Enuresis (from GK. enureo - peeing - term incontinence. Children distinguish the following forms of the disease: nocturnal enuresis (occurs more often, and the article will talk about it) and daytime incontinence. There is a constant leaking of urine, but it is a completely different disease associated with Central nervous system as a result of injury or infection. Under nocturnal enuresis refers to whether the child is older than 5 years of involuntary urination during night sleep. The formation of complete control over urination, the child is aged 1 to 3 years and ends to four years. Depending on the age and amount of fluid exceeds the number of urination in the rate varies from 7 to 9 per day (no more, no less), and in the night there is a break in urination. However, in 10-15% of children 5-12 years this is not the case, and after a night's sleep they Wake up wet. That is, suffer from nocturnal enuresis. As they grow, the prevalence of the disease is reduced, but 1 % of children "takes" his adult life. And boys enuresis occurs in 1, 5-2 times more often than girls.
There are two main types of nocturnal enuresis:
primary nocturnal enuresis (POE) is a disease of children, who never woke up consistently dry; and secondary, or recurrent (recurring), nocturnal enuresis is a condition in which patients re-start wetting the bed after a considerable period of remission (absence of symptoms).
Causes of enuresis
Causes of bedwetting diverse. One of the main factors is damage to the brain of the fetus during pathological course of pregnancy and childbirth due to hypoxia (insufficient supply the brain with oxygen) or injury. These pathologies contribute to delayed maturation of the Central nervous system of the child and the breach of the production of hormones including vasopressin (see below), which leads to the development of enuresis. Prerequisites bedwetting is considered chronic infection Mocenigo-coming system, disorders of the nervous control of the bladder, congenital anomalies of the genitourinary system and delay the skills neatness.
Possible exacerbation of bedwetting is developing on the background of acute respiratory viral infections, hypothermia, provoking an infection of the urinary tract. Often this occurs in autumn and spring, in the period of unstable weather. Stress in a child's life can also cause a repetition of the disease.
The mechanism for the development of primary nocturnal enuresis is not completely clear. It is believed that an important factor in the development of the disease is a genetic predisposition. Identified certain genes responsible for this pathology. If nocturnal enuresis suffered one of the parents, the risk of enuresis in children is 45%, and if both this probability increases to 75%.
In recent years, there is strong evidence that the main cause of POE are the rhythm of secretion of the hormone, synthesized in the brain (in the hypothalamus) - vasopressin. Its other name - antidiuretic hormone, which becomes clear primary function: reduced excretion of urine by the kidneys. Antidiuretic (or the anti-womeone) the action of the hormone necessary to maintain the water-salt metabolism in the body.
In normal concentration of vasopressin in the blood depends on the time of day: at night it is higher than during the day. So the night of the kidneys to excrete less urine, but with a higher concentration. That is, healthy people at night small amounts of urine come into the bladder, but not perekapyvayut it, and urge for urination no.
In primary enuresis secretion of vasopressin in the night time is reduced, which leads to increased formation of concentrated urine. Its amount exceeds the physiological capacity of the bladder, it overflows, and is involuntary urination. Often parents, apparently, from a desire to justify himself, is associated with the sleep of the child. However, it was found that the nature of sleep children suffering from nocturnal enuresis, do not differ from the other peer.
Another cause of bedwetting may be a violation of the nervous control of the bladder with a predominance of increased tonus of smooth muscles, and then to enuresis join frequent urination in small portions rare or abundant urination, as well as daytime incontinence. If the tone of the bladder is reduced, then the child wets rare, large portions, the bladder becomes full, and is involuntary urination.
Noted this situation, when children from different classes and sections almost't normally drink in the morning and home at night, they drink daily intake of fluid and at night do not hold urine. Sometimes it is also regarded as enuresis.
Necessary examinations
Some people believe that there is no need with the problem of bedwetting is to consult a physician-nephrologist (or pediatrician): say, "grow" a child, and
1 Electroencephalography (EEG) - the study of the brain, based on the graphic registration of electric potentials by using the apparatus of allegraallegra and aimed at identifying areas of the brain with abnormal activity.
