary monosymptomatic nocturnal enuresis. Parents of children under 7 years of age who, on examination, are found by a physician to be unable to assume the responsibility of treatment, should be assured of a very likely spontaneous cure for enuresis. As soon as the child is able to take some of the responsibility for enuresis therapy, it is recommended to start simple methods treatment. These include keeping a record of dry nights, bladder training, and controlling fluid intake (see above).

"Urinary alarm" or drug therapy should be used in children who do not respond within 3 to 6 months of behavioral therapy. "Urinary signaling" is preferable to pharmacotherapy, because the effect persists for a long time after stopping the course of treatment and because this method is associated with a lower risk of adverse reactions.

Oral desmopressin is an effective short-term alternative to "urinary signaling" when the latter is ineffective. It can be used as an addition to "signaling" or as a short-term method for use at a children's camp or overnight stay. Fluid intake should be limited 1 hour before and for 8 hours after taking desmopressin.

Tricyclic antidepressants are an effective short-term treatment for nocturnal enuresis. However, the high relapse rate and potentially serious side effects make them less attractive than urinary alarms or desmopressin therapy. Nocturnal enuresis can usually be treated by a local pediatrician. However, children with intractable enuresis should be consulted by a pediatric urologist and nephrologist.

The problem of urinary incontinence concerns many children. This disease is called enuresis, and boys are much more likely to suffer from it. Enuresis in boys is diagnosed more often by 2-4 times than in girls. According to medical statistics, 12-14% of children under the age of 5 years are affected by this disease. The percentage decreases with age: 8% at 7 years old and 2% at 12 years old.

If a child wakes up in a wet bed in the morning, is it possible to judge the disease only on this basis? To answer, we must recall some features of child physiology. And urination is a physiologically complex process. In newborns, it is reflex, i.e. involuntary. Control over this process is created in the child in the process of growth, gradually. A baby at the age of 1 year begins to feel (feel) the filling of the bladder. Urination "in an adult way" is formed in children at 2.5 or 3 years. It contributes to:

• an increase of almost 6 times the bladder;
• the emergence of control over the muscles involved in this process;
• acquiring the ability to inhibit the urination reflex.

Therefore, it is worth worrying about bedwetting in a child only after 3 years. Enuresis in young children under three years of age is not a pathology at all, this situation is rather the norm. The largest number urination disorders falls on the period between 4 and 7 years. Exactly how differently children develop skills to speak, walk, etc. on their own, just like in different ages urination control skills appear.

We can talk about the acquisition of such skills if the baby himself can recognize the urge to urinate and report it to adults, and can also voluntarily withhold urine, “endure”. The connection between the brain of children and the bladder is formed slowly, in the early years it is not yet developed. Boys develop more slowly as the nervous system matures later - hence more cases of enuresis.

According to statistics, even at the age of 3 years, 70% of babies acquire the ability to control urination, 75% achieve this at 4 years old, and at 5 years old, 80% of children can safely sleep dry all night and wake up to pee.

Enuresis is distinguished between nocturnal and daytime. Rarely, but the combination of these two types is also found, which indicates more serious violations in the overall development of the child. But more often, a doctor (urologist, nephrologist) is treated for only nocturnal urinary incontinence. Urinary incontinence is usually divided into primary and secondary. Primary - these are situations when the child does not wake up to empty the bladder. The secondary is a consequence of other diseases (cystitis, diabetes mellitus, mental illness, diseases of the central nervous system, etc.) and manifests itself regardless of sleep.

Causes of enuresis

The reasons why bedwetting occurs are both direct and indirect, physiological and mental. Here are just some of the factors that influence the development of the disease:

• diseases of the genitourinary system, various, congenital or acquired, its anomalies;
• delayed development of the central nervous system;
• disorders of the lumbar sections of the spinal cord that control the functioning of the bladder (spinal enuresis ");
• abuse of disposable diapers, the use of which delays the development of a conditioned reflex;
• psychological (emotional shock, prolonged traumatic situations for the child):
• sleep disorders (difficulty falling asleep, restless sleep, too deep sleep);
• heredity (close relatives suffered from alcoholism, epilepsy, psychopathy, etc.).

