Enuresis: what is it, causes and methods of treatment

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 very concept means, in Greek, “urinating”. ICD-10 defines enuresis as follows: involuntary persistent daytime and / or nighttime urination not of age.

Enuresis is a disease that manifests itself in a dream. This becomes a problem when a child reaches 5 years of age, and it is so important that even the International Society for the Retention of Urine in Children (InternationalChildrenʼsContinenceSociety - ICCS) was created.

What is ICCS enuresis? This is inappropriate 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 the 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 be anxious about this and interested in eliminating these episodes.

What 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 of adults and peers, all kinds of humiliating censure. Often they become isolated due to the expressed psychological discomfort and difficulties in social adaptation. 94.5% of enuretics are children; 4.5% are teenagers and only 1% are adults. But in general, half a percent of the world's population suffers from enuresis. In boys, this phenomenon occurs 2 times more often, and the same advantage persists in adults.

Provocative factors

What is enuresis in an adult? The causes are degenerative changes in the genitourinary system, the brain, abnormalities of the urethra or the bladder itself, and urolithiasis. But that is 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 pelvis. More rare causes: its appearance during apnea, especially in obese people, all types of diabetes, thyroid dysfunction, taking some sleeping pills that give you deep sleep.

Reasons for Men

In adults, the causes of enuresis and treatment are: the postoperative state of the prostate, as well as hormonal age-related changes in this organ, when the muscles of the small pelvis weaken. It has an impact on the development of pathology and Parkinson's disease, as well as MS (remitting CNS disease), stress, alcohol.

Causes of ailment in a child

Causes of childhood enuresis can be:

1. Immaturity of regulation of the central nervous system and urinary tract. The biological chain for transmitting a nerve impulse to emptying has not yet been formed.
2. Psychosomatics of enuresis - psychological reasons include psychological trauma, nervous strain, fear, sleep disturbances during the age crisis (3 and 7 years old) due to asthenia, overly strict upbringing, and neuropsychiatric disorders. Also the reason is attention deficit hyperactivity disorder, tics, hysterical reactions.
3. The causes of childhood enuresis are a delay in psychomotor and neurological development: cerebral palsy, anomalies of the central nervous system, pathology at the chromosome level, organic pathology that developed after injuries and infections, intoxications. These children suffer from psychomotor as a whole, they later walk and talk later than their peers.
4. Psychosocial factors: children from poor families, in boarding schools, with alcoholic parents, etc. It is noted that the formation of the hormone vasopressin, which increases urine production, is often increased in these children.
5. Hereditary burden, especially in the male line. If 1 of the parents suffered, the risk of enuresis increases 3 times, if both - 5 times.
6. Violation of the production of antidiuretic hormone (ADH). If it is not enough at night, the volume of urine increases greatly.
7. Congenital and acquired abnormalities of the genitourinary system: narrowness of the urethra or openings of the foreskin in men, insufficient bladder capacity, etc.
8. Kidney infections.
9. Enuresis can be a manifestation of epilepsy, because in this case it enters the epiprippal 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 signal to wake up to empty the bladder.

Secondary enuresis is a consequence of congenital and acquired diseases. It is preceded by a period of normal urination, when for more than six months the nights were dry, the child himself woke up to go to the toilet. A mixed variant is also distinguished - a combination of immaturity and provoking factors.

Enuresis is also divided into combined and isolated, mono-and polysymptomatic. Isolated called enuresis only at night. When combined - both night and day. Monosymptomatic enuresis - the absence of other concomitant pathologies.

For reference: young men with enuresis are not accepted into the army.

Main symptoms

Symptoms of enuresis are manifested in sleep disturbances (shallow sleep, very deep, difficult awakening, etc.), delayed physical and mental development, nightly episodes of urinary incontinence, nervousness and increased irritability of the child, shyness. Episodes can be rare, but permanent, with different frequencies.

More often this is characteristic of the first half of the night, in the phase of deep sleep. In this case, a wet child does not wake up.

Some children with enuresis are characterized by constipation or fecal incontinence, emotional lability, increased anxiety and sensitivity, isolation, stuttering, tics, fears.

Treatment of enuresis in children and adults

Treatment of pathology is determined by the cause. It is divided into drug and non-traditional. This includes regimen, psychotherapeutic, physiotherapeutic methods, etc. But any kind of therapy excludes self-medication.

