Enuresis in children causes and treatment, drugs and folk remedies

All the children, being young to write for themselves, and it does not cause much suspicion, but over time, the child must start controlling your bladder, if this does not happen then there is a pathology of development, this must fight. There are occasions when bedwetting continues until school age, and then abruptly takes place, despite the fact that no effort has been taken to get rid.

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Urinary incontinence is a very common problem, because of what is not taken into the army, and not always what reason is a dysfunction of the body, often the problem lies at the root of psychological injury. Situation in childhood tightly seated in the unconscious due to powerful emotional coloring, mainly negative, are the source of many of our problems in adult life, because in the subconscious there is no past, there is only the present.

Types and forms of enuresis

For medical reasons up to 4 years, the child has to learn to control the process of daily urination, up to 6 years should develop nocturnal bladder control. If this does not occur within a specified time, it is possible to talk about the problem of urinary incontinence. There are two types of enuresis: primary and secondary.

• Primary. Installed from birth. As a rule, it is hereditary. Conditional micturition reflex, which is usually formed by 3-4 years, not developed. A long period of "dry nights" is not observed. Most cases of child enuresis - the primary view.
• Secondary. Urinary control was established at least six months, but then resumed bedwetting. The causes of secondary enuresis often lie in the realm of the psyche, so it is also called psychogenic, neurotic. Also, the cause may be infectious diseases, complications of intoxication.

According to the degree there are three forms of enuresis:

• light: Celebrated 1 or 2 cases of urinary incontinence per week;
• medium: Is about 5 cases of bed-wetting during the week;
• severe: A child wrote a few times during the night, there are no dry breaks.

By type of bedwetting is:

• day;
• night;
• mixed.

Only 5% of cases occur daily enuresis. If we are talking about enuresis, it is usually meant bedwetting.

classification of enuresis

Enuresis can be a primary and a secondary, isolated and combined, and monosemeiotic polisimptomnym.

Primary enuresis occurs at an early age of the child, when there is no so-called period of "dry nights," no symptoms of the disease or psycho-emotional stress. Secondary enuresis is diagnosed, when incontinence occurs in a child who has already begun to control night's sleep and woke up to urinate. Secondary enuresis occurs after a period of "dry nights", lasting at least six months, and for children there is a clear link between bedwetting emergence and the influence of any diseases, stress, mental factors and other pathological states.

Isolated called enuresis, in which there is no daily urinary incontinence. When combined enuresis celebrated mix day and night incontinence.

Monosemeiotic enuresis diagnosed in the absence of symptoms of other diseases and disorders. Polisimptomny enuresis is determined in the presence of:

• urological disorders (neurogenic bladder dysfunction, congenital malformations of the urinary system);
• neurological, psychiatric and psychological disorders;
• endocrine diseases.

Prevalence.

Nocturnal enuresis - is extremely common in the pediatric population related to the number of age-related conditions. It is believed that at the age of 5 years suffer from this condition 10% of children, and by the age of 10 - 5%.

Later, as they grow older, the prevalence of nocturnal enuresis is greatly reduced; among the 14-year-olds enuresis affects about 2%, and by 18 years of age - only every hundredth individual [4]. Although these figures show a high incidence of spontaneous remissions, even among adult nocturnal enuresis affects about 0.5% of the general population. The incidence of enuresis depends not only on age but also on the sex of the child.

Causes of child enuresis

The most common cause of child enuresis - heredity. If both parents had a child enuresis, the likelihood of disease in the child is around 80%. What else can trigger bedwetting?

• The immaturity of the mechanisms of regulation of urination. This physiological disorders that occur in 15% of children. They are related to the immaturity of the bladder, urinary tract and nervous system. "The link", which tells the brain that the bladder is full, does not function fully.
• Neuropsychiatric disorders. If the child has a birth trauma, disturbances in fetal development, there are seizures, brain dysfunction, mental disorders, enuresis is much more common. In hyperactive children also observed frequent bedwetting.
• Anatomical features of urinary organs. Small bladder, the urethra is too narrow may cause enuresis.
• Diseases of the genitourinary system. These include a variety of diseases and infections, and complications after an illness.
• Reduction of antidiuretic hormone. Children are prone to enuresis, disrupted production of antidiuretic hormone. If it is in a lot of blood, it decreases the amount of urine. If it is small, the urine, on the contrary, it becomes more. When nocturnal enuresis hormone level is reduced, which results in active generation of urine.
• Psychological causes of enuresis in children. By stressful factors include various stresses and depression. They can provoke fear, fears, moving to another city, the transition to a new school, the problems in the children's collective, traumatic atmosphere in the family, separation, frequent conflicts between parents and so on. D. In the first place there are tragic cases - loss of a loved one.