2 Cystography - x-ray examination of the bladder, after which it by means of a catheter, a contrast agent, and then made three x-ray filled bladder, urination, and after emptying the bladder. Aimed at the detection of the malfunction of the bladder.
3 Intravenous urography - x-ray examination of the kidneys using an injected contrast agent that allows you to make a series of x-rays to study the shape, size, position and function of the kidneys and urinary system.
4 Neurointegrative - examination of the kidney using the injected radioisotope that can accumulate in the kidney tissue, which is fixed by the hardware and allows you to see the amount of normal run-soup tissue of the kidney and its Cup-pelvis system.
5 Cystoscopy - a study of the mucous membrane of the bladder and urethra using an optical device of the cystoscope.
6 Uroflowmetry - to study the ability of the bladder and urinary sphincter (circular muscle, on-halasana at the junction of the bladder into the urethra and prevent involuntary urination) to hold urine.
Treatment
Convincing data about the rhythm of secretion of vasopressin during primary night enuresis was the basis for the application of the synthetic analogue of the hormone - desmopressina, preformed shape which is minirin. Dosage for the treatment of pne were observed in children 5 years of age are selected by a physician, to give the medicine before going to sleep.
In the treatment of primary nocturnal enuresis should be especially drinking regime - the last fluid intake should be at least 2 hours before bedtime. At the same time, the child must receive a sufficient amount of liquid throughout the day.
Independently apply analogs of vasopressin is unacceptable as nocturnal enuresis in children can be associated with all other pathology, such as infection of the urinary tract. And that requires antibiotic therapy, after which phenomena bedwetting pass.
If the cause of enuresis is a disorder of the nervous regulation of the urinary bladder, with a predominance of high tone his smooth muscles, leading to a decrease in volume of the bladder, is applied triptan. It increases the volume of the bladder and reduces spasm, making spontaneous contractions of muscles more rare, and eliminating incontinence. In some cases shows the treatment minirena in combination with Criptana.
When lowered the tone of the bladder is recommended during the day to adhere to a regime of forced urination every 2, 5 - 3 hours. It is important that your child drink the bladder and before bedtime. As treatment of minirin and neostigmine. The latter increases the tonus of smooth muscles.
To improve metabolic processes in the brain, and when nevrokopi such conditions recommended medications such as nootropil, pikamilon, Persei, novopassit. In addition, it is shown courses of vitamin therapy (B6, B2, B1, B2, A, E).
In the complex treatment of enuresis include physical therapy, in the form of effects on the bladder various currents, ultrasound and heat treatments (paraffin wax or ozokerite), regulating the nervous system. Also applies restorative 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.
Prevention of disease is better in a timely manner to teach toddler to use the potty and to ensure that the child regularly and completely empty the bladder. Compliance with drinking water treatment is required. It is unacceptable that a child used to drink before going to sleep at night.
Angela Paramonovapsychologist-psychoanalyst: the right mental attitude in the fight against any disease is no less important, even the course of medication. In the case of children's night, enuresis this point is of particular importance. What is more correct and more will be adult to the baby, the less painful will be the problem for the emerging personality of the child.
The disease and the character
Many children, regardless of age, enuresis, like any long-running illness, causes a feeling of inferiority. Even the smallest upset about this issue. Embarrassed by their healthy peers, they often seek solitude, withdraw into themselves, to avoid ridicule and disgust towards other. The feeling of insecurity often appears or aggravated in the kindergarten or school and may lead to the development of low self-esteem, rejection itself, up to the complete inability to learn and realize their potential in various areas of life.
Children who have long maintained incontinence, under the influence of experiences in some cases, change in character. Some people become more aggressive, the other increases timidity, indecision, isolation, separation. There are those who at first glance doesn't worry about my disease, but various changes can manifest in adolescence.
Forms and causes of the disease
Urinary incontinence as a consequence of slow formation control of excretion or destruction of already formed features organic and infectious diseases or traumatic lesions of the nervous system, called neurosis. The presence of neurosis-like enuresis caused by organic lesions of the nervous system of the child is still in utero, does not depend on disturbances and other psychological factors, but increases with fatigue, physical ailments, colds.
