Incontinence in children at night: Causes, What to do, Treatment, General recommendations

One of the main medical and psychological problems of preschool children is a “wet bed”. Enuresis (this is the name of this problem) is a fairly common problem in children over the age of 4 years. Both the child and his parents are often embarrassed, upset by this problem, hesitate to consult a doctor and, at times, miss precious time.

Enuresis - this is urinary incontinence - a common disease in children, most often it occurs in children aged 4-7 years, and in boys 2-4 times more often. Pathology of enuresis is considered in children older than 3 years.

Dear parents! Many believe that it is better not to fix the attention of the child on his problem, so as not to injure the psyche. This is the wrong position. In no case can not blame the baby, but explain that it will be better for him, and that his parents are ready to solve the problem with him, definitely worth it. First of all, you need to calm the baby. He should know that you parents do not judge him. After all, if a child does not understand why he wakes up wet in the morning, fear first appears, then shame, and there it is not far to a serious psychological trauma.

Urination is a complex physiological process. As the child grows in parallel with the skills of movement, control is gained over the mechanisms of urine excretion and the release of the bladder. From 1.5 years of age, the majority of tots acquire the ability to feel the filling of the bladder. Control of the cerebral cortex over the nervous centers of urination regulation is established between 3 and 5 years of life. In this regard, most cases of urination dysfunctions occur at the age of 3 - 7 years.

When urinating, the muscles in the bladder contract. And the muscle that blocks the entrance to the bladder and is responsible for holding the urine relaxes, which leads to emptying the bladder under relatively low pressure. In newborns and children of the first months of life, urination is involuntary, reflex, they cannot control the locking muscle.

As a child grows when forming an adult model of urination (by 2, 5 - 3 years), 3 factors matter:

- increase the capacity of the bladder (6 times) with a decrease in the frequency of urination,
- acquisition of control over the muscles and mechanisms of urination,
- the appearance of inhibition of the urethral reflex.

In the first months of life, urination in a child is very frequent, this process is still almost not controlled by consciousness. By the end of the first - the beginning of the second year of life, “hiking in the small” becomes less frequent, the bladder gradually develops and reaches the desired size. For three years, the process of formation of the functions of the bladder ends. There is no cause for concern if the baby asks for a pot 7–8 times during the day and his bladder “sleeps” at night.

Proceeding from all this, one can speak about the presence of enuresis in a child only after he has reached the age of four or five years. Up to this age, urinary incontinence can be considered normal.

Parents need to remember that the ability to independently control urination is formed in children at different ages. Just as at different times, children begin to walk, talk and dress on their own. Most babies, namely, 70 percent begin to control the work of their bladder by three years, 75 percent - by four, and by five years, 80 percent of children are able to hold their urine during the night and wake up in a dry bed to get up and pee.

Day and night enuresis are usually distinguished, and there is also a combination of daytime incontinence and nighttime incontinence.But this usually indicates serious problems in the health and development of the baby and is found in pediatric practice, to the great joy, quite rarely. The main problem still lies in the wet bed at night. This is the main reason for contacting a pediatric nephrologist or urologist.

Still distinguish primary and secondary enuresis. Primary enuresis is manifested by urinary incontinence at night, during sleep, when the child does not wake up when the bladder is full, while secondary enuresis occurs due to various congenital and acquired diseases and can occur independently from sleep, both during the day and at night.

Causes of Enuresis

The causes of enuresis are varied: changes in the brain, disturbances in sleep and wakefulness, deficiencies in education in the form of excessive freedom or excessive severity, neurotic conditions at home - family conflicts, quarrels, etc. A patient with enuresis should sleep on a hard but warm bed. During sleep, legs and waist should be wrapped warmly.

Experts identify a sufficiently large number of reasons for the development of enuresis, and in most cases, children combine several of them at once. Recently, it was concluded that this disease may even be hereditary. If someone in the family has already suffered from enuresis, and there have been cases of neurosis, psychopathy, alcoholism or epilepsy, then the risk of enuresis in a child increases 6 times.

The cause of enuresis can be a disease of the genitourinary system or anomalies of its structure. For example, a child may be diagnosed with inflammation of the urinary tract or bladder. Or it will be found out that he has insufficient bladder capacity for his age. Anomalies in the structure of the urogenital system can be either congenital or acquired - for example, as a result of injury or surgery. Sometimes in this case it is impossible to do without the appropriate surgery and long-term treatment. Often in this case, the child experiences pain when urinating. If a child complains of pain, you should immediately consult a doctor, and best of all, a pediatrician who will tell you which specialist (urologist, nephrologist, neuropathologist, endocrinologist) should show the child first.

The cause of enuresis can be a slow pace of physical development. If the baby is lagging behind his peers in height and weight, then the development of his central nervous system is also delayed, and she exercises control of urination in the body. This is possible if the mother had complications during pregnancy and childbirth, which led to early organic brain damage. In addition, such children are, as a rule, overly excitable, quickly overworked, and are characterized by increased tearfulness. For them, incontinence-provoking factor may even become a common acute respiratory viral infection or intestinal infection. Therefore, such a child should be protected in every possible way from situations that traumatize the psyche, and try to harden from an early age.

Another cause of urinary incontinence can be a dysfunction of the lumbar segments of the spinal cord responsible for the functioning of the bladder. This is the so-called "spinal enuresis." It is associated with autonomous regulation of the bladder, practically does not depend on any external factors and differs in its monotonous character. The treatment of this type of enuresis is done by a nephrologist, urologist or neurosurgeon. To make a diagnosis, first of all, a snapshot of the lumbar spine is taken, which helps doctors find out the essence of the disease and decide the question of treatment tactics - medication or surgery.

Experts believe that another widespread use of disposable diapers has recently become another cause of enuresis.The fact is that the urination of newborns occurs automatically, but already at six months the baby feels anxiety before wetting the diaper, and discomfort after the bladder is already emptied. In addition, parents also pay attention to the fact that for emptying the bladder there is a pot that you need to use if you want to stay dry. Therefore, some children begin to use pots already from one year old or a little later. Using a diaper, parents no longer worry so much about getting the child to potty. And the baby himself no longer feels discomfort from a wet diaper. Therefore, the formation of a conditioned reflex in a child is delayed. For the same reason, according to experts, the number of children suffering from enuresis has recently increased. Doctors recommend not to wear diapers all the time, but to wear them for a short time - for a walk, a visit, a clinic or a store.

Very often, the causes of enuresis can be purely psychological. This is the so-called neurosis-like enuresis. It can occur in a perfectly healthy child after some emotional shock or a prolonged traumatic situation. It can be a strong fright, getting used to a fundamentally new environment, for example, if a child went to kindergarten, school or family moved to a new apartment. Here is a typical example. In the family where there is already a child, another baby was born. By this time, the elder was already accustomed to the pot. Attention to the eldest child by the parents is weakened before birth. All are focused on the health of the mother, and after the birth - on numerous concerns related to the care of the newborn. In addition, the mother who has just given birth takes some time to restore the spent forces. The child feels abandoned and defenseless, so he returns to the stereotypes of behavior characteristic of the younger age, including incontinence, and thus unconsciously seeks to attract the attention of parents, to return their love and care. There are many options here, it all depends on the specific situation.

Often neurosis-like enuresis leads to the fact that children become timid, suspicious, fearful, unsure of themselves or, conversely, irritable and quick-tempered. Neurosis can also manifest stuttering or ticking. Experts have a considerable number of ways to help a child with neurosis-enuresis. This combination of drugs that strengthen and soothe the nervous system, and a special diet, as well as hypnosis, physiotherapy, reflexology, acupuncture. However, for the success of treatment, first of all, a calm atmosphere in the family and the most active participation of both parents in it is necessary.

Often, children with enuresis may experience sleep disturbances, which are considered by some specialists as the main cause of this disease. In some cases it is the difficulty of falling asleep, with restless superficial sleep, and in others - excessively deep sleep with awakening disturbances.

Enuresis can also be a consequence of insufficient or improper upbringing in children of the skills of tidiness or the occasional fixing of the reaction of emptying the bladder in unacceptable conditions for this. Proper education of children in neatness skills may not be possible if parents adhere to completely opposite educational approaches: one of them treats this without proper attention, with indifference, and the other, on the contrary, shows excessive harshness and even punishes the child for “offense.” And if the first the situation is quite understandable, the second one needs clarification. , and becomes a form of a kind of protest against the mother, whose attitude seems to be unfriendly and evil. As a child grows up, such a child can even enjoy this behavior, because it upsets and annoys the mother. the fact that children who are long-term in institutions are more likely to wet the bed than children living at home.