Previously it was thought that the cause of bed-wetting may be a good phase of deep sleep: the child does not feel like the brain sends signals. It is proved that children who are fast asleep, you still wake up when the bladder is full. The problem is not in a strong dream, and the immaturity of the mechanism of regulation of urination. You can also find the mythical version that diapers are a provoking factor of urinary incontinence.

Delay the development of the nervous regulation

Control over urination act begins to form around 6 months and ends in 4-5 years. Delay the formation of the nervous regulation, some associated with the proliferation of disposable diapers. More serious causes of lack of control may have different mental and neurological diseases - epilepsy, autism, damage to the nervous system resulting from hypoxia during labor. Bedwetting often occurs in boys than in girls. It is believed that the girls formed before the regulation of bladder weakness.

Tip: if the child is under 5 years sometimes write in a dream, it does not mean a pathology. Perhaps the nervous regulation established not quite.

Diseases of the urinary system

• Various urinary tract infections and kidney can trigger bedwetting.
• For example, enuresis may cause cystitis, urethritis, pyelonephritis.
• Recently, more frequent urolithiasis in children.
• Particularly noteworthy are congenital malformations of the genitourinary system structure.

sleep disturbances

Normally during the filling of the bladder pulses are delivered to the brain from him, with the result that there comes an awakening.

When enuresis impulses are not sufficiently intensive and urination process occurs before awakening.

endocrine diseases

Enuresis in children can be caused by diabetes and diabetes insipidus. In diabetes the child all the time thirsty, drink plenty of fluids. Therefore produces more urine. Because of frequent overflow bladder can be stretched, as a result of nerve endings begin to respond less to fill. The child simply does not feel that it is time to go to the toilet.

• A similar situation is observed in diabetes insipidus.
• It is characterized by insufficient production of vasopressin in the pituitary gland.
• This hormone is responsible for the concentration, since it facilitates the reabsorption of water and sodium chloride from the primary urine.
• With a lack of vasopressin urine becomes greater, and its concentration is reduced, which can cause bedwetting both girls and boys.

hereditary predisposition

It is known that children whose parents suffered in childhood enuresis, is several times increased risk of this disease. Most likely, the reason is hereditary peculiarities of the nervous system.

psychological factors

Psychological stress - the most common and broad group of causes of enuresis in children. The disease can trigger virtually any stressful situations:

• transfer to another place of residence,
• change of school or kindergarten,
• the loss of a loved one,
• the death of a pet,
• quarrel parents
• punishment,
• exams or control operation, and so on. d.

As a result of the above situations can form a vicious circle. First, because of the stress begins enuresis, which is itself already leads to constant stress, neurosis, depression. Bedwetting is typical of too emotional or hyperactive children.

Etiology and pathogenesis.

When the etiology of nocturnal enuresis is extremely multifactorial. It is possible that a pathological condition includes several subtypes, which differ by the following features:

1. 1) The time of appearance (from birth or at least after a 6-month period of stable control of the bladder)
2. 2) symptomatology (only nocturnal enuresis - monosymptomatic combined or urinary incontinence in the daytime and nighttime),
3. 3) reaction to desmopressin (good or bad response)
4. 4) nocturnal polyuria (presence or absence)

It is suggested that nocturnal enuresis represents an entire group of pathological states various etiologies Nevertheless decided to consider 4 main etiologic mechanism of incontinence urine:

1. 1) congenital disorder mechanisms of conditional "watchdog" reflex
2. 2) skills formation delay urination regulation,
3. 3) violation of acquired reflex micturition due to the impact of unfavorable factors,
4. 4) family history

Basic moments

Among the causes of nocturnal enuresis can be listed as follows:

1. 1) infection,
2. 2) malformations and renal dysfunction, bladder and urinary tract, 3) damage to the nervous system,
3. 4) psychological stress,
4. 5) neuroses
5. 6) mental disorders (rarely)

That is why first of all you need is to make sure a child with incontinence are no signs from the inflammation of the bladder (cystitis) or any other disorders of the urinary system (you need to make the appropriate urine and carry out all the necessary tests for its intended purpose or a nephrologist urologist). If the genitourinary system has no pathology in the child, it can be assumed that the transfer violated the brain information about the overcrowding in the bladder, then there is a partial immaturity of the central nervous system.

• The appearance of the second family (or another) child may be expected to cause "wet nights" by his older brother (or sister).
• In this case, the eldest child of a sort of "infantiliziruetsya" and learn to control urination in a conscious or unconscious protest against the apparent deficiency of attention, love and affection from parents, overwhelmingly concerned, first of all, the "new" child.

This situation sometimes occurs in standard situations such as moving to a different school, transfer to another kindergarten or even moving to a new apartment.

Quarrels between parents or divorce can also lead to a similar situation as the excessive strictness in education and physical punishment of children.

