Nocturnal enuresis in children. Development of childhood enuresis: causes, types, treatment

Nighttime urinary incontinence in children under 5 years of age is considered normal occurrence. Unfortunately, there are children who, even at the age of 7-10, sometimes wake up on wet sheets. In addition to the fact that it is uncomfortable for a child to wake up in a wet, cold bed, he is also very ashamed. You can get rid of nighttime troubles only by establishing an accurate diagnosis of the disease that caused nocturnal enuresis.

What can cause enuresis in children aged 7-10 years

The processes that contribute to nighttime urinary incontinence (enuresis) in children of primary school age are represented by a physiological and psychological component. A wet bed upon waking causes trouble not only for the child, but for all family members. Most often, bedwetting occurs in boys and disappears by the beginning of adolescence.. This does not mean that the situation that has arisen does not need to be dealt with. If a child pees at night, he feels psychological discomfort, is ashamed and withdraws into himself.

The occurrence of nocturnal enuresis is caused by several reasons

1. Psychological reasons

By the way, the nervous stress that the baby experiences can provoke bedwetting.

• Change of environment (change of place of residence or transfer to a new school).
• Conflicts in the family.
• Loss of a loved one or four-legged pet.
• Exams or tests at school.

In most of these cases, enuresis goes away without outside intervention, but sometimes the help of medical professionals may be required.

2. What happened in the work of the central nervous system failure or immaturity

The body does not receive a signal that the bladder is full and that it is time to empty it. This reason is one of the main ones contributing to the manifestation of enuresis.

3. Hereditary factors

If both mom and dad suffered from the problem of night urination, then the probability of its occurrence in the child is almost 80%, and if one of the parents, then up to 45%.

4. Cold weather

Children are more sensitive to strong drops in temperature.

5. When a child is often taken to the toilet at night

He can sometimes wake up on his own and his conditioned reflex to urinate will quickly work.

6. Malfunctions of the endocrine system

In this case, the child exhibits not only enuresis. His sweating increases noticeably, his face becomes swollen, or he tends to become overweight.

7. Hormonal imbalance

8. Pathological abnormalities in the urinary system

9. Infection in the genitourinary system or vaginal infection (in girls)

10. Weak bladder or kidney function

The problem of enuresis during night sleep at 7-10 years old can be quite prosaic in nature. The baby is just healthy deep sleep or the root cause lies in the large amount of liquid, fruit or cold foods that he consumed before bed. Treatment in these cases will consist of timely monitoring of children.

Which doctor will help children get rid of enuresis?

First of all, parents, faced with nocturnal enuresis, turn to a pediatrician. As a rule, the doctor advises to wait a little, claiming that the problem will disappear over time. At best, he will prescribe a general blood test and an ultrasound examination of the internal organs.

On your doctor's advice, you should not wake your child up more often at night. This can only make the situation worse. Due to frequent getting up at night, the child may later develop symptoms of childhood neurosis.

A good pediatrician should determine what kind of specialist the baby will need and give a referral to a pediatric urologist, psychologist or neurologist. Only a complete examination will help determine what caused urinary incontinence during night sleep.

Don't wait for the problem to resolve without medical intervention. Contact your doctor at the first signs of the disease.

Methods to combat enuresis, depending on the causes of its occurrence

After full examination and discovering the causes of the disease, the doctor decides which method to use to solve the problem in a particular case.

Treatment with medications

• The drug Adiuretin-SD is recognized as one of the effective remedies for childhood enuresis., which contains the substance desmopressin. It is an analogue of vasopressin, a hormonal agent that normalizes the process of excretion or absorption of free fluid by the body. The drug is released in the form of nasal drops and is prescribed to children from the age of eight. For a child who has not reached this age, the doctor reduces the dosage.
• For bedwetting, to improve children's sleep may prescribe tranquilizers having a hypnotic effect. (Radedorm or Eunoctin).
• For neuropathic manifestations of the disease, Rudotel is prescribed, Atarax or Trioxazine (children over 6 years old).
• Neuro-like form of bedwetting is treated with Amitriptyline, however, its use before 6 years of age is contraindicated.
• To increase the volume of the bladder, Driptan is prescribed in tablets.
• To improve brain function, sedatives are prescribed, such as Persen, Nootropil, Novopassit, B vitamins, vitamin A and E. Pantocalcin may be prescribed. With its help, the development of impulses responsible for the acquisition of new skills is stimulated.

These products can only be used as directed and under the supervision of a physician. To avoid harm to the child, strictly adhere to the prescribed dosage.

Non-drug therapy

When the problem of bedwetting is psychological in nature, no medications will help unless irritating factors are eliminated from the student’s life. First of all, you should not scold your child for a wet bed or tease and ridicule him. This will only make the situation worse.