To calm the parents, it must be said that the most common cause of enuresis is a certain immaturity of the nervous system and the bladder. It is as if the system of transmitting information to the brain that the bladder is overfilled and needs to wake up does not work.

However, the problem persists, and parents need to develop a course of behavior towards a child suffering from enuresis. And above all - to go to a doctor as soon as possible, because the effect of treatment directly depends on the duration of the disease: the less time the child is sick, the more effective the treatment will be. First of all, this is a psychological problem, since enuresis necessarily forms the inferiority complex and social impairment of the child. And the longer he suffers from enuresis, the more insecure, withdrawn, shy and vulnerable he becomes. And that means - the harder it is for him to believe in himself and take the road to recovery.

Enuresis and character.

For many children, regardless of age, enuresis, like any long-term illness, causes a sense of inferiority. Even the smallest hard to experience this problem. Being embarrassed by their healthy peers, they often strive for solitude, withdraw into themselves in order to avoid ridicule and disgust of others. The feeling of insecurity often appears or is aggravated in kindergarten or at school age and can lead to the development of low self-esteem, rejection of oneself, up to the complete inability to learn and realize in various areas of life. Children who have long been incontinent, under the influence of experiences in some cases, change in nature. Some become more aggressive, others become more timid, indecisive, isolated, fenced off. There are those who, at first glance, are not worried about their illness at all, but they can manifest various changes during adolescence.

What can parents help?

First of all - follow the daily routine of the child and follow all the recommendations of the doctor.

It is important to develop a stereotype of behavior before bedtime. You need to go to bed and wake up at a certain time. A few hours before bedtime, it is recommended to exclude games, TV. It is advisable a short walk before bedtime. Undesirable soft bed. It is recommended to slightly raise the foot end of the bed.

Never scold or punish a child for a wet bed. He is already punished by his illness and is experiencing no less than yours. In addition, the fear of punishment suppresses the child and only worsens the situation. It should be remembered that the fact of involuntary urination inhibits the psyche of the child and can not be aggravated. It is necessary to instil in the child that his illness is a temporary phenomenon and to stimulate his active desire for recovery in every way.

Try to ensure that the life of your child is no different from the life of other children, despite his problem. For example, you should not refuse any trips to nature, to visit, to rest with the whole family. Firstly, changing the situation often contributes to the fact that the child is less likely to wake up wet than at home. Secondly, it is quite possible for parents to solve a similar problem on a trip, but the child will not feel defective and guilty.

It is recommended to limit the intake of fluids in the evening and at night, filling the right amount of drink in the morning and after lunch.

As a rule, doctors advise, first of all, to limit the intake of fluids in the second half of the day, the last of them can be no later than 3-4 hours before bedtime. In the evening, you need to abandon kefir, milk and fruit. First, they contain a lot of fluid. Secondly, they have a diuretic effect. It is better to offer the child a piece of cheese, herring, pickled cucumber, a few spoons of honey or some salted nuts.This will help retain fluid in the body and prevent it from overflowing the bladder. At the same time, sharp substances and artificial flavors should not be present in the food.

This measure is sometimes able to help, but in some cases it becomes the cause of everyday suffering for both children and parents, only exacerbating the tension, the reaction to which can become the main manifestation of the problem. If a child is stimulated to maintain such a diet, this method can be successful; if not, then it is better not to prohibit the child from taking liquids.

Before going to bed, be sure to remind your child to go to the toilet, and in the last hour it is desirable to do this several times. You can put a pot next to his bed if he suddenly wakes up. Many children are afraid of the dark, and fear can prevent them from getting out of bed at night. Therefore, do not forget to turn on the nightlight in the children's room for the night (very small power, less than 25 W, and blind).

You can wake the child at night so that he went to the toilet and stay dry, and you need to try to determine at what time the child has urinary incontinence and wake him up just in time. If you decide to wake the child up at night, you need to wake him up, fully bringing him to consciousness, otherwise you will only fix the mechanism of enuresis.

There are so-called enuresis alarms - this is a small device that attaches to the underwear of a child and when it gets wet from the first seconds of urination, it gives a signal with a sound or vibration, causing it to wake up. This reinforces the conditioned reflex to urinate. But keep in mind that it is necessary to periodically change the type of signal in order to wake up the reflex specifically for urination, and not for a specific sound or vibration.

The child in any case can not be punished. Of course, he does not do it on purpose and suffers in no way less than his parents. You should also not wear diapers for the night.

If the child is so big that he can serve himself, it is possible to invite him to take a shower in the morning, to make the bed. But this should be done calmly, without irritation and hostility. Such an attitude will help the child to calm down, feel the support and love of the parents, show him that he is not alone in his misfortune. Practice shows that in some cases it is enough to change the model of relations between the child and the parents in order to get rid of the problem.

The reward system for waking up dry has a good effect. Start a calendar with your child, where he himself will mark “dry” and “wet” nights. You can do this as follows. With the help of parents, the child keeps a special diary, which is filled daily. “Dry” and “wet” nights in it are marked with special icons (for example, a child draws a sun or a cloud). It is explained to the child that if he achieves that there will be more “dry” nights for a certain period than “wet” ones, or five or ten times in a row, he will receive a prize. Of course, it is better for parents to approach this procedure creatively and to take into account the child’s individuality. And information about the frequency of enuresis, collected in such a diary, will be extremely useful for the doctor.

From the very beginning of the treatment of enuresis, special exercises for training urination act are useful, aimed at developing a conscious feeling of fullness of the bladder and fixing mechanisms that ensure confidence in independent control of urination.

There are several such exercises. For example, a child is asked to restrain his urge to urinate as long as possible, after which he must measure the volume of urine given (it will correspond to the volume of the bladder, which is important for the doctor to know). Exercise is carried out daily. It is especially effective if enuresis is associated with a small bladder capacity.However, if a child has pain when performing an exercise, then it should not be performed, but you should immediately inform your doctor.

After a sufficient exercise of the conscious desire to urinate, they switch to the complication of this exercise: after a long restraint of urination, the child is asked to start urinating and to suspend it, to start again and to suspend again. In some cases, after these simple exercises, it is possible to achieve the termination of enuresis.

If there is no improvement or the child is unable to perform these exercises for any reason (this may be due to mental retardation), then you can use the nightly awakening method on a schedule. During the first week, the child is awakened every hour of sleep, starting at midnight. In the future, he will be woken up only once per night, some time after falling asleep, which is chosen so that the child does not wet himself for the remainder of the night. This period of time is gradually reduced from three hours to two and a half, two, one and a half and finally up to one hour after falling asleep. If the episodes of enuresis are repeated twice a week, then the cycle of single nightly awakenings is repeated from the time point equal to three hours after falling asleep.

Such techniques can also be very effective. Every evening, before falling asleep, the child for several minutes tries to imagine the feeling of fullness of the bladder and the further sequence of its own actions. He goes to the toilet and urinates.

You can also repeat the child several times slowly just before going to sleep with the goal of a child’s self-suggestion, for example: “I want to always wake up on a dry bed. While I sleep, the urine is firmly locked in my body. When I want to pee, I will quickly get up ".

Strive to save the child from traumatic situations, create a calm atmosphere in the family. Clarification of family relationships and conflict resolution should occur only in the absence of a child. Get rid of your adult problems.

Dress the child according to the season, excluding hypothermia and wet feet. The common cold can often aggravate the situation.

In the evening and before bedtime, avoid noisy, exciting games, long sitting in front of a computer or TV. It is better to offer your child some quiet games, reading books, drawing or coloring pictures.

Doctors recommend a fairly hard bed (not to be confused with bare boards) in case of enuresis. And if his sleep is very deep, then it is recommended to turn him over in a dream several times.

It is also useful to drink special tea, using equal parts of St. John's wort and yarrow as a tea. It should be taken at breakfast and at lunch. However, remember that this is still medicinal herbs - you should prepare a weak tea, and once a month, take a break for ten days.

When enuresis, in addition to medication should not be neglected psychotherapy. In the fight against urinary incontinence, a variety of its methods are used, including the so-called "dolphin therapy", when healing comes from communicating with dolphins. Dolphins, unfortunately, are not sold in pharmacies, which makes them difficult to access. In any pediatric center, there is a psychologist who will be able to balance the psychological background of the child and prepare him to fight the disease.