Control of bladder function

There are significant individual variations in the timing of the formation of a stable self-control urination. Numerous studies of domestic and foreign authors show that the control of the act of urination during the night's sleep is formed later than the analogous function in wakefulness during the day: approximately 70% of children - to 3 years, 75% of children - to 4 years, over 80% of children - to 5 years of age, 90% of children - to age 8.5 years old.

There is no doubt that the control of the function of the bladder (and nocturnal enuresis) depend on several factors:

1. 1) genetic,
2. 2) the circadian rhythm of secretion of several hormones (vasopressin and others.)
3. 3) the availability of urological disorders,
4. 4) the delay maturation of the nervous system, as well as
5. 5) psychosocial stress and certain types of psychopathology.

Genetic factors. Additional genetic factors noteworthy family history, type of inheritance and localization of abnormal (defective) gene.

Scandinavian researchers found that subject to the availability of enuresis in the history of both parents, the risk of nocturnal enuresis in their children is 77%, and if the enuresis suffered only one of the parents - 43%.

Genealogical research method

Genealogical research method twins showed that levels of concordance for monozygotic twins enuresis almost 2 times higher than dizygotic: respectively 68 and 36%. Comparative recently conducted an appropriate genotyping and genetic heterogeneity is set for enuresis with probable loci genetic defects on chromosome 13 (13q13 and 13q14.2), - the region now known as «ENUR1», as well as on the chromosome 12q. H.Eiberg (1995) indicates that the formation of nocturnal enuresis involves one autosomal dominant gene low penetrance, that is subject to influence by environmental factors and / or other genes [15].

• Among boys, 70% of monozygotic twin concordance characterized by nocturnal enuresis compared to 31% for dizygotic male twins.
• Among girls said ratio is respectively 65 and 44% (statistically significant differences were not detected).
• Apparently, girls genetic influence is not as significant as for boys.

The circadian rhythm of secretion of certain hormones (regulating the excretion of water and salt). Normally, individuals are marked circadian expressed (circadian), the variations in the formulation and urine osmolality, and occurs at night production of smaller volumes (concentrated) urine.

In children, this circadian pattern is partially regulated by vasopressin and atrial natriuretic hormone partially system and the renin-angiotensin-aldosterone system.
lib.komarovskiy.net

What should parents do?

The most important thing at a children's incontinence - not to punish the child. He is not to blame for the problem. It is not necessary to focus their attention, swear or shame. If the son or daughter again woke up in a wet bed, you should only ask for a shower and the bed to.

Any accusations in this regard can only aggravate the disease. The room where the baby sleeps should be aired frequently. Do not allow baby hypothermia during sleep time. Some kids are afraid to sleep in the dark, and it can be one of the causes of enuresis. In this case it is better left on the night light. In general, as far as possible it is necessary to protect children from stressful situations.

Parents need to be sensitive to the child's problem and in every way to help him overcome the disease. In this case, urinary incontinence in children is treated much more successfully.
lechim-pochki.ru

diagnosis of enuresis

Install the child enuresis is not difficult: it is done on the basis of complaints of persistent or frequent episodes of urinary incontinence at night in children over 5 years. However, for the successful elimination of urinary incontinence in children is necessary to clarify the form and causes of bedwetting as for medical treatment, for example, hereditary (monosemeiotic) enuresis and enuresis on the background of overactive bladder (polisimptomnogo) are applied principally different methods.

The criteria for the diagnosis of hereditary incontinence are:

• enuresis a history of any of the close relatives of the child;
• permanent urinary incontinence in the first years of life - without the "dry nights";
• nocturia - the prevalence of nocturnal diuresis over day - that is, the night the child produces more urine than during the day;
• Low specific gravity of night urine;
• thirst for the child in the evening;
• details blood test for hormones (low activity of antidiuretic hormone - vasopressin - at night);
• genetic analysis of the data (identifying gene mutations);
• the absence of organic or neuropsychiatric disorders.

Need expert advice

In the process of diagnosing enuresis held:

• consult a pediatrician, neurologist, nephrologist, urologist, endocrinologist, a child psychiatrist and psychologist;
• necessary for a few days being voiding diary (it is fixed, how many times and in what amount the child was writing for the day, and whether episodes of incontinence during the day and at night);
• laboratory tests (general blood and urine tests, urine tests and blood sugar, blood test for hormones, biochemical blood and urine tests to rule out kidney disease);
• US kidney and bladder;
• Uroflowmetry (examination of urinary flow rate during the voiding arbitrary time);
• additionally can be assigned to an x-ray of the spine, excretory urography, voiding tsistoureterografiya and other studies.

treatments

There are many methods of treatment of enuresis. Some parents elect traditional medical solution to the problem. Other more trust psychologists and psychotherapists. Still others acquire special devices to control urination. Fourth believe in the miracle of conspiracies and prayers attendants.

All of these methods work, when really believe in them. Also, you should always take into account the time factor. People say: "grow - and all as the arm lift."

medication

It happens that expectant management is not satisfied with the parents and the doctor insists on the use of medicines. Practice shows that the percentage of curing bedwetting medication is extremely low. If a cure for bedwetting in children has no effect in a few weeks, it overturned.