Drug treatment

How to treat nocturnal enuresis with a neurologist? The approach is only individual and comprehensive. It includes:

1. Restoration or development of the reflex to awakening when urging to urinate - in children, it occurs already with a urine volume of 100 ml.
2. Stimulation of the metabolism in the central nervous system for the maturation of all levels of the biological chain that regulates urination.
3. In case of neurosis, its correction (the appointment of tranquilizers, for example, Atarax).

In other cases, the most widely used nootropics are the most effective drugs for enuresis. What do they give:

• stimulate metabolic processes and improve cerebral blood flow;
• increase glucose utilization and microcirculation;
• are neuroprotective in case of brain damage;
• with hypoxia and intoxication, they improve the integrative activity of the brain;
• have an antiplatelet and antioxidant effect;
• reduce the tone of the vessels of the brain;
• reduce tension, anxiety, fear;
• increase efficiency;
• improve memory and attention;
• reduce vasovegetative manifestations in the form of headache, irritability, emotional lability.

Moreover, they are low toxic.

The most popular nootropics are hopantenic acid and its derivatives (Pantogam, Pantocalcin, Gopantam), Glycine, Piracetam, Phenibut, Picamilon, 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 prescribed by the doctor. It can be combined with vitamins and sedatives. But polypharmacy is not welcome, many drugs are not always good.

If the cause is insufficient bladder capacity, antispasmodics and anticholinergics are prescribed. The most famous and often prescribed because of its effectiveness is "Driptan" (oxybutynin hydrochloride). "Driptan" is a cure for spasmolytic enuresis. Its use will relax the bladder by relieving detrusor spasm. This increases its volume, which in turn reduces the number of contractions of this muscle and prevents the bubble from emptying uncontrollably. Urine stays in such a bladder longer. The drug has many analogues, the most famous is Spazmeks. Helps well in adolescence. It enhances its effect when combined with amitriptyline and with anticholinergics. 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 is a synthetic analogue of vasopressin. Used for children over the age of 6 years, with diabetes insipidus, nocturia, etc.

"Adiuretin" from the same group. Available in tablets and nasal drops.

"Imipramine" - is effective only in half the cases, and its result is unstable, often gives relapses. It is an antidepressant. It is dangerous for its cardiotoxic effects. Today it is almost never used.

Phytotherapy

Alternative treatment of enuresis in children is not universally welcomed, although it is widespread. His opponents 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 the mistake is the belief in the benefits of such a natural treatment. But, nevertheless, with the permission of the doctor, herbs such as chicory, wild strawberry flowers, fragrant violet, lemon balm, peppermint, centaury, knotweed, birch leaves, chamomile, burdock, and wheatgrass roots can be used with enuresis.

Physiotherapy

With physiotherapy, the doctor takes into account the cause of enuresis and the type of impaired functions of the bladder. They can be hypo- and hypertonic. The latter form is more common, and here they use techniques with an antispasmodic effect that will relax the spasm detrusor:

1. Electrophoresis of cholinolytics (Atropine, Platifillin, Eufillin, etc.), antispasmodics, paraffin therapy in the form of applications on the lower back or bladder region, ultrasound paravertebrally on the region of 2 and 3 of the lumbar vertebrae. They restore the normal conductivity of the signals to the detrusor.
2. With hyporeflex neurogenic dysfunction, with detrusor hypotension, its stimulation is effective (myostimulants). These include diadynamic currents (DDT), SMT therapy (sinus-modulated currents), electrophoresis of cholinomimetics (with Proserinum, Galantamine) to the bladder zone.
3. 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 Shcherbak galvanic collar are widely used.
4. Balneotherapy - salt-coniferous, valerian, oxygen, pearl baths at a temperature of 35-37 ° C.
5. Mud therapy (peloid therapy) in the form of applications.

Regime activities - 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 stiff and even bed;
• in deep sleep, the child needs to be turned over several times overnight on different sides;
• eliminate hypothermia and drafts in the bedroom;
• ventilate the room just before bedtime;
• 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 complete awakening;
• a night light should be lit in the bedroom so that the child is not afraid of the dark.

Tips for parents with enuresis in a child

What to do to parents:

1. The situation in the family should always be calm to the maximum, especially in the evenings. All games exciting, activating the child, television programs, the computer are excluded.
2. You can not scold and punish the described baby, it will not do anything, except for complexes.
3. 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 a child to sleep on his back, and the foot end of the bed can be slightly lifted to somehow restrain urination.
4. Going to bed at the same time is important.
5. It is better to eat and drink 3 hours before bedtime. At the same time, products with a diuretic effect (milk, strong tea, coffee; juicy fruits - watermelon, melon, apples, strawberries) are excluded. For dinner - boiled egg whites, stewed fish or meat, weak, slightly sweetened tea. Some adults on the Krasnogorsk diet eat something salty at night to wake up at night (a slice of salted herring, bread and salt, cheese). It’s better for the child not to use it.