A beneficial effect on the psyche of the kid drawing. The younger the child, the more interesting it is for him to paint in gouache paint with thick brushes on large sheets of paper of various shapes, white and colored. Many children like to create pictures with their fingertips or the whole palm. Parents do not always welcome such creativity, dooming kids from an early age to stamps and patterns. But if we are talking about the treatment of enuresis, it is necessary to liberate the child’s thinking as much as possible and relax his body.And in drawing colors with fingers and the whole palm, children most fully reflect their emotional state.

It is quite affordable for parents to conduct an autogenic training aimed at relieving the child’s muscular and nervous tension, creating an atmosphere of calm and relaxation and allowing it to be adjusted to relieve the problem of enuresis. Here is one of the options for conducting such a training for preschool children - in a poetic and soft game form. This game is not difficult either for parents or for children.

Classes should be held every night before bedtime. The duration of the training varies from 15 to 30 minutes. The words of auto-training should be read to the kid in a calm, slow and quiet voice. Over time, when a child learns them by heart, he can conduct a lesson every evening on his own, without the participation of an adult. Before training, you need to learn the name of all body parts with your child. When conducting an evening class, an adult should take care of his inner mental balance. If mom or dad is overstrained or upset, then the lesson should be entrusted to someone close to you, because in a relaxed state, induction (transfer of emotional state) from one person to another is very strong, and the result can be the opposite: the baby will not calm down , on the contrary, perevobitsya. All the words should be pronounced in a soft, calm voice, slowly, with long pauses, and when naming baby body parts, gently touch them with the palm (to the head, knees, feet, and so on). Separate formulas of suggestion are repeated 2-3 times with a change in the logical stress. With proper autogenic training, the baby relaxes and can even fall asleep.

The game "Magic Dream" (autogenic training for children of preschool age in a poetic form).
Now I will read poetry, and you close your eyes. The new game "Magic Dream" begins. You will not fall asleep for real, you will hear everything, but you will not move, but you will relax and rest. Listen carefully to the words and repeat them to yourself with your inner speech. Whisper is not necessary. Rest easy with your eyes closed. Attention, comes the "Magic Dream" ...
Cilia fall ...
Eyes close ...
We rest quietly (2 times) ...
We fall asleep magically ...
It breathes easily ... smoothly ... deeply ...
Our hands are resting ...
Legs are resting too ...
Rest ... fall asleep ... (2 times) ...
The neck is not strained and weak-le-na ...
Lips slightly open ...
Everything relaxes wonderfully ... (2 times) ...
It breathes easily ... smoothly ... deeply ...
(A long pause is made and words are said to correct the problem):
Today I sleep dry ...
I'll wake up dry tomorrow
The day after tomorrow I'm dry
Because I'm dry ...
How I feel, wake up,
Be sure to wake up!
- Your body is relaxed, but you know that you are sleeping dry ... Tomorrow you will wake up dry ...
- If at night you want to go to the toilet, then you will feel and wake up, you will definitely wake up ...
- In the morning you wake up dry. You are the master of your body and he listens to you.
- You're well done, you sleep dry. If you want to use the toilet, then you wake up, you will definitely wake up and go to the toilet. Your bed is dry. You're doing great, you will succeed. "
I would like to pay special attention to parents: you should not try to independently adjust the mental state of the child with any psychological games. The problem of enuresis in children is quite complex and complex, even if it is not noticeable at first glance. Therefore, it is better to contact the experts. The inept actions of parents can lead to a complication of the situation - the disease worsens and requires more time to heal.

Drug treatment of enuresis

The question of the treatment of enuresis drugs decides the doctor.Depending on the underlying cause of this disorder, which the doctor determines during the examination, various drugs may be chosen for treatment, which belong to the groups of nootropics, adaptagens, antidepressants. Recently, a completely new effective remedy for the treatment of enuresis, Adiuretin-SD (desmopressin, MINIRIN), used in the form of nasal drops, has appeared in our pharmacies. As a result of the action of this drug, nocturnal urine formation is reduced to such a volume that can be retained in the bladder until the morning awakening. This drug best helps children who have violated the daily rhythm of urine formation and accumulate too much at night.

It should be borne in mind that the use of any medication, as a rule, is regulated by a certain period (usually from one to two or three months) and can be resumed after termination of the course of treatment. Therefore, during the year the doctor usually prescribes several courses of treatment. In consultation with the doctor, children are advised to give medicine during travel, trips to the camp, during periods of living together with friends or strangers. Independent use of vasopressin analogues is unacceptable, since nocturnal enuresis in a child can be associated with a completely different pathology, for example, an infection of the urinary system. And this requires the appointment of antibiotic therapy, after which the phenomenon of nocturnal enuresis pass.

If the cause of enuresis is a violation of the nervous regulation of the bladder, with a predominance of increased tone of its smooth muscles, leading to a decrease in the volume of the bladder, DRIPTAN is used. It increases the volume of the bladder and reduces spasm, making spontaneous muscle contractions more rare and eliminating urinary incontinence. In some cases, treatment with MINIRINOM in combination with DRIPTAN is indicated.

With a reduced tone of the bladder, it is recommended to follow the regime of forced urination every 2.5 to 3 hours during the day. It is important that the child empties the bladder before bedtime. MINIRIN and PRAZERIN is prescribed as therapy, which increases the tone of smooth muscles.

To improve the metabolic processes in the brain, as well as in neurosis-like conditions, such drugs as NOOTROPIL, PICAMILON, PERSEN, NOVOPASSIT are recommended. In addition, courses of vitamin therapy are shown (B6, B12, B1, B2, A, E).

The complex treatment of enuresis includes physiotherapy, in the form of effects on the bladder with various currents, ultrasound and thermal procedures (paraffin or ozocerite) regulating the work of the nervous system. Also used for strengthening massage and therapeutic exercises aimed at strengthening the pelvic floor muscles.

In the treatment of enuresis in children, other methods can be successfully used, in particular phytotherapy, physiotherapy, reflexotherapy, psychotherapy. A prerequisite for the success of their application is the high qualification of specialists performing the treatment.

Treatment of nocturnal enuresis is a long process, it takes months and sometimes years, so parents need to be patient.

Psychological

  • Changing the usual conditions (change of housing, school, kindergarten).
  • The tense situation at home.
  • Events that require increased attention and concentration (exams, admission to a new section, performance).
  • Loss of family or separation from relatives.

The psychological factor in the occurrence of incontinence, can sometimes go away on its own after eliminating the annoying factor, but if the reason lies in deep shock, then work with a psychologist is necessary.

  • The immaturity of the nervous system of the child or disruption in her work. The body loses the ability to signal to the brain about the need for emptying.
  • Hereditary factors.Parents who are faced with such a problem as baby urinary incontinence at night should remember their childhood, if they had such a problem. According to statistics, if one parent suffered with nocturnal enuresis, then the probability of its manifestation in a child is 40-45%. In cases where enuresis was observed in the history of both parents, the likelihood of their children is 70-80%.
  • The autumn-winter period and a cool room can trigger bed-wetting.
  • Nocturnal enuresis in a child after 12 years may have a hormonal nature of origin. At this time, children begin adolescence, which entails a lot of changes in the children's body.
  • Disorders of the endocrine system. In addition to involuntary urination, there are also symptoms such as excessive sweating, changes in body weight, and puffiness of the face.
  • Infectious or inflammatory disease of the urinary system.
  • The weakening of the functional state of the kidneys and bladder.

Nocturnal enuresis in a child older than 7 years can be observed due to the high activity of children of this age, high fluid intake and fruit juices, as well as sound sleep. It is necessary to control the regime of primary school students and monitor the use of drinks before bedtime.

What to do

Who should I contact?

First of all, after identifying problems with incontinence in their offspring, it is important to remain calm and not focus the child’s attention on the problem. Many parents believe that if a baby is pointed to a problem or threatened, he will be able to control himself or get up at night. This is absolutely impossible to do. The child will begin to worry even more and, even worse, to be afraid of his mom and dad.

It is necessary to visit your pediatrician, or a family doctor who knows your child from birth, will be able to ask in detail about the causes and factors that could contribute to incontinence.

Further, if the pediatrician considers it necessary or your opinion of this specialist is not enough, consultation of a neurologist and a psychologist will be required.