• When enuresis prescribe such drugs, "Spazmeks" "Desmopressin", "Driptan".
• They reduce and restrain involuntary urination, increased bladder capacity.
• Also, when neurological enuresis and increased anxiety child's doctor may prescribe antidepressants "Amitriptyline", "Dosulepin", "dothiepin", "Imipramine".

Motivational therapy

Highly effective method of treatment, which in 80% of cases gives a full recovery. It is noteworthy that the best therapist in this situation becomes a child himself. There is a fair opinion: while the child did not want to get rid of the problem, it will not disappear. This method is used in children older than 5 years, because before this age with the question of personal motivation difficulties arise. Child while it is difficult to formulate the goals, to understand and to direct volitional efforts. What is the method? The proverbial "carrot": if there is a dry night - so there will be a prize, gift, reward, praise.

• Each child has his own motivation.
• Someone important to his praise.
• Someone needs a dog, a bicycle, a new toy, a sea trip, going to the movies, and so on. D.
• Rewards can be both tangible and intangible.
• You can hang the calendar in the baby's room and mark dry nights on it.
• It is necessary to concentrate on the success, not to focus on the "wet affairs".

It is important that all family members supported the chosen method of treatment. If the mother says one thing, Dad - the other, and my grandmother all over head grabs, is the use of therapy is enough. In this case, you need to "treat" the whole family.

Psychotherapeutic treatment of enuresis treatment extends not only to the child but also the parents or close relatives who have a strong impact on the patient. Enuresis - the problem of intra-family communication, which is often adults do not want to admit.

Sessions

This method is effective only when a child has a desire to get rid of the problem. Typically, therapy is conducted with children of school age and teenagers.

• It is important that there was a trust specialist.
• Also be aware that the work touches deep layers of the psyche, there may be negative emotional outbursts.
• To determine the cause of urinary incontinence, it will take time and effort.
• Most often, this problem occurs in anxious, vulnerable, resentful children, who hold the truth in emotions throughout the day, and at night, "relax."
• There is an opinion that reflects the relations of bedwetting children from their parents, often mothers and sons.
• Strong control of the child, the desire to make it better than others, excessive tutelage of adult hand - all these unconscious actions and objectives may contribute to persistent incontinence.
• Therefore, without the participation of the parents lost the meaning of therapy.

Enuresis in boys were more frequent (about 60% to 40%). This is due to the fact that the regulation of physiological maturity urinating in girls is faster than that of boys. There's another psychological reason: the adaptive capacity of the girls higher intrinsic motivation have developed stronger.

The controlled volume of fluid

An important point in the treatment of enuresis. After 17 hours the child should drink 20% of the daily requirement of liquid. A few hours before bedtime desirable to provide a minimum amount of liquid.

• It is important that the air in the room was damp and cool, and the child was not wrapped in a warm blanket to sleep.
• In this situation, the feeling of thirst is a natural and inevitable.
• Also, do not allow active play and exercise before going to bed.
• The child will be hard to sweat, to ask for a drink.

Lifestyle

How much time a child spends in the fresh air? What time he goes to bed? The busy during the day? It is important to lead an active life, observe the regime of the day, go to bed at about the same time. It is equally important to ask how often the child plays computer games? What kind of movies, cartoons and TV shows he watches? What peers and adults to communicate?

Everything that emotionally imbues the children during the day, in full issued during sleep time. Bedwetting in children may be the result of emotional overload in the afternoon. Before going to bed should be a calm atmosphere in the house.

Regime and diet

Seven tips to parents when a child enuresis:

1. Create the most quiet in the family. Especially important is the atmosphere in the evening hours: eliminate quarrels, punishment of the child at night, extremely undesirable action games, computer, watching TV.
2. Never scold or punish your child for what he peed in the bed - that you do not solve the problem, but only to develop the child's complexes.
3. Properly arrange berth: bed child's bedroom should be organized pravilnodolzhna be flat, rigid enough. If the child is sleeping on the oilcloth, it must be completely closed sheet, which would not have crushes and does not move with the movements during sleep. The room should be warm, draft-free (airing just before bedtime), but not too stuffy, not to a desire to have a drink while falling asleep or during the night. Encourage your baby to sleep on his back. Prevent involuntary urination at low functional bladder capacity helps cushion planted under the knees, or a raised foot end of the bed.
4. Bedtime should be carried out in one and the same time.
5. Dinner and drinks should be given no later than 3 hours before bedtime. This excludes products having a diuretic effect (dairy products; strong tea, coffee, cola and other caffeinated beverages; juicy vegetables and fruits - watermelon, cantaloupe, apples, cucumbers, strawberries). Recommended for dinner cooked hard-boiled eggs, crisp cereal, baked fish or meat, weak tea with a little sugar. Directly can be given a small amount of food before sleeping child promoting fluid retention (salted herring piece of bread with salt, cheese, honey).
6. Make sure that the child pee at least 3 times within an hour prior to bedtime.
7. Leave the child in the bedroom source of dim light (night light), so he was not afraid of the dark and quietly went on the potty or toilet, when he wakes up with a desire to urinate.