In psychological terms, the type of boys who lack self-confidence and courage is very characteristic. In response to too firm demands, for example, mothers, reproaches, they develop enuresis as a kind of protest. Treatment is prescribed taking into account all the prerequisites and reasons.

enuresis symptoms

The main symptom, of course, is involuntary urination and frequent urination. But a number of other symptoms also appear that affect the central and autonomic nervous systems. It can be:

• slow heart rate, lower body temperature, blue extremities;
• isolation and depression, timidity and indecision, irascibility, decreased attention.

If this disease develops as a secondary one, then the child may even experience some pain when urinating. The problem of urinary incontinence in a child will be solved much faster if you do not delay the first visit to the pediatrician, who, after a preliminary examination, will refer you to a more “narrow” specialist: urologist, nephrologist, endocrinologist, neuropathologist. The main thing is to start treatment on time.

Diagnostics

To make an accurate diagnosis, it is very important to correctly describe the whole picture of the development of enuresis. For the doctor, information about the course of pregnancy, childbirth, the presence of injuries in the child, and the diseases that he suffered will be important. The doctor should tell about the attitude of the child himself to this problem, how people around him react to it. Before visiting a doctor, it would be good for parents to try to keep a diary for several days, where they reflect the course of the disease.

Whatever the causes of urinary incontinence, the doctor will most likely prescribe an ultrasound examination of all abdominal organs, necessarily a blood and urine test. If necessary, other studies are also used: X-ray, electroencephalography, cystography, urography, etc.

Treatment

Enuresis is usually treated at home, unless urinary incontinence develops in the background of another acute illness. Urinary incontinence should be treated comprehensively, using both medication and folk remedies, physiotherapy and psychotherapy. And once again we recall that we can talk about the disease and its treatment only after the child is 3-4 years old.

Based on the diagnosis, the doctor decides which medications the child should take. When the cause is formulated as insufficient maturity of the nervous system, nootropic drugs are prescribed that are able to normalize the metabolism that occurs in brain cells (Cortexin, Pantocalcin). If the causes are in the overactivity and irritability of the bladder, drugs will be prescribed that help block the activity of the muscles of the bladder - Oxybutynin (Driptan). If a small patient has polyuria (production of an increased amount of urine), treatment is carried out with Minirin tablets or Presignex spray. Antibiotic treatment (Supraks, Augmentin, Furamag, Kanefron N) is carried out when enuresis is caused by a urinary tract infection (pyelonephritis, cystitis).

In addition to medicines, children suffering from enuresis are also prescribed physiotherapeutic procedures. A fairly good effect is observed after applying paraffin applications to the pubic area.

Psychotherapy

An important role is played by psychological therapy, which, in turn, uses a variety of techniques and methods: color therapy, autogenic training, etc. There is even dolphin therapy - healing through communication with dolphins. The psychotherapist conducts special sessions, the purpose of which is to free the child from the complexes that develop in connection with the problem of urinary incontinence.

Parents can give a child a lot to help with medical treatment:

• create a friendly, calm environment in the family;
• never scold a child for a wet bed;
• before going to bed to stay with the child, help to avoid noisy games, watching TV;
• to learn with the child a special autogenic training;
• do drawing with the baby, which has a beneficial effect on the psyche;
• put the child on a fairly hard bed;
• avoid hypothermia, which can aggravate the situation;
• monitor the diet (limit fluid intake in the evening).

Boys tend to be more important than girls to get approval from their parents. They already have a desire to achieve independent results, a desire for competition, just at the genetic level. Therefore, in overcoming this illness, the psychological support of the father is very important for the boy.

Folk remedies

In the treatment of enuresis, it is necessary to use and folk remedies, you can treat with their help at home. Effective for the treatment of nocturnal urinary incontinence is the use of numerous herbal preparations. Collections of medicinal herbs are prepared in the following sequence: the necessary dry herbs are crushed and mixed, then 1-2 tablespoons are poured into 1 liter of boiling water and insisted overnight in a thermos.