To relieve anxiety about the situation, a visit to a psychologist must be conducted in a course for at least 1 month. During this time, the psychologist will be able to put together an opinion about the causes of the problem and enter into a relationship of trust with the child.

If problems related to the functioning of internal organs and systems are identified, appropriate specialists and diagnostic measures are appointed.

Treatment for nocturnal enuresis in children does not have protocols of management, since therapy depends on the cause of the disease. Each child must be reviewed by experts individually.

  • With increased bladder tone, drug Driptan is prescribed.
  • With bladder hypotension Driptan + Prozerin.
  • For neurotic reasons, vitamin B supplements, herbal-based sedatives and nootropic drugs (Phenibut, Noofen, Pantogam) are prescribed.

In addition to drug therapy for enuresis, the general recommendation, regardless of the etiology of occurrence, will be a calm home environment, support for loved ones, establishing trusting relationships with adults, the correct mode of sleep and rest for the child.

General recommendations

  • Planning a daily routine for a child, taking into account the time for a daytime sleep or rest.
  • Limit fluid intake and food for 2 hours before bedtime.
  • Bladder training helps the child learn to control the urge to urinate. It is necessary to explain to the baby that, before going to the toilet, it is necessary to hold urine for a few seconds.
  • Motivation for holding night urination. Together with the child, choose what will be his reward for “dry pants”, and in case of failure, support from the adult is necessary and no humiliation is required.
  • Physiotherapy activities.
  • Psychological help.
  • Therapeutic exercises to improve the functioning of the nervous system and stimulate the proper functioning of the nerve endings.
  • Means of traditional medicine. Apply only after consultation with the doctor with the selection of the mode of use and dosage in each individual case.

Enuresis in children. Bed-wetting

This is so unpleasant and embarrassing. Every morning, wake up on a wet sheet in wet pants. The body failed again, the "bell" did not work, and now the kid does not want to go further out of the room, he is ready to fall underground. Unfortunately, this insidious disease can have both medical and psychological reasons. How to help your child cope with the disease?

Enuresis (from the Greek. enureo - urinate) - the term for incontinence. In children, the following forms of this disease are distinguished: bedwetting (it occurs most often, and the article deals with it) and daytime incontinence. There is still permanent urinary incontinence, but it is a completely different disease associated with damage to the central nervous system as a result of injury or infection. Under night enuresis means the presence of a child over 5 years of involuntary urination during a night's sleep. Formation of full control over urination in a child occurs between the ages of 1 and 3 years and ends by four years. Depending on the age and amount of fluid you drink, the number of urinations normally ranges from 7 to 9 per day (no more and no less), and during the night's sleep there is a break in urination. However, in 10-15% of children 5–12 years old this does not happen, and after a night's sleep, they wake up wet. That is, suffer from nocturnal enuresis. As they grow older, the prevalence of this disease decreases, but 1% of children "take" it into adulthood. Moreover, in boys, enuresis occurs 1.5–2 times more often than in girls.

There are two main types of nocturnal enuresis: primary nocturnal enuresis (PNE) - a disease in children who have never woken up steadily dry, and secondary, or recurrent (recurring), nocturnal enuresis - a condition in which patients begin to urinate into bed after a significant period remission (no evidence of disease).

Causes of enuresis

The causes of bedwetting are varied. One of the main factors is damage to the brain of the fetus in the pathological course of pregnancy and childbirth due to hypoxia (insufficient oxygen supply to the brain) or injury. These pathologies contribute to delaying the maturation of the child’s central nervous system and the disruption of hormone production, including vasopressin (see below), which leads to the development of enuresis. Chronic urinary tract infections, impaired neural regulation of the bladder, congenital anomalies of the urinary system, and delayed tidiness skills are also considered to be prerequisites for bedwetting.

Possible exacerbations of nocturnal enuresis, developing on the background of acute respiratory viral infections, hypothermia, provoking infection of the urinary system. Often this occurs in the fall and spring, that is, during a period of unstable weather. Stressful situations in the life of a child can also cause recurrences of the disease.

The mechanism for the development of primary nocturnal enuresis is not completely clear. It is believed that genetic predisposition is an important factor in the development of the disease. Identified certain genes responsible for this pathology. If one of the parents suffered from bedwetting, then the risk of developing enuresis in a child is 45%, and if both are, this probability increases to 75%.

In recent years, convincing evidence has emerged that the main cause of PNE is arrhythmia secretion of a hormone synthesized in the brain (in the hypothalamus) - vasopressin.Its other name is antidiuretic hormone, from which the main function becomes clear: a decrease in urine excretion by the kidneys. Antidiuretic (or anti-diuretic) action of the hormone is necessary to maintain water-salt metabolism in the body.

Normally, the concentration of vasopressin in the blood depends on the time of day: at night it is higher than during the day. Therefore, at night, the kidneys secrete a smaller amount of urine, but with a higher concentration. That is, in healthy people at night, small portions of urine enter the bladder, but do not overfill it, and there is no urge to urinate.

During primary enuresis, the secretion of vasopressin at night is reduced, which leads to an increased formation of unconcentrated urine. Its number exceeds the physiological capacity of the bladder, it overflows, and involuntary urination occurs. Often the parents, apparently from the desire to justify themselves, associate this with the sound sleep of the child. However, it turned out that by the nature of sleep, children suffering from nocturnal enuresis do not differ from other peers.

Another cause of nocturnal urinary incontinence may be disorders of the nervous regulation of the bladder with a predominance of increased smooth muscle tone, and then frequent urination in small portions or abundant rare urination, as well as daytime urinary incontinence are attached to the enuresis. If the bladder tone is reduced, then the child rarely urinates, in large portions, the bladder becomes full, and involuntary urination occurs.

This situation was also noted when children, due to attending various classes and sections, almost fail to drink properly in the morning, and at home, before going to bed, they drink the daily ration of fluid and do not hold urine at night. Sometimes it is also regarded as enuresis.

Required examinations

There is an opinion that there is no need to contact a nephrologist (or pediatrician) with the problem of nocturnal enuresis: a child will “outgrow” him, and 1. Often, a more extensive examination of the urinary system is also required: cystography 2, intravenous urography 3, nephroscintigraphy 4, cystoscopy 1, urofluometry 6. According to the results of the examination, the nephrologist, if necessary, may refer the child for consultation to other specialists, for example, to a neuropathologist, a psychologist or for additional examination in the nephrology or urology department. Only after the cause of enuresis is established can the correct treatment be prescribed.

1 Electroencephalography (EEG) is a study of the brain, based on a graphic recording of its electrical potentials using an electroencephalograph apparatus and aimed at identifying areas of the brain with pathological activity.
2 Cystography - X-ray examination of the bladder, in which a contrast agent is injected into it using a catheter and then three X-rays of the filled bladder are taken at the time of urination and after emptying the bladder. Aimed at identifying abnormalities in the bladder.
3 Intravenous urography is an x-ray examination of the kidneys using an intravenous contrast agent, which allows a series of X-rays to study the shape, size, position and function of the kidneys and the urinary system.
4 Neuroscintigraphy - the study of the kidneys with the help of an intravenous radioisotope that can accumulate in the kidney tissue, which is fixed by the equipment and allows you to find out the volume of the normally functioning kidney tissue and its cup-pelvis system.
5 Cystoscopy - a study of the mucous membrane of the bladder and urethra using an optical device cystoscope.
6 Urofluometry - a study of the ability of the bladder and urinary sphincter (a circular muscle, in the -ustere at the place of transition of the bladder into the urethra and preventing involuntary urination) to hold urine.

Enuresis treatment

Convincing evidence of vasopressin secretion rhythm disturbances during primary nocturnal enuresis was the basis for the use of the synthetic analogue of this hormone - desmopressinwhose tablet form is minirin. Doses of the drug for the treatment of PNE in children from 5 years of age are chosen individually by the doctor, and the medicine should be given at bedtime.

In the treatment of primary nocturnal enuresis, a special drinking regimen should be observed - the last fluid intake should be no less than 2 hours before bedtime. At the same time, the child should receive enough liquid throughout the day.

Independent use of vasopressin analogues is unacceptable, since nocturnal enuresis in a child can be associated with a completely different pathology, for example, an infection of the urinary system. And this requires the appointment of antibiotic therapy, after which the phenomenon of nocturnal enuresis pass.