Wake or wake up?

If the child is wet, it is necessary to wake up

Over whether or not to wake up wake up the little baby at night to urinate, medical opinions differ: some believe that artificial awakening with the landing on the pot contributes to the development of sustainable reflex followed by self-awakening when Overflow bladder, other experts are of the opinion that such a reflex to develop in preschool children is difficult, and it quickly lost.

• But if you wake the baby, then awake to 2-3 hours after bedtime and always full - that he woke up, he came to the pot or toilet and he would get back.
• To show compassion and to wear a sleepy baby in his arms to the toilet and back is useless: it does not help develop the reflex to the awakening of the children do not realize what they are doing, and in the morning, and usually do not remember what they awakened.
• But if the child has wet himself, it must be unequivocally wake, change into dry (even better if he himself will change clothes), perestelit bed: these events will shape the child's concept of a comfortable sleep, as sleep in a dry bed, and accustomed to the need to keep his bed and clothes dry.

Older children (pupils) is recommended to wake up at night, and this is done in a specific pattern ( "awakening schedule"):

• the first week of the child's waking every hour after falling asleep;
• in the following days interval between awakenings gradually increased (wake after 2 hours, then 3, then only a single night).

Bedwetting is treatable

Treatment "scheduled awakening" goes on for a month. If after a month no effect (enuresis episodes are repeated more often than 1-2 times a week), you can repeat the course once, or to proceed to other methods of struggle with enuresis.

It should be borne in mind that the "awakening schedule" violates the normal course of a night's sleep the baby, and this leads to a serious strain on the nervous system.

As a result of the child during the day will be tired, listless, moody, it will be bad to learn new information, because this may diminish its performance in school. Therefore, the method is desirable to use during the holidays.

Bladder training

This method is recommended if there are no problems with urology. Any negative impact on the function of the urogenital system, this method does not have. Accustom bearable since the age of three before every day going to the toilet "in a little." This does not mean you have to endure a half-hour or hour. Suffice 5 minutes to the child gradually develop bladder control.

urinary Service

Unfortunately, in Russia and post-Soviet countries the device is not as well known. Urinary enuresis alarm cures with almost 100% efficiency. How it works?

1. To pant baby attached wired sensor that reacts to moisture.
2. Another part of the wire sensor is attached to an alarm clock.
3. Once the child begins to write, and the sensor is triggered the alarm clock rings.
4. The child wakes up, fixes the beginning of urination, off the alarm, sits on the potty or going to the toilet.

The essence of the method - to consolidate control of nocturnal urination. There are advanced wireless alarm bladder model that facilitates its use.

Is it possible something to replace a device? Simplified version:

1. mum starts normal alarm for a certain time, for example, at 0:30;
2. within two weeks of the child wakes up in the same time, planted in a pot or lead to the toilet;
3. so it goes every night for six months.

After two weeks Service should be placed at 1 am, two weeks later at 1:30, and so on. D. In this way, control of urination is generated. It is important that the baby woke up to the end, and the process of urination took place in an informed, not half-asleep state.

Elaboration of conditioned reflexes to the awakening of the complete bladder ( "urinary alarms")

There are non-drug treatments for enuresis through the development of conditioned reflexes in children. The bed child placed special signaling device (enurezny Service), which responds to the sensor to have a few drops of urine humidity sensor. The sensor in the pad is placed in the underwear of the child (in modern alarm clocks sensors can be attached to the outside of the laundry - where most just the first drop of urine will be liberated) - and at the very beginning of involuntary urination sensor responds, the device emits a loud signal.
At the signal, the child wakes up and goes to the toilet.

• If a child under the age of 10 years, it must stand as the parents: they help the child to change into clean clothes and put him to sleep again.
• This technique was invented in 1907 and is considered to be effective (gives a positive result in more than 70% of children with enuresis), but after the use of relapses.
• Success is possible to achieve in a month of using the signaling method, and another two weeks after discontinuation of Enuresis humidity sensor is left in the child's underwear.
• If within 2 months of use enureznogo alarm is no effect, the treatment by the method of "urinary alarm" stop.

Physiotherapy

Parallel medication often prescribed courses of physiotherapy activities: laser, acupuncture, electrophoresis, etc. but their efficiency is quite low, and if used in isolation (separately from other methods), physical therapy usually does not give positive results.

other methods

The child is set to a "dry" night

In older children (about 10 years) in the treatment of enuresis are widely used and give good results psychotherapy (including family) and auditory training - child train yourself to tune in "dry night" and the awakening of the overflow of the bladder through repetition nightly bedtime phrases like "I want to sleep in the dry bed. I feel sure if I want to use the toilet and be sure to wake up, "etc.