Fear of punishment or ridicule will provoke the development of the disease. You cannot tell strangers about the problems of your son or daughter, especially in their presence.

Creating a favorable microclimate in the family is the first step to success in the fight against childhood enuresis.

In addition, other factors have a beneficial effect on solving the problem

• Daily regime. It is necessary to properly organize the teenager’s rest and study time. He should avoid heavy loads that lead to fatigue and increase the duration of sleep. The last meal should be 2.5-3 hours before bedtime. In the evening, you need to limit your intake of liquids, especially juices, dairy and fermented milk products.
• Bladder training. The procedure begins at the age of seven. The child is taught to delay the process of urination. Watch when your baby goes to the toilet, ask him to be patient a little longer. Increase the delay time little by little. This will help you develop control over bladder.
• Motivational therapy. The method is highly effective, allowing to solve the problem of nocturnal enuresis in 80% of children. The best doctor in this case is the child himself. The essence of the method is very simple - rewarding children for every dry night. One child needs simple praise, another needs a new toy, bicycle or skates. Hang a calendar above your son or daughter's bed, marking all the dry nights. Agree with your child that with a certain number of dry nights per week or month, the baby will receive a long-awaited gift. If he fulfills his part of the agreement, you, without any excuses, must fulfill yours.
• Physiotherapy. The procedures promote improved functioning of the nervous system, brain and bladder. As medical procedures To ensure that the baby has a dry bed, they use electrophoresis, acupuncture, magnetotherapy, electrosleep, a circular shower and therapeutic exercises.
• Psychotherapy. The specialist teaches the child self-hypnosis and relaxation techniques. During the exercises, the reflex connection between the bladder and the nervous system, weakened for various reasons, is restored. In cases of severe neurotic enuresis, therapy for depressive mood shifts - tearfulness, fear, irritability or anxiety - is used. Family psychotherapy plays a big role in this, that is, creating a favorable climate in the family and comprehensive support for the child.

Traditional methods of combating bedwetting

Traditional medicine with its recipes can also become an assistant in the fight against illness.

1. A tablespoon of dill seeds Brew a glass of boiling water and leave for 1 hour. Children up to 10 years of age are given half a glass to drink in the morning on an empty stomach.
2. A decoction of St. John's wort leaves is added to the lingonberry compote. and give the child something to drink several times a day. The product helps well with incontinence, which is caused by psychological factors.
3. Pour 2 tablespoons of rose hips into one liter of boiling water. and let it brew. You need to drink the infusion several times a day, replacing tea or compote with it. Rosehip not only helps to cope with enuresis, but also has a general strengthening effect on the entire body.

Traditional medicine offers great amount recipes for enuresis. But before using them, do not forget to consult your doctor.

For treatment to be effective, family members must become a moral support for the child. Praise him for every dry night, don’t scold him if the bed suddenly turns out to be wet again.

You need to reassure your loved one, inspire him that you can get rid of all this and that he is able to cope with the problem that has arisen. Feeling the full support of loved ones, the baby will quickly cope with such an unpleasant phenomenon as nocturnal enuresis.

All parents are faced with the problem of bedwetting in children, but not everyone knows that you really need to start worrying when it happens after 5 years. The disease means the bladder is unable to hold its contents. When a person sleeps, the muscles relax, so involuntary urination occurs.

If “trouble” happened to a small child, then there is nothing to worry about. Parents of children who have crossed the five-year mark and continue to wet the bed should sound the alarm. Factors contributing to the onset of the disease.

Until a certain age, urination in babies is not regulated due to the fact that from the moment of birth they adapt to new conditions, form all life processes and skills to meet their physiological needs. If by the age of 4 these processes have not returned to normal, then parents need to ask themselves the question of the causes of the pathology.

According to the famous pediatrician Komarovsky E.O., enuresis does not mean the presence of serious pathologies in the body, so its treatment can quickly help get rid of involuntary urination during sleep, if it is properly organized. The main thing is that parents must remember the need for a gentle attitude towards the child, even if the treatment is delayed. The activity of all organs in the body is carried out through the brain, which is connected to them by nerves through the central nervous system, so the problem of urinary incontinence at night is not only physiological and medical in nature, but also psychological.

Anything can become an irritating factor: quarrels, parental divorce, the appearance of a small child in the family who receives more attention, fear, relationships in the classroom. Along with sessions with a psychologist, parents need to create a favorable environment in the family that minimizes stress: no punishment, ridicule, or publicizing the problem.

About the causes of the disease

In newborn children, the nervous system is not yet sufficiently developed, so urination occurs uncontrollably - up to 20 times a day. As the baby grows, nerve endings develop, children begin to control urges and learn to go to the toilet.