If the cause of enuresis is a violation of the nervous regulation of the bladder, with a predominance of increased tone of its smooth muscles, leading to a decrease in the volume of the bladder, apply driptan. It increases the volume of the bladder and reduces spasm, making spontaneous muscle contractions more rare and eliminating urinary incontinence. In some cases, treatment is indicated. minirinom in conjunction with Driptan.

With a reduced tone of the bladder, it is recommended to follow the regime of forced urination every 2.5 to 3 hours during the day. It is important that the child empties the bladder before bedtime. As therapy assigned minirin and prozerin. The latter increases the tone of smooth muscles.

To improve the metabolic processes in the brain, as well as in neurosis-like states, drugs such as Nootropil, Picamilon, Persei, Novopassit. In addition, vitamin therapy courses are shown (B6, AT2A b1A b2, A, e).

The complex treatment of enuresis includes physiotherapy, in the form of effects on the bladder with various currents, ultrasound and thermal procedures (paraffin or ozocerite) regulating the work of the nervous system. Also used for strengthening massage and therapeutic exercises aimed at strengthening the pelvic floor muscles.

Treatment of nocturnal enuresis is a long process, it takes months and sometimes years, so parents need to be patient.

In order to prevent disease, it is better to train your baby to use the pot in a timely manner and to ensure that the child regularly and completely empty the bladder. Compliance with the drinking regime is mandatory. It is unacceptable that the child get used to drink before bedtime and at night.

Angela Paramonova, a psychoanalyst psychologist: A true psychological attitude in the fight against any disease is no less important, even a course of medications. And in the case of childhood night, enuresis, this moment is of particular importance. The more accurate and more attentive the adults are to the baby, the less painful the problem will be for the child's emerging personality.

Disease and nature

For many children, regardless of age, enuresis, like any long-term illness, causes a sense of inferiority. Even the smallest hard to experience this problem. Being embarrassed by their healthy peers, they often strive for solitude, withdraw into themselves in order to avoid ridicule and disgust of others. The feeling of insecurity often appears or is aggravated in kindergarten or in school and can lead to the development of low self-esteem, self-acceptance, up to the complete inability to learn and realize in various areas of life.

Children who have long been incontinent, under the influence of experiences in some cases, change in nature. Some become more aggressive, others become more timid, indecisive, isolated, fenced off. There are those who, at first glance, are not worried about their illness at all, but their various changes may manifest themselves during adolescence.

Forms and causes of the disease

Urinary incontinence, as a consequence of the delayed formation of urinary control or the destruction of an already formed function due to organic and infectious diseases or traumatic lesions of the nervous system, is called neurosis-like. The presence of neurosis-like enuresis caused by an organic lesion of the child’s nervous system even during the period of prenatal development does not depend on anxiety and other psychological factors, but is enhanced by fatigue, physical ailments, and hypothermia.

With the destruction of the already formed function, urinary incontinence appears not at an early age, but after a postponed injury (for example, brain damage) or infection (for example, meningoencephalitis - inflammation of the membranes and the substance of the brain). In this case, enuresis is usually monotonous, uniform. In cases where the rate of onset of compensation is slowed down or there are additional negative factors that impede recovery, neurosis-like urinary incontinence can drag on for years and in adolescence sometimes leads to pathological personality formation. In such cases, the doctor may recommend long-lasting sessions with a psychologist during a medical treatment.

The urinary function may also be destroyed due to various psychological causes (due to acute psychological trauma). In this case, talking about neurotic enuresis. This form of the disease can be both short-term and longer. For example, if a child had an involuntary urinary incontinence due to fright. Usually, a neurotic reaction with enuresis lasts for several hours or days and passes as mental stress disappears.

In cases when emotional excitement persists for several weeks and months and painful manifestations are fixed, they speak of a neurotic state. Its causes may be:

  • family relocation from one residence to another, where the child is acutely experiencing the loss of friends and buddies and is faced with the need to adapt to a new kindergarten or school,
  • death of close relatives or acquaintances
  • the birth of a brother or sister in the family,
  • long-term chronic disease of relatives,
  • chronic family conflicts,
  • parental divorce or pre-divorce and post-divorce situation,
  • death of a pet - cats, dogs, parrot.

In such cases, the child is seriously experiencing an internal conflict and his prolonged illness.

A clear dependence on the mental state leads to the fact that the neurotipathic course of enuresis, unlike the neurosis-like disorder, can manifest itself irregularly - either disappear or increase depending on the emotional state of the child. Such enuresis can be flickering and last from several weeks to several months. But the strength of the child’s experiences is very intense. In these cases, a qualified psycho-correction of his internal conflict is effective.

What can adults

It is important for parents to know that enuresis, like any disease, is different for each child. To date, more than 300 independent methods of its treatment are known. Proper recognition of the disorder and individual selection of appropriate methods for each particular baby guarantee complete recovery in the shortest possible time.And the implementation of all the recommendations of the specialist and the prescribed procedures, coupled with the connection of psychological family resources, quickly lead to a lasting positive effect.

Key recommendations for parents:

  1. With a sharply developed enuresis, first of all, it is necessary to eliminate the situation that traumatizes the psyche of the child. Ensure maximum calm in the family, remove the conflict atmosphere, normalize the psychological climate.
  2. Chronic conflict in the family often leads to aggravation of the problem. The child needs to pay more attention: read books together, go for walks, especially before bedtime.
  3. Children suffering from enuresis are given a certain diet and fluid intake: at least 2 hours before bedtime, their amount is reduced or drinking is canceled altogether. It is important to follow these rules and to teach the child to new eating patterns, for example, to limit salty and spicy foods that increase thirst. You can replace the juice, tea, fruit orange slice, apple. If the baby is urging to drink, he can be distracted by something, give a small spoonful of drink. Gradually, this diet becomes familiar to the child and does not cause difficulties in compliance.
  4. If the crumb categorically refuses to sleep during the day, do not make a stressful situation out of laying down. The kid can spend the afternoon in the chair, listening to a familiar tale or cassette.
  5. It is important during the treatment to reduce or temporarily abandon the long watching TV and computer games hobbies, which greatly affect the child's immature nervous system. The book in this case can replace the TV.
  6. Before a night's sleep, it is a good idea to ritualize classes as much as possible, that is, in the same order, perform the same actions with your child every evening. For example, putting toys into place, swimming, telling a fairy tale or a spontaneously contrived story with sequels, fulfilling the evening recommendations of a doctor.
  7. Jealousy for the younger brother or sister is also often the cause of enuresis in the older child. In this situation, parents need to analyze their attitude towards the elder, reconsider, if necessary, his role in the family. Mother, even if she has a newborn in her arms, needs to give the firstborn a little more attention. It may be difficult for him to play the role of an older brother or sister, given by adults. Or maybe he o ^ is not emotionally involved in the relationship of parents with a baby, which causes a burning jealousy. The child wants to feel again small, unique and loved. Some parents put the child enuretic in bed to wake him up at night or take him to the toilet. This is not recommended, as the presence of adults does not allow him to develop the habit of waking up on his own at night. Toddler and parents should sleep in different beds and in different rooms. This contributes to the peaceful sleep of the child and the gradual schooling of him to control his desires or to wake up at night when the toilet urges.
  8. In the evening it is better to refrain from active, energetic games so that the child does not overwork. Before bed, it is better to do board games, such as lotto, mosaic, cubes or constructor. They not only develop the baby, but also stabilize his nervous system.
  9. A beneficial effect on the psyche of the kid drawing. The younger the child, the more interesting it is for him to paint in gouache paint with thick brushes on large sheets of paper of various shapes, white and colored. Many children like to create pictures with their fingertips or the whole palm. Parents do not always welcome such creativity, dooming kids from an early age to stamps and patterns. But if we are talking about the treatment of enuresis, it is necessary to liberate the child’s thinking as much as possible and relax his body.And in drawing colors with fingers and the whole palm, children most fully reflect their emotional state.

Contact your doctor if:

• the child continues to wet the bed after 5 years,
• again began to wet the bed after a long period, when it had already stopped doing it,
• hardly controls the bladder function during the day and at night.

And, of course, you need to strictly follow all the recommendations of the doctor, because you can get rid of this ailment only with the help of a specialist. In any case, it is necessary to take care that the child lives a normal life, does not shun peers, goes in for sports and everything that interests him. With the right approach, nocturnal enuresis is practically no limit to the child. In addition, it is known that with adequate and proper medical care, enuresis is cured or passes on its own with the maturation of the child.