It is necessary to take fees before meals for 100-200 ml. Herbs can add bitterness, not every child will drink them with pleasure. To improve the taste, it is permissible to add honey, jam, sugar. All folk remedies give effect only after long-term use, therefore, fees should be taken in courses lasting up to four months. After a break of two weeks, you can change the collection and continue treatment again. Fees for the treatment of enuresis are prepared from the following herbs:

• grass knotweed, mint, St. John's wort, centaury, birch leaves, chamomile flowers;
• chamomile flowers, arnica, thyme grass, yarrow, St. John's wort, shepherd's purse, dill fruits, lingonberry leaves;
• herb knotweed, lungwort, St. John's wort, centaury, cuff leaves;
• elecampane root, mint herb, horsetail, motherwort, wormwood, yanetka, meadowsweet flowers, fireweed leaves.

In the above traditional medicine recipes, all components are taken in the same parts.

Other treatments

As you can see, in the fight against enuresis, you can use a lot of traditional, traditional, and alternative medicine. It is possible to treat this problem with the help of acupuncture massage. And the “enuresis alarm clock” device, which you see in the photo on the right, may be of interest to boys if it is popular and accessible to them to tell everything. This device is easy to use: the sensor is attached to the underwear and when the first drops of urine appear, the signal drops. The following chain is formed: urine output - signal - awakening - going to the toilet, which contributes to the gradual development of a conditioned reflex.

As a rule, subject to all the recommendations of the doctor, by the age of 12, the problem of urinary incontinence can be parted.

Enuresis in children is a common phenomenon, and it is not always possible to establish its exact extent, because due to the special delicacy with the problem of such a plan, mothers are often embarrassed to contact a pediatrician.

Nevertheless, the problem exists, which means that there are methods to get rid of it. This is told by the famous doctor Evgeny Komarovsky.

About the problem

Enuresis in medicine is called a type of urinary incontinence, prone to relapse and most often occurring at night, that is, in a dream.

According to some reports, up to 20% of five-year-olds write in their sleep, up to 15% of seven-year-olds, and even about 5% of teenagers. Most often, sleep incontinence occurs in boys, among all children with such a problem, about 60% are assigned to the share of small representatives of the stronger sex.

Enuresis should not always be considered a disease, says pediatrician Yevgeny Komarovsky. Most often, this is a manifestation of insufficient maturity in childhood of the central nervous system and individual receptors that control the processes of urination.

The statistics in Russia are disappointing - up to 30% of parents punish and scold their children for episodes of bedwetting. And this is much worse than enuresis itself, Komarovsky believes.

No punitive pedagogical methods can't solve the problem, which has nothing to do with the conscious actions of the baby. What happens at night is involuntary, happens on its own, and therefore the child is not to blame for anything. Nonetheless, nocturnal enuresis can not be ignored With the right actions, parents can help the baby cope with this unpleasant problem.

Kinds

To understand how serious everything is, you need to answer the question of what kind of enuresis the baby has.

There are primary and secondary incontinence:

• primary the problem is called if it has always taken place, almost from birth;
• secondary enuresis is a condition that has arisen after some traumatic events, illness, after at least a six-month break in night “incidents”.

Most often, eight out of ten children have the primary form. In addition, enuresis is monosymptomatic, when the only manifestation is wet sheets and pajamas in the morning, and polysymptomatic, when the child experiences very frequent urge to urinate during the day. The polysymptomatic form occurs in about 15% of babies.

According to the time of day, daytime, nighttime and combined enuresis are distinguished. The vast majority of children (at least 85-90%) incontinence occurs only at night.

The reasons

Dr. Komarovsky believes that the main cause of childhood nocturnal enuresis lies in the immaturity of the central nervous system, and it is quite difficult to influence the process of its maturation. But at a certain time, when the nervous system matures, there will be no trace of the problem. According to this scenario, everything goes well for 85% of the guys.

• Doctors have long paid attention to the fact that children whose parents wrote in their sleep, with a probability of 50 to 75%, will also suffer from enuresis. But even if the parents never, even at the most tender age, did not suffer from this, the risk of developing incontinence is still from 15 to 20%. Komarovsky emphasizes that this can happen to absolutely anyone.
• As a concomitant symptom, enuresis can occur with various diseases of the nervous system, with problems with hormones and the health of the urinary system, and also with some mental disorders.
• Neurotic enuresis can be a response of the nervous system to experienced stress, psychological trauma (occurs in about 5% of cases), endocrinopathic enuresis is a consequence of a hormonal imbalance, for example, children with severe obesity, as well as those with diabetes. Epileptic enuresis is one of the symptoms of epilepsy.
• Enuresis can develop after serious illnesses, after inflammatory diseases of the urinary tract (for example, after cystitis or pyelonephritis). The causes of "night troubles" may be a neurogenic bladder and some anomalies in the structure of the organs of the urinary system.