Traditional methods

Treatment of enuresis in children folk remedies has a long history, includes a lot of different ways.

• Healing. The fact that the conspiracies and prayers heal, it is a fact. Some believe in a miracle. Others believe that behind all this are rooted psychological reasons. Parents often turn to the grandmother, while acknowledging that all previous methods are powerless. And any old woman from a remote village suddenly appears the last resort. Recognition of grandmothers - it's also a recognition that you can not control life and totally, to pain, to control their own child. This is not only psychological but also philosophical, moral and ethical aspect. This applies not only enuresis, but also other diseases (sometimes severe, incurable).
• Herbal treatment. In folk recipes from enuresis broths used cranberries, St. John's wort, centaury, fragrant violets, sage, plantain seeds, dill.
• Inclusion of attention. This advice can be found in the theme of "folk methods of treatment," although he used with great success in NLP (Neuro-Linguistic Programming) and is called by the anchors. What is the essence? The child wears the ring on his finger. When there is a need to urinate during the day, every time he has to remove the ring and put it on another finger. In this case, the attention is fixed on the thought: "I'm pissed." Another similar method: before going to bed a child must tell yourself that will wake up dry, and knocked three times on the wall with his fist. So you need to prodelyvat for a long time. Most importantly - the child must do so with the desire and faith.
• Cold foot bath. In the bathroom you need to dial the cold water up to his ankles. Within 10 minutes, the child must wander in water. When the legs freeze, you need to get out of the bath and trampled on the floor. can not wipe their feet, they need to dry off.

social adaptation difficulties

The older the child becomes, the more often there are problems with social adaptation. This applies to a variety of trips, overnight stays away from home. Often require a psychologist and therapist to work with the correct perception of the disease. The question is not only how to get rid of enuresis, but also how to accept yourself in this situation. This is an important step toward healing.

• Abroad, the problem of nocturnal enuresis in children are easier.
• There exist specialized products to those who suffer from this disease at different ages.
• Sell ​​special sheets, diapers, diapers and so on. N. In the West, the approach is: yes, there is a problem, but it should not interfere with fulfilling life.
• And there is nothing wrong if the "overgrown lad" wears a diaper at night, when you have to sleep in a tent, train, hotel and so on. D.
• It turns out that a social problem - it is a question of mentality.

Of course, it is also family issues. In ancient times, it tried not to disclose, so to speak, does not wash dirty linen in public. The point is not that it is "shameful topic", and to conserve energy for the solution of this problem: not be sprayed, not to complain, not to be ashamed, and accept the problem and solve it sensibly.

Perhaps enuresis is given to the child and his family as a test. Someone understands the disease takes and passes an obstacle to success. Someone built up in faith in a higher power, someone believes in herself and her child. Someone rejects fear, shame, but persistently treated with medicine.

Treatment of enuresis in children includes a variety of methods. More often medication and psychotherapy. Treatment for a neurologist, urologist, the therapist. However, the most effective way to still have time and patience of parents. It is important to be aware of: by teaching manuals enuresis is not treated, but only worse. Children can not blame, shame, blame that is independent of their will, character, behavior.
kids365.ru

hereditary form

For the treatment of hereditary forms of enuresis appointed desmopressin (Minirin) overnight rates at 3 months with intervals of 1 month. The drug is a synthetic analogue of vasopressin and leads to relief of nocturia, and behind her, and enuresis. During treatment Minirin simultaneously observe strict drinking regime: the liquid is strictly limited in the evening and night hours (give the child to drink only to quench thirst).

Enuresis against the backdrop of neurogenic bladder dysfunction

Enuresis against the backdrop of an overactive bladder, manifested by the presence of the child's "imperative" urges to urinate, which he was unable to restrain, treated with several groups preparations:

1. M-holinoblokatory: driptan spazmeks and used more often. Driptana Efficacy is 90%. Assign it to children older than 5 years, the duration of intake should not be less than a month (European researchers recommend 2-3 months of treatment courses). In the case of recurrence of enuresis appointed refresher courses. Spazmeks appointed
   Drug "Spazmeks" help podrostkampodrostkam suffering from enuresis, rates of 1 to 3 months. When using driptana, especially at high doses and for a long time, can develop unwanted side effects: palpitations, dry mouth, feeling burning and dryness of the eyes, blurred vision, increased intraocular pressure, constipation, abdominal pain, dizziness, sleep disturbances, anxiety, hallucinations. For the occurrence of side effects is necessary to closely monitor and, if they occur usually requires removal of the drug. Spazmeks rarely gives similar side effects, because they do not overcome the biological membrane and does not penetrate the central nervous system. Both drugs are contraindicated in case of detection on ultrasound in an amount of residual urine over 20 ml, because they can enhance the urethral sphincter spasm. In addition, recently proven the safety and efficacy of the children of another drug from the group M-anticholinergics - detruzitola (tolterodine).
2. Alpha 1-blockers - doxazosin (cardura) and alfuzosin (dalfaz) - relax the bladder, increase its volume and improve functional urination. Dalfaz appointed for 3 months of daily administration, with little effect of the course can be extended to a year. The drug is contraindicated in heart disease, orthostatic hypotension, in congenital malformations of bladder and severe diseases of the gastrointestinal tract and kidneys.