When the destruction of already formed functions incontinence does not appear at an early age, and after perenesennoy injury (for example, Sotra turmoil of the brain) or infection (e.g., meningoencephalitis - inflammation of the meninges and the brain). When enuresis is, as a rule, monotonous character. In those cases, when the rate of occurrence of compensation is delayed or there are additional negative factors hindering the recovery, neurosis-like incontinence can last for years and in adolescence sometimes leads to pathological personality formation. In such cases, the doctor may recommend against medical treatment long sessions with a psychologist.
To deteriorate the function of the urinary tract can and influenced by various psychological reasons (due to acute trauma). In this case we speak of neurotic enuresis. This form of the disease can be both short-term and more permanent. For example, if the child fright appeared involuntary incontinence. Usually neurotic reaction with enuresis lasts several hours or days and is held as the disappearance of mental stress.
In cases where emotion is stored for a few weeks and months and painful manifestations are fixed, say neurotic condition. His reasons may be:
- moving families from one residence to another, where the child suffers the loss of friends and buddies and faces the need to adapt in the new kindergarten or school;
- death of close relatives or friends;
- birth in the family of brother or sister;
- long-flowing chronic illness of a loved one.
chronic conflicts in the family;
- parents ' divorce or predraft owned and posleratna situation;
- the death of a pet - cat, dog, parakeet.
In such cases, the child is seriously experiencing internal conflict and his protracted illness.
A clear dependence on the mental state leads to the fact that neuroti-cecoa course of enuresis, unlike neurosis-like disorders may appear unstable to disappear, then increase depending on the emotional state of the child. Such enuresis can wear shimmering character and last from several weeks to several months. But the force of the feelings of the child at the same time very intense. In these cases, effective qualified psycho-correction of his inner conflict.
What can adults
It's important for parents to know that enuresis, like any disease, each child's experience is different. To date, we know of more than 300 independent methods of its treatment. Correct recognition of the disorder and the individual selection of appropriate methods for each particular child guarantee full recovery in the shortest time. And the implementation of all recommendations of the specialist and prescribed procedures, coupled with the psychological connection family resources quickly lead to lasting positive effect.
The main recommendations for parents
1. In stark occurred enuresis first need to resolve the situation, damaging the psyche of the child. To ensure the family maximum peace of mind, to remove the conflict atmosphere, to normalize psychological climate.
2. Chronic conflict in the family often leads to aggravation of the problem. The child needs to pay more attention: to read the books together, go on walks, especially before going to sleep.
3. Children suffering from enuresis, establish a specific diet and fluid intake: at least 2 hours before bedtime, its amount is reduced or drink is cancelled altogether. It is important to follow these rules and to teach the child to new eating habits, for example to limit salty and spicy food, which increases thirst. You can substitute juice, tea, juice with a slice of orange, Apple. If the kid asked for a drink, you can distract with something, give a little spoonful drink. Gradually, this power becomes familiar to the child and does not cause difficulties in meeting.
4. If a kid refuses to sleep during the day, 't have to do anything from placing a stressful situation. The kid can spend the afternoon in the chair, listening to the familiar tale or cassette.
5. It is important during treatment to reduce or to waive long watching television and Hobbies computer games, which have a strong influence on the immature nervous system of the child. The book in this case can replace the TV.
6. Before the night's sleep is a good maximum to ritualize classes, i.e. in the same order every night to make together with your child the same steps. For example, to remove the toy in place, to swim, to tell a tale or spontaneously invented story with sequels, perform evening the advice of a doctor.
7. Jealousy of the younger brother or sister is often the cause of enuresis in older child. In this situation, parents need to examine their relationship to the elder, to revise, if necessary, his role in the family. The mother, even if her arms newborn should be given to the firstborn a little more attention. Perhaps it is difficult for him to play the allotted older role of the older brother or sisters. Maybe he o^not enough emotionally involved in the relationship between parents and child, which causes jealousy. The child wants to feel once again a little, the only and beloved. Some parents put the child enuretic to bed with me that night to Wake him up or take in toilet. This is not recommended, as the presence of adults does not allow him to develop the habit yourself to Wake up in the night. The kid and the parents have to sleep in different beds in different rooms. It helps calm sleep of the child and gradually teach him to control his desires or Wake at night with the urge to the toilet.