Full formation of the reflex should occur on average by 4 years, but depending on individual characteristics body, can happen a year earlier or upon reaching 5 years. The alarm should be sounded if, at the age of 6, 7, 8, 10, 11 years, involuntary urination in a child occurs during daytime and night sleep. Causes of enuresis:

• complications during pregnancy or childbirth, as a result of which the child was found to have perinatal hypoxic damage to the nervous system;
• hereditary predisposition - this means that a gene is passed from the parents to the child, which helps to increase the level of substances that reduce the response of bladder cells to antidiuretic hormone in the blood;
• presence of infection in the urinary tract or urological disease;
• stressful situations, unfavorable environment, psychological trauma;
• insufficient bladder capacity - this symptom must be taken into account if the child has previously had pyelonephritis;
• congenital or acquired diseases of the brain or spinal cord;
• diabetes;
• allergic reaction.

The cause of urinary incontinence can be psychological trauma received by the child. The nervous system of children is unstable, so even a quarrel in the family sometimes turns into health problems.

Enuresis in children can occur as a result of the action of several factors simultaneously; one cause can give rise to another. A very simple reason for involuntary urination at night can be, in the absence of pathologies, a sound sleep or an excessive amount of liquid, fruit, cold foods taken immediately before bed, or hypothermia of the body. Do not discount the psychological factors that contribute to the development of urinary incontinence: quarrels, night terrors, jealousy, etc.

Which specialist should I contact?

The doctor who deals with the primary diagnosis and treatment of all childhood diseases is a pediatrician. Despite the fact that the disease is associated with the urinary organs, it is worth starting with a visit to this particular specialist. A qualified doctor must identify the specialist who will be needed for a more accurate diagnosis and refer the parents and child for a full examination.

Considering that enuresis is a disease that can be caused by a number of different factors, it is appropriate to undergo examination by several specialists:

• the neurologist prescribes electroencephalography, which should reveal the state of the nervous system;
• the psychologist finds out whether there was stressful situations how the child develops, with the help of special techniques, reveals the emotional background in the family, gives recommendations to parents;
• The urologist prescribes an ultrasound of the kidneys and bladder, a urine test, and then drug treatment.

Each specialist works in turn, looking for the causes of the disease in their area.

If there is any doubt about determining the cause, the council may refer the child for examination to other specialists - a nephrologist, an endocrinologist. A core range of specialists is usually enough to confidently make a diagnosis and prescribe treatment that will help relieve the child of involuntary urination at night.

How to treat enuresis?

There is no single prescription for the treatment of bedwetting in children, since the prescription depends on the causes of its occurrence. Each specific case requires individual approach. Methods of drug treatment are prescribed based on the results of diagnosing the condition of the bladder muscles, the content of the hormone vasopressin, which regulates fluid levels, as well as the condition of its receptors:

1. Minirin - produced on the basis of vasopressin in the form of nasal drops, instilled before bedtime;
2. Driptan – with increased bladder tone;
3. Minirin in combination with Proserin - for hypotension of the bladder in the form of injections;
4. Nootropil, Persen in tablet form, B vitamins - treat nocturnal enuresis of neurotic origin.

All medications are used only after examination, identification of the causes and prescription by a specialist with strict adherence to the rules of administration and dosage. Alternatively, patients may be referred to a homeopathic physician who will prescribe alternative remedies:

1. Pulsatilla – in the presence of infectious diseases of the urinary tract, also for emotionally excitable children;
2. Gelsemium – for symptoms of relaxation of the bladder muscles as a result of stressful situations;
3. preparations containing Phosphorus are prescribed to children who drink a lot of cold water;
4. Sepia – for urinary incontinence when coughing, laughing at any time, also in the first 3 hours after falling asleep.

Modern homeopathic medicines are able to guarantee a cure for enuresis, provided that the diagnosis is correct. Alternative Methods may be prescribed if medications have not had the desired effect and enuresis in children cannot be cured.

Diseases of nervous origin are often treated using traditional medicine. Persen is considered one of the safest sedatives. About non-drug methods

Medications will not have the necessary effect on curing enuresis if the cause of its occurrence is psychological. Other factors that help normalize the urination process:

• Organization of the daily routine. Correct regulation of all processes during the day will accustom the body to internal discipline (eating at strictly defined hours, walks, daytime rest, sleep, entertainment) and will gradually eliminate enuresis in children. It is necessary to teach your child to stop eating 3 hours before bedtime. To fulfill this difficult condition best example parents themselves must become
• Bladder training exercises. It is necessary to teach how to control the process of urination. To do this, you need to learn to briefly delay the desire to go to the toilet.
• Creating a motive. Motivational therapy is a powerful psychotherapeutic tool that is used for children suffering from enuresis. It is used exclusively in cases where the cause of the disease is psychological factors. The motive should be to reward the child for “dry” nights. What will be the subject of reward and for how many successful nights is an individual decision, but the technique works in 70% of cases.
• Physiotherapeutic treatment. Physiotherapy in the form of electrophoresis, acupuncture, magnetic therapy, electrosleep, circular shower, and therapeutic exercises is designed to improve the functioning of the brain and nerve endings.
• Psychotherapeutic assistance. Using special techniques, the specialist teaches the child methods of self-hypnosis. As a result, the reflex connection between the central nervous system and the bladder muscles should be restored. If the neurotic nature of bedwetting is pronounced, then psychologists use their tools to shift depressive states. The main role in psychotherapy should be played by creating a favorable positive atmosphere in the family.