Enuresis in the background of neurotic disorders and anxiety

• When enuresis in a child with neurotic syndrome of hyperexcitability and can be assigned to tranquilizers (hydroxyzine, medazepam) sidnokarb, amitriptyline, imipramine.
• also widely used nootropics (glycine, Phenibut, pikamilon, piracetam).
• Preparations of these groups aimed at the normalization of the depth of a night's sleep, the acceleration of the process of maturation of the nervous system of the child, elimination of irritability, anxiety and depression.

conclusion

If the child is older than 5 years, periodically or continuously wets the bed at night, parents should begin nonmedicamental measures to combat enuresis, while referring to the doctor to rule out organic causes of incontinence and polisimptomnogo enuresis. Also, begin to struggle with enuresis is necessary and in children younger than 5 years if they understand that bedwetting is wrong, suffer from this and want to avoid it.

And although in many cases the kids "outgrow" enuresis - bedwetting episodes of child's age is becoming less and less, and then gradually pass - to treat all the same necessarily as children grow older, begin to experience psychological distress and hard to bear his state.

To which the doctor ask

If bedwetting is necessary to consult with your pediatrician. If no effect of treatment is necessary to check the neurologist, nephrologists, urologist, endocrinologist, psychiatrist and therapist as well-physio physician.
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At what age should begin incontinence treated?

In children, the problem is quite serious. It is believed that up to five cases of "wet" night - a normal phenomenon, and treat children before this age is not necessary. By five years usually ends the formation of a conditioned reflex to urinate. In most cases, urinary incontinence in children is not a serious disease, but these episodes affect their mental state, psychological climate in the family, but also can contribute to complications such as urinary infection ways.

What is the reason enuresis?

Urinary incontinence is most often associated with delayed maturation of the central nervous system: the brain does not receive the signal of the bladder is full and needs to be emptied. Often, the raised allocation of urine at night preceded by trauma, fear, placing the child in an unfamiliar environment. Enuresis in this case - only an integral part of the existing neurosis.

Unfamiliar surroundings can "wait" and the baby at home. For example, the emergence of another child in the family. Another option - the emergence of a new adult in the family (remarriage of the mother or the father) that can be strongest stress for the baby, even if the "new dad" treats him well (not to mention the situations conflict).

Enuresis Treatment largely depends on its cause.

Most often the disease is diagnosed and cured on an outpatient basis. The hospitalization is usually no need, if only enuresis is not associated with severe abnormalities of the kidneys and bladder.

How to cope with enuresis?

One of the most important aspects of treatment of enuresis is the child mode and the rhythm of fluid intake. Here are some tips that will help you to quickly deal with the problem.

• For 2 hours before bedtime child is better not to drink. In the daytime exclude silnogazirovannye and artificial drinks. By cranberry, cranberry fruit drinks are also best avoided due to their diuretic action. Give preference to water, non-carbonated, juice, compote of dried fruits.

• Dinner should be 3 hours before bedtime. Of yogurt, milk and fruit in the evening should be discarded: they have a lot of water, yogurt and apples have a diuretic effect. Dinner washed down with a few sips of special tea: Take a mixture of equal amounts of Hypericum and yarrow. Liquids can be drunk 50-100 milliliters. After dinner, it is better not to drink.

• An hour before bedtime, and before going to bed, the child has to go to the bathroom "for a little." Put beside the bed a pot. At night, turn on the night light in the nursery: many children are afraid of the dark, but not everyone is talking about it to parents. Fear can stop to get up to relieve himself.

• Do not pick up the child to the toilet during the night. Interrupting sleep, you prevent relaxation of the nervous system. Knowing that wake, kid probably will sleep "critical moment."

https://medportal.ru/enc/pediatrics/reading/15/

Who should contact if you suspect a child nocturnal enuresis?

In the first place to the pediatrician. After conducting tests and the exclusion of kidney and bladder, you will be given a referral to a neurologist. The neurologist may prescribe an ultrasound or even brain scans to rule out anomalies in its structure and development. And in the future, depending on the survey results, prescribe treatment.

How to behave parents whose child suffers from nocturnal enuresis?