Komarovsky emphasizes that neither the fact that the child reveals itself in a dream, nor the presence of any particular food in the diet affect the frequency of manifestations.

Official statistics say that up to 95% of cases of enuresis do not have the pathological causes that we have listed. The child is examined, but no abnormalities are found in him, which confirms the version that the predominant reason still lies in the age-related characteristics of the nervous system.

When asked at what age a child should normally stop writing at night, Dr. Komarovsky replies that it is quite natural if the problem persists up to 5-7 years. Daytime enuresis should normally resolve by 4 years of age. But the rules are rather arbitrary.

How is it manifested?

Most often, enuresis is manifested by single or repeated urination at night. A baby may not pee every night and, according to Komarovsky, it is the dynamics that play an important role - how many dry nights there were per month at 3 years old, at 4 years old and beyond. Normally, dynamics should be present, and it should be positive. Most often, children are written in the phase of deep sleep, in the first half of the night.. After emptying the bladder, they do not wake up.

If enuresis in a child is complicated, then daytime problems are added to nighttime urination: the baby often or rarely goes to the toilet for little need, the urine stream is weak. Quite often, children are characterized by increased nervous excitement, suffer from nightmares or other forms of sleep disturbance. With a neurosis-like form, there may be delays in the development of speech, stuttering, tics.

How to find the reason?

Yevgeny Komarovsky advises parents to cast aside false shame and turn to a pediatrician with a problem. If necessary, the pediatrician can involve narrow specialists for help - a urologist, neurologist, endocrinologist or child psychiatrist.

It will help the doctor a lot in establishing the true cause of the child's parental diary of urination. It is recommended to keep it for at least a few months.

In a special notebook, you need to note the number of dry and wet nights, as well as indicate the total number of urination per day and circumstances. For example, on that day I got sick with the flu or went to the circus, where I got a lot of new impressions.

Of the diagnostic tools and methods, a general urinalysis and a clinical blood test, biochemical tests, urine bakposev will be useful and informative. To exclude anatomical problems, an ultrasound of the bladder, ureters and kidneys is done. Other methods may also be prescribed: cystometry, sphincterometry. For special indications, ureteroscopy or cystoscopy, as well as an x-ray of the bladder, may be prescribed.

Treatment

Treatment will depend on the cause identified. One child is shown hormonal therapy, and the other - the use of sedatives and psychotherapy sessions (from the age of 10).

• In all forms, it is recommended to teach the child Be sure to go to the toilet before going to bed. Komarovsky recommends limiting the baby's fluid intake in the afternoon. In the first half of the night, you can wake up the crumbs in order to land him on the potty.
• Very effective, according to Komarovsky, is the so-called motivational therapy. It includes rewarding the child for every night that passed in a dry environment. Encouragement can be anything - toys, sweets, going to the park or zoo.

• Food has no effect whether the little one pees in bed at night or not, says Dr. Komarovsky. Therefore, there is absolutely no reason to give a child salty foods before bedtime, as some experts in the field of alternative medicine advise. After salty, the child, on the contrary, will want to drink, and the circle will close.
• To train the bladder is an interesting measure, but ineffective, according to Komarovsky. But if parents have the time and desire, then they can set aside a little time for such training, it will not be worse for sure. They consist in be patient a little from the moment the child asked for a potty. 1-2-3 minutes will be enough to gradually teach the child to endure. This usually helps to get rid of daytime incontinence, but it has no effect on nocturnal involuntary enuresis.
• Recently, so-called urinary alarms. Komarovsky considers them a useful and effective device. Such devices consist of a sensor and the actual alarm clock. The moisture sensor is placed in underpants, and when the first drop appears, it sends a signal to the alarm clock, as a result, the child wakes up, interrupts urination and goes to finish everything on the potty.