In some cases, the child may benefit from therapeutic exercises, which stimulate nerve endings and strengthen the nervous system. Remedies traditional medicine in the fight against disease

Traditional medicine is a storehouse of healing methods for all kinds of diseases, so you should not neglect effective home recipes that came from time immemorial. They have been tested in practice by many generations of people and contain only natural ingredients:

• For children under 10 years old, brew a tablespoon of dill in a glass of boiling water and leave for an hour. Drink half a glass in the morning on an empty stomach.
• Cook lingonberry compote with the addition of 2 tablespoons of rosehip, let it sit. The infusion can be drunk several times a day; it has a calming effect on the nervous system.
• Pour 2 tablespoons of rose hips into one liter of boiling water and leave. Instead of tea, drink throughout the day. Rosehip strengthens nerve cells well.
• Bring lingonberry berries and leaves, St. John's wort in an arbitrary small amount to a boil in ½ liter of water. Leave for 30 minutes, strain, cool and take throughout the day.
• Brew 30 g of crushed plantain leaf in 350 ml of hot water, let it brew, take 10 g 4 times a day.
• Chop the herbs of mint, St. John's wort, birch leaves, chamomile flowers in equal parts and mix. Pour 50g of the mixture into 1 liter of hot water in a thermos and leave for 8 hours. Take 100 g half an hour before meals. To ensure that your child drinks the infusion with pleasure, you can add honey to it. After 3 months you need to take a break for 2 weeks, then continue taking the drug.
• A collection of knotweed, yarrow, St. John's wort, and blackberry leaves will relieve the symptoms of enuresis. All ingredients must be crushed and mixed in equal parts. Pour 300 ml of boiling water over the finished 10 g of the mixture and leave in a thermos for 2 hours. The infusion should be taken 5 times a day before meals.

Folk remedies will have the desired effect if taken under the supervision of a physician. Herbal remedies are an addition to the main treatment and should not be a complete replacement for it. Besides, herbal teas may have a good effect in preventing enuresis.

Reading time: 5 min.

Enuresis is persistent nocturnal urinary incontinence, involuntary urination at night that does not correspond to the psychological age of the child. Enuresis in children may be associated with organic reasons, and may be psychogenic.

The disease is considered primary if involuntary urination at night is observed regularly, and secondary when the child has already had a “dry period” - the disappearance of incontinence symptoms for 6 months or more.

1. Prevalence

In general, boys suffer from the disease 1.5-2 times more often than girls. Among those children whose parents were also diagnosed with enuresis, the likelihood of its occurrence increases to 70%. The frequency of involuntary urination at night is higher in dysfunctional families.

Cystectomy, transurethral resection and other types of bladder surgery

2. Causes of bedwetting

Proven causes of enuresis in children are:

1. 1Hereditary predisposition. If one of the parents suffered from the disease, then the probability of it occurring in the child is about 40%, if both parents, then the risk of the disease increases to 70%. Currently, experts distinguish several types of pathology caused at the gene level: type 1 (*600631, 13q13–q14.3, ENUR1 gene, Â) and type 2 (*600808, 12q13–q21, ENUR2 gene, Â).
2. 2Infection genitourinary tract. According to research data, the frequency of asymptomatic infections urinary tract in five-year-old girls it is 1%, and in enuresis – 5%.
3. 3Stress. If a child experiences severe emotional shock at the age of 3-4 years, then the likelihood of pathology doubles. Typical stressful conditions for children are separation from their mother for more than 1 month, parental divorce, moving, the birth of a second child, accidents, hospitalization, sexual abuse, etc.
4. 4Social disadvantage. This means living in orphanages, cramped apartments, and being raised in socially disadvantaged families.
5. 5Delay neuropsychic development. Enuresis in a group of children with delay speech development and motor skills are observed 2 times more often.
6. 6Late potty training.
7. 7Insensitivity of the kidneys to antidiuretic hormone (ADH) at night.

Unlikely causes of enuresis include structural abnormalities development of the urinary tract, decreased functional ability of the bladder, sound sleep, epilepsy.