The most important thing - In no case can not be punished and scoldedBecause punishment only worsen the emotional state of the child and contribute to the problem. But we can not pretend that nothing is happening. This problem can and should be discussed with the child, but not in terms of "Oh, what a nightmare, how can we live with it ?!", but in terms of "I'll help you deal with this." Here it must be said that in the old days it was thought that to write the child's need to publicly ridicule, he says, it will help him to realize his shame, he stopped writing. And some grandmothers still use this method. This grandmother is necessary to explain that we can not do that.

Doubtful seems the same "babushkovsky" method to awaken the child at night, so that he went to the toilet. This technique is only effective when a healthy baby is too sound asleep, so tightly that it ceases to feel in a dream his bladder. The child in this case may dream as he removes panties and defecate, but he did not wake up in the state. In all other cases, it is not accustom to control the bladder, it is just a way to save the bed sheet from another puddle. Similarly, recommendations are questionable not to give the child to drink at night. Most children wet the bed, regardless of whether they were given to drink at night or not, but the refusal to drink is an additional stress for the child and an additional reason to pee at night.

Since enureznye kids usually fall into the category of anxiety, excitable, impressionable, they in any case can not give coffee, cocoa, cola and any tonic beverages and foods. An hour before going to bed you must complete all the noisy outdoor games, replacing them with a quiet reading, drawing or sculpting.

Contrary to the horror stories of grandmothers, disposable diapers have no effect on the presence or absence of enuresis. Despite the fact that potty children who were held in "diapers" and start a month later than those who did without them, precisely enuresis does not depend on whether worn on the baby's disposable diapers.

Young moms love to share recipes, including enuresis - "We have got a very good doctor, he wrote to us here are the pills and helped us." In no case, treatment should not be prescribed the most. Medications should appoint a doctor strictly individually according to the results of surveys that helped one child may not help, and even harm another.

Show good child psychologist to help you find and eliminate the causes of a psychological nature, as well as help the child to get rid of complexes and worries about enuresis.

Sometimes there are recommendations to ignore incontinence in a child, they say, will grow - will pass by itself. In fact, leaving the problem can not be ignored. Nocturnal enuresis is a disaster, not only children but also adults, about 1% of all people who suffer from enuresis, - adults. Most of these are launched, insufficiently treated as a child. Perhaps, in regards to your child it is only a delay of the development of the central nervous system, and on the case - it will grow, and everything will be fine, but you should make sure that there are more serious reasons for concern.

https://azbyka.ru/zdorovie/nochnoj-enurez-u-detej

He felt a child suffering from enuresis?

He is going through a difficult internal conflict, feels a sense of shame and guilt for what is happening; He loses faith in himself because of the reaction of parents, if he is punished, humiliated words; suffering from ridicule from peers and let the silent, but the negative attitude of foreign adults; feeling of inferiority due to limitations in social activities (impossible to sleep for a long time to be away from home). Forms of enuresis are the following forms: nocturnal enuresis, which is most common in medical practice, and daytime incontinence.

Under nocturnal enuresis It refers to the presence of a child older than 5 years of involuntary urination during the night. Normally, the number of voiding varies from 7 to 9 per day depending on the age and number of the liquid drunk during the day. During the night there is a break in urination. Approximately 10-15% of children between 5 and 12 years suffer from bedwetting. As the percentage of maturation of the disease is greatly reduced, but about 1% of these children enuresis persists into adulthood. Boys enuresis occurs in 1,5-2 times more often than girls.

Primary and secondary enuresis

The diagnosis of "primary enuresis" put in if almost was not a child of "dry" nights, t. e. the child continues to be written from childhood and this happens from time to time that day, that night. Formation of the complete control over urination in a child occurs between the ages of 1 to 3 years, and ends at 4 years. Formed conditioned reflex connections: the urge to urinate leads to awakening. Most often there is a delay of forming this connection, in the case of primary enuresis. If there was a period (month or longer), when the baby does not write, then, most likely, we are talking about the secondary enuresis, formed when the reflex is broken or breaks. Secondary enuresis has psychological reasons or develops on the background of chronic somatic diseases (diabetes, urinary tract infection). A small child is not able to talk about their problems and experiences, and it begins "Speak" the body, as in the period of early childhood, there is a continuity of physical and emotional processes. A distinction is also neurosis and neurotic forms of enuresis. The most common cause of neurosis enuresis - organic lesion of the nervous system in utero or neyroinfektsy that is slowing the formation of control over urination or complete destruction of the previously formed functions. As a rule, the development of this form of enuresis does not depend on disturbances and other psychological factors, but increases with fatigue, physical ailments, colds.

When neurotic enuresis urinary function collapses under the influence of various psychological reasons. Enuresis becomes a response to a stressful situation. This very situation is traumatic for the baby not only awake, but repeated many times in his dreams, drawings, conversations. However, often enough in addressing the situation passes and enuresis, even without treatment. Although without timely psychological assistance to the child should not be left.

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