8. In the evening it is better to refrain from an active, energetic games that the child is not tired. Before going to sleep it is better to play table games such as Lotto, mosaic cubes or the designer. They not only develop your baby, but also stabilize the nervous system.
9. Beneficial effect on the psyche of the kid drawing. The younger the child, the more interesting it is to paint with gouache paint thick brush on large sheets of paper of different shapes, white and coloured. Many children love to create paintings with fingertips or palms. Parents do not always welcome such creativity, dooming kids from an early age on stamps and templates. But if we are talking about the treatment of enuresis, it is necessary to liberate the thinking of the child and to relax his body. And in paints fingers and palms children more fully reflect their emotional state.
The power of suggestion
It is available for parents holding autogenic training, aimed at relieving muscular and nervous tension of the child, to create atmosphere of calm and relaxation and allow you to customize it to remove the problem of enuresis. One of the options for such training for children of preschool age in the poetic and soft play. This game is not difficult either for parents or for children.
Lessons have to be done every night before going to sleep. The duration of training varies from 15 to 30 minutes. Words of auditory training need to read the kid is calm, slow and quiet voice. Eventually, when the child will learn them by heart, he can every night to carry out the activity independently, without adult participation.
Before you start training you need to learn with your child name all the parts of the body. Spending the evening class, an adult should take care of your inner psychic equilibrium. If mom or dad is stressed or upset, the lesson should have someone from the family, as in the relaxed state is very strong induction (transfer of emotional state) from one person to another, and eventually it may get the opposite result: the kid will not only calm down, but on the contrary, 'm excited.
To pronounce all the words are soft, calm voice, slowly, with long pauses, and naming parts of the body of the child, gently touch them by hand (to the head, knees, feet, and so on). A separate formula of the suggestions are repeated 2 to 3 times with changing logical stress.
When properly conducted autogenic training toddler relaxed and may even fall asleep.
The game "Magic dream"
(autogenic training for pre-school children in poetic form)
"Now I'll read the verses, and you will turn a blind eye. Start a new game "Magic dream". You will not fall asleep really will be all to hear, but will not move and will relax. Listen attentively to the words and repeat them to myself, inner speech. Whisper is not necessary. Quietly resting, his eyes closed. Attention, comes the "Magic dream"...
Cilia fall...
Eyes closed...
We rest peacefully (2 times)...
Sleep magic fall asleep...
Breathe easy... exactly... deeply...
Our hands are resting...
Foot rest too...
Relax... go to sleep... (2 times)
The neck is not strained and RAS-weak-Les-nna...
Lips slightly opened...
All wonderfully relaxed... (2 times)...
Breathe easy... exactly... deeply...
(It's a long pause and said words aimed at correcting problems):
Today I sleep dry...
Tomorrow I'll Wake up dry,
The day after I dry
Because I'm dry...
As you feel awake,
Will Wake up!
Your body is relaxed, but you know that you sleep dry... Tomorrow you'll Wake up dry...
If in the night you want in a toilet, you will Wake up will Wake up...
In the morning you will Wake up dry. You're the master of your body, and he listens to you.
You're doing fine, you sleep dry. If you want in toilet, Wake up, will Wake up and go to the toilet. Your bed dry. You're my boy, you will do it".
Adults should understand that the elimination of enuresis in a child is a laborious and sometimes lengthy process, but to achieve a positive result is possible only with the active participation of professionals and families. Parents need special tact and respect for his crumbs. Because in the end the bedwetting can be cured, just need to be patient.
I want to draw special attention parents: do not attempt to adjust the mental state of the child some psychological games. The problem of enuresis in children is quite difficult and complex, even if it is not noticeable at first glance. Therefore it is better to consult the experts. Inept actions of parents can lead to the complication of the situation - the disease will worsen and Tamarina E., pediatric nephrologist, K. M. N.
Angela Paramonova, psychologist-psychoanalyst
Author:
Temerin E., pediatric nephrologist, K. M. N., A. Paramonov, psychologist-psychoanalyst
Source:
Orthodox
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