Do I need to wake the baby at night to empty the bladder?

The child should be awakened at night, and he should be aware of this so that there is no negative reaction. Some parents plant a sleepy child on the pot, but then the reflex is not produced. The kid should not only wake up, but also go to the pot or toilet and go back himself. Out of pity, carrying the sleepy baby to the toilet and vice versa is pointless. There will be no reflex, and in the morning the child will not remember that he was carried on the pot at night. If the baby has already wetted himself, you should definitely wake him up and change clothes.

For schoolchildren apply “scheduled awakening":

• The first week the child is awakened every hour after falling asleep.
• In the following days, the sleep interval is gradually increased (wake up after 2 hours, then after 3, then only once at night).
• Such treatment lasts a month. If necessary, repeat the course.

Children do not tolerate such an awakening, they do not get enough sleep and fall asleep in the classroom. Therefore, it is better to deal with such treatment during the holidays.

Alarm method has long been a method of awakening. This is the use of enuresis alarm. There are no side effects. Efficiency - 80%, and relapse in only 30% of children. Urinary alarms interrupt sleep immediately as the first drops of urine appear. In the underpants is a sensor that sends an alarm. Then the child can immediately get up and run to the toilet. He turns off the alarm himself. A reflex to self-awakening with a full bubble will gradually form.

Efficiency in children - 90%, adults - 50%. Specialized sheets, mattress covers, diapers for adults, and urinary alarms are similar. You can purchase them on specialized sites. This makes life convenient, and the patient does not feel flawed. He can go on a visit with an overnight stay, to a camp, etc.

Technique - Bladder Training

Helps moderately. If the child wants to pee, he is invited to wait a minute, then go. The bladder is gradually training.

Psychotherapy

Psychotherapy for neurotic disorders is carried out by children's psychotherapists. Use suggestive and behavioral corrective approaches. Since the age of 10, the use of affirmations is effective. The child, before going to bed, for 10 minutes, repeatedly repeats the “formulas” of self-awakening when urinating to urinate in the form of a whole biological chain. He says: “I want to always wake up in a dry bed. While I sleep, urine is firmly locked in my bladder. When I want to write, I will wake up myself. ”

Family therapy

Parents should be tolerant and follow the rules:

1. The child should not be ashamed or punished.
2. The regime of his day should be rational.
3. The child should avoid unrest - positive and negative.
4. He should not watch horror films, run and play noisy games before going to bed.
5. It is necessary to tune the child to recovery and instill in him faith in his own strength.

Motivational therapy

It is quite effective (80%), but is applicable after the age of 6-7 years in babies with safe intelligence. Parents introduce a system of rewards for their “dry” nights in the form of toys and prizes. This is done taking into account the desires of the child himself. 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 ability to fill the bed and change underwear himself after he has described himself. This creates a reflex to the comfort of a dry bed. The negative relationship in this case is the inverse. The baby himself tries to avoid enuresis.

How to teach a child a potty

This can be practiced after 6 months, when the child has already learned to sit. First, he stays on the pot for 1-5 minutes, and at the same time he should be encouraged with the idiomatic expressions “letter-letter” and “aaa” in order to develop a conditioned reflex. And then the children themselves make these sounds, asking for a pot. When the child is safely emptied, it is necessary to praise him. Under 2 years of age, children should not be scolded for wet panties. Even older children need only to give a soft understanding that it is better to ask for a pot.

Enuresis Prevention

Preventive actions:

• do not use diapers after 2 years;
• instill in the child the habit of an evening toilet;
• do not drink abundantly at bedtime;
• treat urinary tract infections in a timely manner.

So, what to do with the enuresis to the parents of the baby? It is important to achieve a wake-up reflex, activate the maturation of the regulation of urination with the use of nootropics and other drugs, and correct the neurotic manifestations of psychotherapy.

Reviews about the treatment of enuresis are as follows: Picamilon helps the children, a sheet with a battery, psychotherapy and homeopathy, hypnosis, bladder training. Some parents say that nothing helped until they changed their place of residence, reached adolescence, and then everything went without any treatment. Among adults, good reviews were received with the appointment of "Ovestin", "Picamilon", "Minirin", "Driptan".