Secondary enuresis can be one of the symptoms of the following diseases:

1. 1Developmental anomalies, injuries and tumors of the spinal cord - spina bifida, myelomeningocele, etc.
2. 2Epilepsy - against the background of ongoing antiepileptic therapy or during minor seizures.
3. 3Attention deficit hyperactivity disorder.
4. 4Neurosis and neurosis-like conditions.
5. 5Intellectual disability, mental retardation.
6. 6Taking medications used in neurology - phenytoin, valproate, diazepam, baclofen, botulinum toxin, thioridazine, etc.
7. 7Food allergies.
8. 8 Malabsorption syndrome, intolerance to certain foods - gluten, lactose.

Urinary incontinence in women - causes, diagnosis, treatment methods

3. Diagnosis criteria

According to the International Classification of Diseases, X Revision (ICD), there are 5 main criteria for diagnosis.

Table 1 - Diagnostic criteria for enuresis

Causes, symptoms, treatment tactics and main groups of antibiotics prescribed for cystitis in children

4. Features of pathogenesis

The physiological development of urinary control in a child occurs in several stages:

1. 1Infantile bladder. It is observed in the first months of life after birth. The bladder fills and then empties under the influence of the parasympathetic nervous system. This process is not controlled by consciousness.
2. 2Immature bladder. At the age of 1-2 years, impulses from the bladder, when it is filled, are sent to the cerebral cortex, so the child already partially controls urination independently. First, involuntary urination disappears during the day, and then at night.
3. 3The bladder usually becomes mature by 3-4 years, less often by 5-6 years. By this time, its volume increases, the baby is able to actively contract the pelvic floor muscles and the urethral sphincter, as well as suppress detrusor hyperactivity.

With enuresis, bladder maturity is not observed. In some children, the maturation process is completed by 6-7 years, less often by adolescence, after which spontaneous healing occurs.

5. Pathogenetic mechanisms

Whatever the causes of enuresis, the mechanisms of development of the disease can be reduced to 3 main ones:

1. 1Violation of the correspondence between the volume of the bladder and the amount of urine.
2. 2Increased detrusor activity at night.
3. 3Disturbance of awakening processes.

Violation of the correspondence between the volume of the bubble and the amount of contents can be caused by:

1. 1Anomalies in the structure of the genitourinary system, initially accompanied by a decrease in the volume of the bladder, etc.
2. 2Impaired production of hormones that reduce urine formation at night - vasopressin (ADH), etc.
3. 3 Habit of drinking at night.
4. 4Insensitivity of the kidneys to the action of antidiuretic hormone.
5. 5 Diabetes mellitus or diabetes insipidus.
6. 6Snoring, episodes of apnea.
7. 7Pathologies of the nervous system, leading to increased detrusor tone and sphincter weakness.

5.1. Increased detrusor activity at night

The detrusor is the main muscle of the bladder, responsible for contracting it and expelling urine.

With him increased activity uncontrolled urgent urination is observed at any time of the day, including at night, so overactive bladder syndrome is often accompanied by enuresis.

5.2. Disruption of awakening processes

It is now believed that deep sleep alone does not contribute to bedwetting. Most often, the awakening processes are disrupted: the child does not wake up, despite the fact that the bladder is full.

This is partly due to insufficient interaction between the brain stem structures - the locus coeruleus, which is responsible for awakening, and the urinary center. Now research in this direction is actively continuing.

6. Classification and types of enuresis

We present the classification of the disease in the form of Table 2.

Primary		80-90% of all cases of the disease among young children, the child wets the bed regularly
Secondary		50% of all cases among children 12 years of age and older have a period of “dry” nights lasting at least 6 months, there is a connection with neuropsychiatric, urological or endocrine diseases
Uncomplicated		Absence of objectively confirmed abnormalities in the neurological and somatic status of the child
Complicated		There are deviations in the neurological and somatic status
Organic		With changes at the anatomical and physiological level
Inorganic		With changes at the psychoneurological level
Primary	Monosymptomatic	Bedwetting only
	Combined	Night and daytime urinary incontinence

Table 2 - Classification and types of enuresis

Table 3 - Forms of enuresis based on EEG and clinical observations

6.1. Neurotic form

The neurotic form of enuresis differs from others in that children are absolutely not indifferent to the fact that they have episodes of bedwetting.

Children can experience a variety of emotions, ranging from simple interest in what is happening to painful experiences. As a rule, a major role in the occurrence neurotic form enuresis plays a role in psychotrauma.