Power of suggestion

It is quite affordable for parents to conduct an autogenic training aimed at relieving the child’s muscular and nervous tension, creating an atmosphere of calm and relaxation and allowing it to be adjusted to relieve the problem of enuresis. Here is one of the options for conducting such a training for preschool children - in a poetic and soft game form. This game is not difficult either for parents or for children.

Classes should be held every night before bedtime. The duration of the training varies from 15 to 30 minutes. The words of auto-training should be read to the kid in a calm, slow and quiet voice. Over time, when a child learns them by heart, he can conduct a lesson every evening on his own, without the participation of an adult.

Before training, you need to learn the name of all body parts with your child. When conducting an evening class, an adult should take care of his inner mental balance. If mom or dad is overstrained or upset, then the lesson should be entrusted to someone close to you, because in a relaxed state the induction (transfer of the emotional state) from one person to another is very strong, and the result can be the opposite: the baby will not calm down , on the contrary, perevobitsya

All the words should be pronounced in a soft, calm voice, without haste, with long pauses, and calling parts of the child’s body, gently touch them with the palm (to the head, knees, feet, and so on). Separate suggestion formulas are repeated 2–3 times with a change in the logical stress.

With proper autogenic training, the baby relaxes and can even fall asleep.

Game "Magic Dream"
(autogenic training for children of preschool age in a poetic form)

"Now I will read poetry, and you close your eyes. A new game, Magic Dream, begins. You will not really fall asleep, you will hear everything, but you will not move, but you will relax and rest. Listen to the words carefully and repeat them to yourself , inner speech. No need to whisper. Rest easy with your eyes closed. Attention, the "Magic dream" comes.
Cilia are lowered.
Eyes close.
We rest quietly (2 times).
Sleep magically fall asleep.
Breathe easy. smooth. deep.
Our hands are resting.
Feet too have a rest.
Have a rest. fall asleep. (2 times)
The neck is not tense and ras-weak-le-nna.
Lips slightly open.
Everything relaxes wonderfully. (2 times).
Breathe easy. smooth. deep. (A long pause is made and words are said to correct the problem):
Today I sleep dry.
I'll wake up dry tomorrow
The day after tomorrow I'm dry
Because I'm dry.
How I feel, wake up,
Be sure to wake up!
Your body is relaxed, but you know that you sleep dry. Tomorrow you wake up dry.
If you want to go to the toilet at night, you will feel and wake up, you will definitely wake up.
In the morning you wake up dry. You are the master of your body, and he listens to you.
You are well done, you sleep dry.If you want to use the toilet, then you wake up, you will definitely wake up and go to the toilet. Your bed is dry. You're doing great, you will succeed. "

Adults should understand that the elimination of enuresis in a child is a painstaking and sometimes lengthy process, but you can only achieve a positive result. with the active participation of professionals and families. Parents are required special tact and respect for their crumbs. After all, in the end, enuresis is cured, you just need to be patient.

I would like to pay special attention to parents: you should not try to independently adjust the mental state of the child with any psychological games. The problem of enuresis in children is quite complex and complex, even if it is not noticeable at first glance. Therefore, it is better to contact the experts. The inept actions of parents can lead to a complication of the situation - the disease worsens and requires more time to heal.

Recipes Vangi from bedwetting in a child

About 2 kg of the watercress (Nasturtium Officinalis R. Br. L.) cook in 10 liters of water. You need to know that this herb is the most healing in May when it is preparing to bloom. Strain the broth, wait until it cools down, and do sit-up trays up to the waist for seven nights in a row before going to bed. The grass taken out of the water should be mixed with pork fat, make compresses - on the first day on the stomach, and the next day - on the lower back. Compress should be kept all night. This recipe Vanga advised to apply only to those who are in the order of the spine. If the vertebrae are too distant from each other, then before proceeding to the baths, in the summer you should do a course of sunbathing, and in front of each bath the child’s lower back should be lubricated with gun oil.

1 tablespoon of seeds of dill garden or ordinary pour a glass of boiling water, close the lid and infuse for 4 - 6 hours, filter. Give the child a drink at one time. The course of treatment is 7 to 10 days.

1 tablespoon of birch buds pour boiling water and infuse for 1 hour, then strain. Give the child a drink at one time. The course of treatment is two weeks.

Pour 50 g of medicinal sage leaves or sage grass in an enamel saucepan, pour 1 liter of cold boiled water, boil for 15 minutes. Insist 30 minutes, filter. Give the child to drink the broth in the form of heat and 1/2 cup 3 times a day. The course of treatment is 10 days.

Fresh shepherd's grass bag mince and squeeze juice out of it. 50 drops mixed with 1 teaspoon of water and drink. And so - 3 times a day. Or prepare a water infusion: 2 - 3 tablespoons of raw materials pour a glass of boiling water, insist 4 hours and give the child to drink 1/3 cup 3 times a day half an hour before meals. The course of treatment is 7 to 10 days.

In the morning and at lunch, give to children in 1 teaspoon of water 30 to 40 drops of pantocrine. The course of treatment is 10 days.

When kidney disease in children, it is necessary to follow a strict diet, eat only corn bread and drink a decoction of corn hair.

You need to put a child to sleep after taking only light food. No need to water it before bedtime.

Take dry coriander and red rose with cut edges of the petals - 15 g each, lettuce seeds and garden portulace seeds - 45 g each, 15% Armenian clay, 3,000 g garnets flower, 1.5 g camphor. At a time to give child 4 g of powder from this mixture.

What is enuresis?

Enuresis is a violation of the ability of the bladder to hold urine.

In most cases, the disease is diagnosed in children 5-7 years.

Boys are at particular risk. Pathology due to the negative impact on the brain of certain factors (natural or pathological causes). In some cases, enuresis is considered normal.

What age is considered normal?

The process of formation of the genitourinary system in a child continues until about four years old.

In rare cases, urinary incontinence is not a deviation in five-year-olds.

If enuresis occurs in children older than five years, then this factor is an alarming signal. This condition will not be the norm.

In the event of nocturnal enuresis, diagnosis of the disease should be carried out. as soon as possible.

What are the reasons?

Nocturnal enuresis in children may occur under the influence of not one but several factors at the same time. For example, if an allergic reaction is combined with constant stressful situations or infectious diseases are complemented by exacerbations of diabetes.

The intensity of the symptoms and the general condition of the small patient also depend on the specific factor that provoked the pathology of the urogenital system.

Provoke The following factors can cause night enuresis:

  • damage to the nervous system during fetal development,
  • genetic predisposition
  • progression of urological diseases
  • effects of stressful situations
  • bladder injuries
  • infectious lesion of the genitourinary system,
  • violation of sleep and wakefulness,
  • exacerbation of diabetes,
  • complications of allergic reactions
  • hormonal changes in the body,
  • the effects of pyelonephritis,
  • excessive sensitivity of the psyche,
  • congenital or acquired brain disease,
  • spinal cord pathology.
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Can you talk about any diseases?

Enuresis that occurs in children over 7 years of age always indicates the progression of pathological processes in the body.

In this age group of patients, the urogenital system must be fully formed.

Spontaneous urination at night may indicate diseases of the nervous system, damage to the body by infections or other factors that relate to the causes of the development of this symptom.

Night enuresis in medical practice is divided into two main categories - primary and secondary form diseases.

In the first case, a small patient has a violation of the connection between the brain and the urogenital system (the child does not wake up when there is a desire to empty the bladder).

Secondary enuresis is a consequence of physiological or psychological factors.

This kind of pathology develops against the background of existing deviations in the work of the internal systems associated with the bladder.

Types of nocturnal enuresis depending on the reasons:

  • stressful,
  • mixed,
  • dysplastic,
  • urgent,
  • epileptic,
  • neurotic,
  • endocrinopathic,
  • neurosis-like.
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The main symptom of nocturnal enuresis is spontaneous urination in a child. during sleep.

Additionally, the baby may show signs of concomitant diseases that provoke such a condition.

The overall clinical picture depends on the individual characteristics of the child’s body and the presence of abnormalities in the functioning of the internal systems.

Incontinence may be accompanied by by signs:

  • restless sleep
  • pain sensations of various locations,
  • signs of overexcitement of the child.
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What if accompanied by encopresis?

Encopresis is a fecal incontinence. In combination with enuresis, this pathology indicates the presence of abnormalities in the internal systems of the child.

The most common causes of this combination are diseases of the digestive, nervous, urogenital systems and the brain.

If night enuresis supplemented daytime incontinencethen provoke this pathological condition can not only related diseases, but also the emotional exhaustion of the child.

