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Enuresis - A condition in which children older than five years, night or day comes involuntary urination . Enuresis in children spread widely enough, this disease is very often turn to experts. What signs of enuresis clearly expressed, and diagnosis is easy, sometimes gives the impression that the disease can be quickly and easily cured. But in fact such a violation requires an individual approach to treatment, because in each case the disease can trigger other reasons. Therefore, parents and children should be aware that the treatment of enuresis continues sufficiently long period, and for its successful completion requires a lot of effort and patience from all family members. Attempts unsystematic treatment are often unsuccessful.
Types of enuresis
To date, to distinguish between enuresis primary and secondary , and daily and night . Primary enuresis - A condition in which a child born there urinary incontinence . Consequently, if such symptoms occur only during the day, we are talking about the daily primary enuresis. If bedwetting should talk about the night primary enuresis. These states can be combined.
Secondary enuresis It is diagnosed when a child in a certain period, which shall not be less than six months, was "dry", after which he again began to suffer from urinary incontinence. As in the first case of secondary enuresis in boys and girls is day, night or two of these forms are combined.
At daytime enuresis become a cause of urinary disturbances in the functioning of the bladder muscles. If these muscles are extremely excited, then the child is determined giperreflektorny or neurogenic urinary bladder . If the excitation of the muscles is insufficient, then we are talking about giporeflektornom bladder .
At nocturnal enuresis urinary incontinence during the night is due to delay ripening of certain brain centers that are responsible for control of bladder function. To date, more common among children it is nocturnal enuresis. In the case of primary nocturnal enuresis often occurs spontaneously self-treatment.
Features enuresis
This disease has described Avicenna in his work " The Canon of Medicine ". Today the disease is quite common: according to statistics, about 15-20% of children under the age of five, about 10% in seven years, a decade of 5% of children and 3% of twelve can not supervise the work of the bladder. Besides enuresis occurs in adults: by different data, the disease suffers from 1% to 3% of adults. Enuresis in boys occurs in about two times more often than girls.
If a child is developing normally, then he gradually acquires the ability to control their bladder, and in 2-3 years, children learn to consciously control urination. However, many children this process may be delayed, which is considered a normal variant. Therefore, parents may not sound the alarm before the child's fifth birthday. However, if the sixth year of the life of a child can not control this process, in this case, you have to visit a doctor.
Causes of enuresis
All of the above types of enuresis in children is caused by the different reasons. The most important factor which affects the appearance and fluorescent secondary enuresis considered emotional stress . At the same time the manifestation of primary nocturnal enuresis, usually occurs due to delay ripening centers of the brain or shortage vasopressin .
Also note that the common factor in the emergence of all kinds of enuresis, is a genetic factor. About seventy percent of patients with this disease have relatives who also suffered from enuresis.
Daytime enuresis and secondary nocturnal enuresis in boys and girls seen as a consequence of specific deregulation of the nervous system. The disease develops under the influence of emotional stress: initially child imbalance in the nervous system, because of which there is a disorder of bladder functioning. There are many things that can be a source for the child severe stress: it is the death of loved ones, and parents' divorce, and the appearance in the family another baby.
Another cause of daytime enuresis experts believe the wrong approach to a child accustomed to the pot. In some cases, this process begins in the family too early may parents show excessive severity or inconsistent approach to the issue.
In addition, the causes of these types of enuresis may be the child's behavioral problems, as well as a small bladder capacity (inherent problem).
Primary nocturnal enuresis in children is manifested as a consequence of the delay in the maturation centers in the brain that are responsible for overseeing the functioning of the bladder. Because of this delay in the child there is a very deep sleep disorders and the ability to wake up to urinate on their own. Before the brain of a sick child not getting impulses from the bladder. As a consequence, the wake up signal does not occur.
Another reason for nocturnal enuresis - insufficient production of vasopressin in the body of the child. Urine is produced in the body all the time, around the clock. To the night the person did not appear the need to get up to the toilet several times, the body produces the hormone of the posterior lobe pituitary - Vasopressin. Under its influence the production of urine during the night suspended. In children with enuresis sometimes this hormone is not produced in the right quantities. As a consequence, during the night they have to empty the bladder at the same rate as during the day. Most often enuresis in children occurs as a consequence of the presence of several factors.
In more rare cases, the presence of enuresis may indicate the development of a child in the body of organic disease. This can be defects of the lumbar vertebrae . congenital or acquired lesions of the lower spinal cord . sleep apnea . epilepsy . sugar or diabetes insipidus . In order to eliminate these diseases, it is necessary to visit a specialist, who will appoint necessary in case of inspection. Find out the cause of enuresis, your doctor will prescribe the correct and effective treatment of the disease.
In addition, the cause of urinary incontinence are sometimes urological disorders character of the disease, and abnormalities in the structure of the urinary system.