Types of neurotic form:

1. 1Asthenoneurotic. It develops after psychological trauma in weakened, emotionally vulnerable, quiet and shy children only during certain age periods associated with critical age (3, 5, 7 years). They are very sensitive about their defect, which leads to a feeling of inferiority. Restless sleep, you may dream about a traumatic situation. No changes are observed on the EEG.
2. 2 Hysterical. It is more common in artistic, active, sociable girls with a lively temperament and rich facial expressions. No changes are observed on the EEG.
3. 3Jet. In this form, enuresis itself serves as a psychological trauma and causes a severe emotional state (up to and including suicide attempts). If symptoms persist, it is fraught persistent changes personality even after the disease disappears at an older age.

7. Treatment

Treatment of bedwetting in children is complex, including the use of psychotherapeutic techniques, drug therapy, and lifestyle changes.

7.1. Mode optimization

It should be aimed at strengthening the conditioned urination reflex or its development. Includes:

1. 1Psychologically comfortable mode – eliminating stress, prolonged viewing of TV shows, overwork, etc.
2. 2Maintaining optimal body and surrounding temperature (avoid hypothermia, warm bed).
3. 3Wake the child until he is fully awake at the same time to consciously go to the toilet.

7.2. Diet correction

Have dinner no later than 3 hours before bedtime. In the evening meal, exclude foods that increase urination: strong tea, coffee, cucumbers, apples, watermelons, milk, kefir.

For dinner you can give dry crumbly porridge, cheese, egg, a sandwich with jam, butter.

7.3. Attitude of family members

It is necessary to create a warm and cozy atmosphere in the family. The attitude towards the child should be even and calm. He should not be punished for involuntary urination, so as not to increase feelings of guilt and anxiety. After each case, it is necessary to change bed linen and wet clothes; the baby should not be left in a wet bed until the morning.

7.4. Self-control training

Regular performance of special exercises contributes to the development and consolidation of mechanisms for independent control of urination. Important aspects are strengthening faith in one’s own strengths, elements role playing games, behavioral psychotherapy, alarm therapy (urinary “alarm clocks”).

7.5. Physiotherapy

Exercises are prescribed to strengthen the abdominal and pelvic floor muscles. Skating, skiing, cycling, and swimming are quite effective.

7.6. Drug therapy

As a rule, treatment of primary enuresis begins with the appointment of an analogue of the antidiuretic hormone - desmopressin, minirin. According to the recommendations of WHO and the European Society for the Study of Enuresis, these are the drugs of choice No. 1, which have proven their effectiveness.

The dose of desmopressin is selected individually, starting from 0.2 mg. The course of treatment is 3 months. Then they take a week's break, and if the episodes recur, then a repeat three-month course is carried out with an adequate dosage of the drug (up to 0.4 mg).

The effectiveness of desmopressin reaches 80-90%, therefore foreign clinics treatment begins with him. Desmopressin can be combined with many antibacterial agents.

If desmopressin is intolerant, drugs of other groups are prescribed. The choice of a specific tool depends on clinical picture and the suspected nature of urinary incontinence.

Nocturnal enuresis in children is considered a fairly common problem in preschool and school age. This is the uncontrolled separation of urine in a small or large volume at night. This problem needs an urgent solution, since over time, in the absence of proper treatment, it can develop into a permanent condition. Why does enuresis occur and how to treat bedwetting in children?

“Wet bed” does not happen rarely in growing children, but this phenomenon should not be treated as temporary and left to chance.

Types of enuresis

There are two main types of bedwetting:

1. Primary enuresis - occurs for the first time in a child and is manifested by uncontrolled urination at night. This type of enuresis has a mild form and there is no need to apply a specific treatment method to it.
2. Secondary - occurs under the influence of certain factors (it may appear and then disappear again).

Types of enuresis depending on the form of occurrence:

1. uncomplicated - symptoms appear related only to uncontrolled urination, otherwise everything is fine with health;
2. complicated - the malaise is expressed not only characteristic symptoms, but also affects internal organs, provoking an inflammatory process and some deviations in the development of the child.

Minor types of incontinence in children:

1. Neurotic enuresis - appears in children who are ashamed and to some extent afraid of their condition. Such children have disturbed sleep, as they fear that they may wake up “wet.”
2. Neurosis-like enuresis - incontinence appears in overly nervous and hysterical children. Until adolescence, they do not worry about their condition, and then, beginning to understand that it is bad, they withdraw into themselves and alienate society.

We struggled with enuresis for a very long time, but there was no point, we sinned because my husband also had enuresis in childhood, then it went away on its own, we waited for the child to go away, and when the age had already reached 10 years, I became seriously worried, I looked for Doctors, according to all our friends and acquaintances, came to the center for the treatment of enuresis. We turned there for help, we went through everything necessary tests, X-ray, ultrasound, filled out a diary of fluid intake and urine emissions, and we were prescribed Minirin 60 mcg per day. We took the course, then a test week and a month break, during this period the child settled down again, and we went to the second course of treatment, after which everything got better.