Ignore the symptoms of urinary incontinence or feces can not in any way. The only exception is the presence of such symptoms in newborns and infants.

If there is a suspicion that the baby’s bowel and bladder emptying happens too often, the visit to the doctor should be carried out as soon as possible.

Diagnostics

Participate in the diagnosis of nocturnal enuresis pediatrician, neurologist, urologist and psychologist.

Each of the specialists makes an individual clinical picture of the health condition of a small patient and makes his own conclusion.

To identify hidden pathologies and more detailed examination child is assigned a set of laboratory and instrumental studies.

The following methods are used for diagnostics:

  • general and biochemical analysis of blood and urine,
  • Ultrasound of the bladder and pelvic organs,
  • electroencephalography,
  • nephroscintigraphy.
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Treatment tactics

How to treat a child? The scheme of treatment of nocturnal enuresis depends on the causes of the pathology and the degree of progression of the factors that provoked a malfunction of the bladder. Self-medication in this case should be excluded.

If you treat enuresis, but not get rid of the cause of the disease, then there is a risk of complications, leading to irreversible consequences.

In the treatment of enuresis, doctors use physiotherapy procedures, certain categories of drugs and psychotherapy.

Medicines

The list of drugs for the treatment of nocturnal enuresis is selected depending on individual clinical picture health condition of a small patient.

The key role is played by the factors that provoked the pathology, the degree of progression of existing diseases, as well as the level of the baby’s immune system. Make a regimen of therapy should a qualified specialist.

Examples of drugsused in enuresis in children:

  1. Preparations based on the hormone Vasopressin (Minirin, Driptan).
  2. Alternative drugs (Gelzemium, Pulsatilla).
  3. Soothing means (Persen, Nootropil).
  4. Preparations for reducing the amount of urine (Adiuretin-SD).
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Physiotherapy

Physiotherapy treatments are considered integral part of therapy nocturnal enuresis in children.

Techniques belonging to this group, not only reinforce the effect of medicines, but also carry out powerful prevention of complications and recurrence of pathology.

Based on the individual clinical picture of the health status of a small patient, the doctor determines the need to assign specific types of procedures.

Examples of physiotherapyused in enuresis:

  • electrophoresis
  • magnetic therapy
  • circular shower,
  • acupuncture,
  • electrosleep.
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Psychotherapy

Methods of psychotherapy used in the treatment of enuresis, if the pathology has arisen against the background of psycho-emotional abnormalities The child has.

Specialists can use various techniques to improve the self-esteem of a small patient, to teach him self-control, to eliminate the effects of stressful situations and other factors that have a negative impact on the psyche of the child.

Additionally, the doctor conducts a conversation with parents and makes recommendations on how to create optimally favorable conditions to speed up the process of recovery of the baby.

Folk remedies

Alternative medicine prescriptions are not used in children with enuresis. main type of therapy.

Folk remedies can only be used as a supplement to medicines, physiotherapy and psychotherapy.

The selection of recipes takes into account the individual characteristics of the child's body. If a small patient has susceptibility to allergic reactions, it is necessary to exclude potentially dangerous components from the list of ingredients.

Examples of folk remedies for the treatment of enuresis:

  1. Dill infusion (pour a glass of boiled water over a tablespoon of dill, insist the preparation for an hour, take the remedy in the morning and on an empty stomach, a single portion should not exceed half a glass).
  2. Rosehip infusion (two tablespoons of rosehips should be poured with a liter of boiling water, it is recommended to use a thermos for the procedure, the preparation should be infused for several hours, regular use of the infusion in small portions will help strengthen the nervous system of the child).
  3. Medicinal Fee (in equal parts, mix chamomile, St. John's wort, peppermint and birch leaves, two table boats of the mixture pour a liter of boiling water and insist for several hours, the infusion of the child should take half a glass twice a day before eating, you can add a small amount of honey improve taste properties.

Is surgery necessary for hydronephrosis in children? Find out the answer right now.

Opinion Komarovsky

Dr. Komarovsky draws the attention of parents to the need correct diagnosis of the causes of nocturnal enuresis.

This pathology is the result not only of physiological disruptions in the body, but also a sign of a malfunction of certain parts of the brain, as well as the nervous system of the child.

To provoke bed wetting may any psychological factor. In determining the causes of enuresis, it is important to take into account such a nuance and try to objectively evaluate the atmosphere in which the baby is raised.

Based recommendations of Dr. Komarovsky The following conclusions can be drawn:

  1. Excessive use may provoke nocturnal enuresis. diapers.
  2. It is impossible scold the child for bedwetting (such actions will lead to additional complications).
  3. Independent disease enuresis to be can not (pathology is a concomitant symptom of failures in the internal systems of the body).
  4. Enuresis can eliminate by myself (for example, if it was caused by the immaturity of the child’s nervous system).
  5. The tendency to enuresis in a child may occur due to fear of the dark (baby is afraid to go to the toilet and tries to keep urine until the morning).
  6. The cause of enuresis definitely need to find out comprehensive examination little patient in a medical facility.
  7. A good addition to basic therapy is adherence to a special diet (the diet should not contain products with a diuretic effect, for example, chocolate, cocoa, juicy fruits, carbonated drinks).
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Prevention

Preventive measures to prevent enuresis are aimed at control of the urogenital system baby

The baby should be taught to the pot in a timely manner, eliminating the abuse of diapers. If there are symptoms of bladder infections, a baby should be examined as soon as possible.

Transferred enuresis implies special parenting to the prevention of its recurrence.

  1. Control programs that the child watches on TV and computer games (excluding their negative impact on the child’s psyche).
  2. Creating a favorable atmosphere in the family (you can not quarrel with a child, excessively scold the child, subject the child's psyche to constant stress, etc.).
  3. Control of sleep and wakefulness (from an early age, the child should be taught to wake up and fall asleep at the same time).
  4. At night, the child should not consume excessive amounts of fluid (otherwise incontinence will occur).
  5. All infectious and viral diseases should be treated promptly and fully (special attention should be paid to the treatment of infections of the urogenital system).

Enuresis can trigger serious complications that violate the child’s quality of life. The disease has a negative impact on the psyche of the baby.

The child may become withdrawn, indecisive and prone to various phobias. Treatment of enuresis should be carried out as soon as possible after its detection.

Recommendations on the diagnosis and treatment of glomerulonephritis in children can be found on our website.

ABOUT the reasons and treatment of nocturnal enuresis in children in this video:

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Types of enuresis

Varieties of the disease are determined by the formation of the “watchdog” reflex, when a person wakes up when there is a desire to go to the toilet, as well as other negative factors that trigger the development of the symptom.

Not a disease per se. It is observed in all children and passes without special treatment in the first years of life. Usually, 90% of babies fully develop the “watchdog” reflex by 6 years, and in 99% of cases it completely disappears when they switch to high school.

  • Secondary

If the child had no manifestations of nocturnal enuresis for 6 months, and then he resumed again, this is a secondary phenomenon. In some cases, treatment is required, depending on the severity of the disease and the age of the patient.

Bedwetting is not accompanied by any other symptoms.

A variant of the development of the disease, when enuresis is a consequence of deviations in psychological or physical development. In some cases, incontinence accompanies inflammatory processes in the bladder and kidneys.

It occurs, as a rule, in children, but it is diagnosed in cases of severe mental disorders and in adults. Neurotic bedwetting appears in timid or shy people. Accompanied by sleep disorders, because a person is afraid to fall asleep and wet oneself.

  • Neurosis-like

Manifested in people prone to hysterical behavior. Unlike patients with a neurotic form, the type of illness does not cause moral anxiety until the transitional age. Then the person is aware of the scale of the problem and falls into severe depression. To prevent this, neurosis-like enuresis is treated promptly and comprehensively.

Causes of occurrence and development

Initially, in newborns, all urination processes are carried out uncontrollably about 20 times a day. Then, when the child begins to sit, the task of the parents is to accustom him to the pot as soon as possible - so the process of habituation will pass quickly and without unnecessary worries.

The complete formation of the reflex, in which the control of the nerve impulse from the bladder is maintained, occurs by 4 years. Norma is considered the earlier development of the “watchdog” reflex from 3 years, and a little later - up to 5.5 years. Parents should be wary if uncontrolled urination occurs in a child 6 years and older at any time of the day. The main reasons for the development of this phenomenon include:

  • Congenital damage to the nervous system,
  • Hereditary predisposition
  • Infection in the urinary organs, urethritis,
  • Severe stress or psychological trauma,
  • Complications after pyelonephritis,
  • Various diseases of the brain, brain or spinal,
  • The presence of a pronounced allergic reaction,
  • Diabetes.