Diagnosis enuresis
In the case of nocturnal enuresis diagnosis is mainly guided by the patient's complaints, as well as carried out the study of history, both individual and family. To date, there are studies showing that if the bedwetting episodes occurred in the father or mother, then the risk of developing the disease in a child increases by about three times.
The process of collecting medical history is necessary to understand how to raise children is conducted and how he passes the formation of skills of neatness. In this case, the doctor takes into account what the incidence of urinary incontinence, what type of enuresis, clarifies the nature of urination, checks whether the child moved a urinary tract infection, not whether there is a encopresis or constipation . Furthermore, it is important to determine the presence or absence of sleep apnea, epilepsy, food allergies or drug, hives . asthma . Allergic rhinitis . All of these diseases affect the condition of the bladder, making it more excitable.
Some medications, mostly tranquilizers and anticonvulsants May have the side effect of urinary incontinence, so it is important to find out whether their child received before.
It is also in the process of diagnosing doctor conducts a physical examination, paying attention to the structure of the abdominal organs, endocrine glands, urogenital system. It is important to assess the adequacy of the physical development of the child and his psycho-neurological status.
To eliminate the pathology of the genitourinary system conducted laboratory tests of urine, ultrasound of the bladder and kidneys. In some cases, the doctor prescribes any additional investigation.
There are also a number of states, which differentiate enuresis in children. This epileptic seizures, some types of allergies, some endocrine disease, sleep apnea, as a result of side effects of medication.
Enuresis Treatment
To date, the treatment of enuresis is conducted by doctors who work in different fields of medicine. A versatile approach to the treatment of the disease is important in order to effectively eliminate all the causes that lead to enuresis in children
As the day therapies and secondary enuresis usually used methods to exercise the muscles of the bladder, as well as psychological help. Sometimes children prescribed reception preparatov- holinoblokatorov .
For the treatment of nocturnal enuresis is used as a psychologist, and the impact of the special unit "Night Service", which stimulates the brain to wake up to train at night. As of drugs prescribed desmopressin , More rarely used tricyclic antidepressants .
Medications are also versatile effects. Holinoblokatory lower the tone of the bladder, while the frequency of urination is reduced. Tricyclic antidepressants have a different effect: they relax the muscles of the bladder and make sleep less deep. Imipramine should be taken at night, he starts to work after a week. This drug is used for three months, and the amount gradually decreased. But very often after receiving this drug appears enuresis in a child again. In addition, imipramine may negatively affect the state of the child's heart. Therefore, it is important to constantly monitor his condition, conducting an electrocardiogram.
Desmopressin take those children who have nocturnal enuresis occurs as a result of shortage in the body of vasopressin. This drug is a synthetic analogue. The drug affects about thirty minutes, the action lasts about 8-12 hours. After receiving means the disease is often renewed.
Thus, therapy with medication is often only temporarily removes the symptoms of the disease, it does not lead to complete recovery. Medications recommended situationally, for example, in the days of long-distance travel, and others.
However, very often the doctors, taking into account the large number of cases of arbitrary cure enuresis in children, it is advised never to treat those children who perceive the problem peacefully. To treat nocturnal enuresis is necessary when children are very experienced because of this problem. The treatment of enuresis usually lasts from two to six months, and repeated twice.
Training methods for patients with enuresis are used to train the child to control their bladder. Special exercises that teach longer hold urine, urinating interrupt via Kegel exercises Gradually helping to show the child how to influence this process.
In addition, doctors often recommend a special method to try nighttime awakenings. Throughout the week, the child should wake up at night in the same time - after midnight every hour. Later, the child's need to wake up repeatedly during the night at a certain time, trying to pick up the watch so that the child does not have time to wet oneself. Then if there are repeated cases of enuresis, the course is carried out again.
In addition, some experts prescribing practices of other treatments related to unconventional therapies. This can be acupuncture . magnetotherapy . music therapy and etc.
In the treatment of the parents should pay attention to the features diet child. It is important to significantly limit the amount of liquid as well as those products which promote frequent urination. After dinner, before bedtime fluid intake must be limited to the maximum. Also, special attention should be paid to monitoring the use of products that contain caffeine - They have a diuretic effect.
In addition, it is important to follow some general rules that will help to quickly deal with the problem. Parents and other family members have the most relaxed and tolerant of a sick child. You can not punish children for the failures, it is important to constantly impress upon them the belief that they will be able to cope with the problem.
A child with enuresis should not experience severe stress and situations that exciting from an emotional point of view. No need to avoid strong supercooling child. Before going to bed, the child must go to the toilet.
Prevention of enuresis in children
There are some preventive measures designed to prevent nocturnal enuresis in children. Experts advise in time to give up diapers as reusable and disposable. Usually, the best time to reject the diaper - a two-year age of the child. Given the time of year and the air temperature, the parents need to monitor how much fluid a child consumes. In addition, parents are required to pay special attention to sanitary and hygienic education of children, teaching them the rules of the care of the external genital organs and other.
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