If a child urinates in bed during sleep at night, they speak of nocturnal enuresis. This problem is very common in childhood. Modern medicine does not classify it as a disease, but calls it a developmental stage during which the child masters the functions of his own body.

Depending on the time of formation of the “guard” reflex, the following types of incontinence are distinguished:

• Primary. The child has not yet learned to control urination. This is the mildest form, which in 98% of children goes away on its own without therapy.
• Secondary. The child had already learned to control his bladder in the past and his bed was dry for more than 6 months.

If a child develops enuresis after controlling urination for six months, the problem is more difficult to correct

Depending on the symptoms, enuresis can be:

• Uncomplicated. The child has no other abnormalities besides enuresis.
• Complicated. The baby has inflammatory diseases, developmental disorders and other pathologies.

Depending on the child’s reaction to the problem, the following types are distinguished:

• Neurotic. This form of incontinence is typical for a fearful and very shy child with shallow sleep. The baby is very worried about failures at night, which leads to sleep disturbances.
• Neurosis-like. This form of enuresis occurs in children with hysterical behavior. A child is not very worried when he sees a wet bed until adolescence, when incontinence can cause isolation and neuroses.

At what age is this normal?

Normally, a child learns to control his urination at night by the age of 6 years. At the same time, about 10% of children who turned 6 years old have not mastered such control. Over time, the problem becomes less common. By the age of 10, nighttime incontinence is noted in 5% of children, and by the age of 18 - only 1%. In boys, the problem occurs twice as often.

If a child under 6 years of age does not always control urination during sleep, do not worry. Causes In boys

The problem of incontinence occurs more often in boys. The following factors lead to it:

• Birth injury, affecting the spinal cord or brain.
• Long-term formation of a conditioned reflex. Some boys develop this reflex later than their peers.
• Stressful situations. Enuresis can occur as a result of severe fright, constant quarrels between parents, changing schools, moving and similar factors that greatly influenced the child’s psyche.
• Heredity. If incontinence was observed in both parents, then the problem is possible in 70-80% of cases. If one of the parents suffered from enuresis, the boy will have this problem in 30-40% of cases.
• Inflammatory diseases of the bladder. They are determined by the results of a urine test. Congenital pathology of the urinary tract can also lead to incontinence.
• Long-term use of diapers. The child gets used to the fact that after urination the bed is not cold or wet.
• Hormonal disorders. With insufficient production of hormones that affect the functioning of the bladder, the volume of urine excreted and its concentration, the child develops incontinence.
• Overprotection. It is often observed in single-parent families, when a boy is raised by his grandmother or mother. Due to too much guardianship, the child subconsciously behaves like a toddler, because he has the feeling that he is small.
• Hyperactivity. When a child is highly excitable, the activity of processes in the brain prevails over signals from the bladder. And the brain simply does not “hear” the urge to urinate at night.
• Lack of parental attention. With such a deficiency, the child subconsciously does everything in order to feel cared for by loved ones.
• Allergies. It is noted that in boys with allergic reactions, as well as bronchial asthma, episodes of enuresis are a fairly common problem.

To eliminate enuresis, it is necessary to identify the cause of uncontrolled urination during sleep In girls

Thanks to the peculiarities of the nervous system, girls quickly learn to control the functioning of the bladder and begin to go to the potty earlier, so the problem of enuresis appears much less often in them, and if it does arise, it is easier to cure it in a girl.

Incontinence may occur in the following situations:

• If the development of reflexes is slightly delayed. Some girls learn to control their reflexes later than their peers.
• As a result of stress or psychological trauma. A girl may be affected by the divorce of her parents, the appearance of a second child in the family, a change of place of residence, a transfer to a new kindergarten, and similar factors.
• With very sound sleep. It can be a sign of either congenital characteristics of the girl’s nervous system or overwork.
• If a girl drinks a lot at night. Soldering during a cold can also lead to a “wet bed.”
• Under the influence of a hereditary factor. It causes the release of the hormone vasopressin, which reduces urine production at night. Lack of this hormone can be passed on from parents. If one of them had enuresis as a child, there is a 30 percent chance of incontinence in the daughter. If both parents had the problem, the risk of enuresis in a girl increases to 75%.
• For spinal cord and spine injuries. They disrupt the pathways of impulses from the brain, as a result of which they do not reach the bladder.
• If there is a developmental delay. If a girl is delayed, the formation of all reflexes occurs later.
• If you develop a urinary tract infection. Due to the wide and shorter urethra in girls, microorganisms that develop on the genitals can enter the bladder.

Enuresis occurs much less frequently in girls than in boys. In adolescents

At this age, enuresis is observed in 5% of children and it is often secondary, but it can also drag on from an early age.