Nocturnal enuresis in adults and children may develop under the influence of one or several factors. Once a phenomenon is observed in cases of severe fatigue and hypothermia. But if the symptom bothers often - there is a reason for a visit to the doctor.

Who is prone to nocturnal enuresis

Most often, doctors diagnose nocturnal enuresis in children. They are more emotional and prone to psychological trauma. However, adolescents and adults may suffer from the disease. In any case, if a problem occurs, you should contact a specialist for diagnosis and treatment.

Incontinence in girls

Psychological development in girls is faster than in boys, so their control over the bladder comes earlier. Naturally, the incidence of enuresis among girls is much less, and the disease itself responds well to treatment. The main causes of bedwetting include:

  • Lack of sufficient control over reflexes

In some cases, the debugging of the nervous system is a little slower, so the little ones are lagging behind in some parameters of development from their peers.

Associated with frequent quarrels of parents or with significant life changes, for example, moving to another city or the birth of a second child in the family. Sometimes such circumstances lead to intentional enuresis as a way to attract the attention of parents.

You should not be worried if sound sleep followed overwork. Incontinence under such conditions is rare. When the girl does not feel the bladder overflow all the time, this is probably a congenital feature and you should consult a doctor.

  • Reception of a large amount of liquid for the night

This is most pronounced in times of illness, when even doctors advise to drink a lot, and even in summer, accompanied by frequent watermelon delicacy. It should strictly control the amount of liquid taken by the child for 2-3 hours before bedtime.

The phenomenon in which the amount of vasopressin in the body decreases, and as a consequence, the volume of urine produced during the night increases. As a rule, the phenomenon is temporary and it just needs to "outgrow".

If at least one of the parents in the early years of life was diagnosed with enuresis, then the probability of its development in a girl is approximately 30%. If both mom and dad were affected, this percentage rises to 75.

We are talking only about infections of the urogenital system - a common problem in women of all ages, arising from the peculiarities of the structure of the body. To cure the disease, you need to install the pathogen and drink a course of drugs.

  • Mechanical injury

This includes not only spinal problems resulting from accidents, but also difficult childbirth. Sometimes birth injuries adversely affect the speed of the impulse transmitted to the brain, which is why enuresis occurs.

Characteristic for children diagnosed with serious pathologies leading to a general developmental delay. In such girls, the age of psychological or physical development is significantly lower than the actual one, therefore special conditions are in effect for them - a longer period is necessary for the formation of a reflex.

Incontinence in boys

In young male patients, problems with urination control are noted in every tenth case. Most often, treatment requires a strict daily routine, but sometimes doctors prescribe medication. Common causes of enuresis in boys include:

  • Incomplete reflex control

If girls in most cases track their urge to urinate as early as 3-4 years, then boys need 4-5 years to do this.

  • Increased activity

In children, a new generation of hyperactivity is no longer a symptom, but a variant of the norm. But when a strong excitation of the central nervous system interferes with the normal functioning of reflexes, it is time to turn to a specialist.

If girls have a problem with global events in their lives, then a dog barking, the absence of some parents, etc. can scare the boy. Although boys are considered “strong sex”, in childhood they need even more attention than babies.

Enuresis as an attempt to attract the attention of parents is a common problem. In this case, exactly the same result is given by the excessive care of the child - he believes that he is still very small and behaves accordingly.

This includes the incorrect development of hormonal background, and infections of the urogenital system, and injuries received during childbirth. All these ailments are detected in laboratory studies of urine analysis.

With modern diapers, parents live much easier than with simple diapers, because there is no need to constantly change clothes for the child. However, when the boy removes a little need for his pants, he does not feel moisture, cold and discomfort, therefore he considers that this is necessary.In order to avoid such situations, diapers should be abandoned before another two years.

Incontinence in adolescents

Nighttime enuresis in a teenager is a serious disease, as it leads to mental problems. A young man or girl is embarrassed to talk about his illness, which only leads to a deterioration of the condition and the development of isolation. The causes of incontinence in adolescents are different:

  • Congenital abnormalities,
  • Heredity,
  • Mechanical injury
  • Frequent stress
  • Mental disorders
  • Change hormonal levels.

When it comes to congenital pathologies and heredity, enuresis manifests itself at an earlier age and persists until adolescence. In other situations, the disease of the secondary type occurs as an independent symptom. For his treatment using a comprehensive approach - identifying and getting rid of the cause of the disease, medication.

Adult urinary incontinence

Nocturnal enuresis in adult men and in women is classified into two types - childhood disease, preserved in adulthood, and a symptom that has resulted from the existing pathology in the body. If the cause of the disorder lies in another disease, it should be urgently diagnosed and eliminated if possible. The most common factors for the development of bedwetting are:

  • Hormonal changes,
  • The appearance of benign or malignant tumors in the urogenital system,
  • Age-related loss of pelvic muscle tone,
  • Pathological process in the central nervous system.

Some of these diseases are treatable, after which the symptom disappears and no longer bothers the patient.

How to treat enuresis

Despite the fact that in most cases, enuresis is a temporary condition of the child, sometimes it is very difficult to get rid of him. Methods of treatment of bedwetting depends on the etiology of the disease. Combined therapy involves the use of such treatment methods as medication, physiotherapy, regimen methods, and other non-drug methods.

Regime events

Maintaining a certain regime is useful for the organism as a whole - the time for rest and activity is normalized, the body uses its resources rationally. In the matter of treatment of enuresis, a few simple rules are added to the standard day regimen:

  • Limiting fluid intake a few hours before bedtime,
  • Hard bed,
  • Calm emotional atmosphere in the family,
  • Exclusion of fatigue,
  • Maintaining a normal temperature in the baby’s room,
  • Exclusion from the diet of diuretic and tonic foods and beverages,
  • Required toilet before bed,
  • Visit the toilet in the middle of the night.

Constant adherence to these rules leads to the fact that the body gets used to the regime and adheres to it independently. But we must prepare for the fact that the process takes several months.

Medications

The question of which pills for children will suit the specific case of treatment for enuresis is only decided by the doctor after a thorough diagnosis and detection of the etiology of the disease.

If urine is not properly administered, Adiuretin is prescribed. These are nasal drops that reduce urine production during the night. As a result, the bladder does not overflow, there is no need to have a bowel movement.

If the nature of the disease is in neurological and psychological disorders, the doctor prescribes the use of light sedatives during the day and a number of means to normalize night rest.

Being engaged in self-treatment of enuresis, in no case can you register yourself taking any medications. Any tool has a narrow action and will be effective only in the case of a correct diagnosis.

Traditional methods of treatment

Violation of urination is not a new disease, that is why folk healers know many effective methods for its treatment.

A tablespoon of dry herbs brewed with boiling water and infused for one hour. Accepted from any age in the morning before meals for 100-150 ml. In order to simplify the brewing procedure, the pharmacy purchases ready-made sachets with standard dosage per cup of water.

The compote is based on 200-250 g of lingonberries, added to her hips, 2 large spoons, pour water and boil for 15 minutes. The medicine is bitter, therefore during cooking it is recommended to add some sugar.

A couple of tablespoons of dried fruit pour 1 liter of boiling water and insist at least half an hour. Drink throughout the day instead of simple tea.

Folk remedies, despite their effectiveness, are not recommended for use as an independent therapy - it is best to include them in the complex treatment.

Which doctor to contact

If a child is sick, then the first instance in the examination is a pediatrician, and adults should contact the therapist. At the reception, the doctor will prescribe tests or immediately identify a narrowly focused specialist who will help to cope with urinary incontinence. You usually have to go through a comprehensive inspection:

  • A neurologist will check the state of the central nervous system,
  • The urologist will perform an ultrasound scan of the urinary system and kidneys to rule out serious pathologies,
  • The psychologist will determine the stress or depression of the patient.

In some cases, even after such a comprehensive study, it is impossible to identify the cause of the disease. Then an additional examination is prescribed by an endocrinologist and a neurologist. The more accurate the diagnosis, the more effective the treatment, so you should not neglect the examination of various specialists.

Watch the video: How to Stop Bedwetting Naturally. Bedwetting Permanent Solutions Natural Way (December 2019).

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