The main reasons for possible incontinence in a teenager are:

• Stress. The child may be overly sensitive to the tense situation at school or family, suffer from physical punishment, conflicts with peers, moving, loss loved one and other stressful situations.
• Mental illnesses. Neuroses and depression can lead to incontinence, which is further aggravated by worries and teenage complexes.
• Congenital pathologies. They can be both in the nervous system and in the organs of the urinary system.
• Hereditary tendency. As in younger age, enuresis in adolescents may be due to such a problem in his parents.
• Injuries. They can lead to disruption of the urination reflex.
• Hormonal changes. Hormone levels change during sexual maturation, so the production of hormones that affect urination may be disrupted.

In adolescents, enuresis can lead to various psychological problems Psychological problems

Nocturnal enuresis is almost always a significant problem for a child, and if incontinence develops in a teenager, it can cause a serious inferiority complex. Children with enuresis find it difficult to communicate with peers, even if other children do not know about this problem.

The child feels inferior, withdraws, tries to avoid contact with other children, and seeks solitude. This can leave an imprint on the character - children with incontinence experience embitterment, indecisiveness, aggressiveness, and uncertainty, which carry over into adulthood.

Such changes especially often occur when parents ridicule the child, if the child is punished and scolded for wet sheets. That is why parents should be sensitive and caring, and their reaction to enuresis should be delicate and correct.

The successful solution to the problem largely depends on the reaction of the parents. Diagnostics

If the child is over 6 years old and does not yet have full bladder control, additional testing should be done. The child is prescribed urine tests (general urine test and Zimnitsky test) and ultrasound of the excretory system. In many cases, MRI, cystoscopy, EEG, X-ray examination, examination by a neurologist, endocrinologist, psychiatrist and other specialists are additionally prescribed.

There are quite a few ways to eliminate incontinence, but their effectiveness differs in the situation with each individual child.

Medicines

• If enuresis is associated with hyperactivity and excitability of the nervous system, the child is prescribed sedatives.
• When inflammatory and infectious processes are detected, antibiotics are prescribed.
• If the development of the nervous system is delayed, the child may be prescribed nootropic drugs.
• For disturbances in the production of hormones that affect the composition and volume of urine, as well as the functioning of the bladder, desmopressin is prescribed.

Urinary alarm clock

This is very effective technique combating incontinence, which consists of using a special alarm clock. A sensor is connected to it, which is placed in the child’s panties. When the first drops of urine fall on the sensor, it is triggered and sends a signal to the alarm clock, as a result of which the child is forced to wake up, turn off the device and go to the toilet.

Urinary alarm clock is considered an effective way to combat enuresis Other methods

Physiotherapeutic procedures are recommended to improve the functioning of the bladder and nervous system. The child may be prescribed magnetic therapy, electrophoresis, therapeutic shower, acupuncture, electrosleep, a course of therapeutic baths and other methods of physiotherapy. Therapeutic exercises and massage are also recommended.

The effects of psychotherapy are also noted. The psychologist will teach the child to relax and use self-hypnosis. Many people find it helpful to keep a diary, in which dry nights are indicated by suns, and for a certain number of such suns in a row, the child is given a reward.

In addition, a child with enuresis is recommended to establish a daily routine and follow a certain diet. Drinks are limited in the evening, and at night the child is given food that helps retain water in the body. It is important to ensure a sufficient supply of vitamins in the children's diet.

A well-established daily routine will help the child psychologically calm down before bed. Folk recipes

People consider honey to be one of the excellent means of treating enuresis. It is advised to eat it before bed to retain fluid in the body during the night and calm the nervous system.

You can also give your child:

• A decoction of young cherry branches and dried blueberry stems. After steeping the brewed plants for 15 minutes, add a little honey to the drink and give this decoction to the child twice or thrice a day, a glass between meals.
• A decoction of dill seeds. Seeds dried in a frying pan (2 tablespoons) are brewed in an enamel container with 0.5 liters of boiling water and left for four hours. You should drink this remedy before meals for 14 days, twice a day.
• Infusion of centaury and St. John's wort herb. Take half a glass of each plant in dry crushed form and brew 500 ml of boiling water. After steeping for three hours, the decoction is given to the child before meals 3-4 times daily for two weeks.
• Corn silk tea with honey. A teaspoon of stigmas is poured with boiling water, and after 20-30 minutes a teaspoon of honey is added to the drink. You should drink this tea twice a day.
• Tea made from dried berries and leaves of lingonberries and dried St. John's wort. Plants are taken in a 1 to 1 ratio; for one serving, two teaspoons of crushed raw materials are brewed with a glass of boiling water. After 15 minutes, the broth should be drunk in small sips (preferably after lunch).
• Balls made from crushed egg shells and honey. The components are mixed 1 to 1, balls with a diameter of 2 centimeters are made and the child is given 4 pieces daily for a month.

However, do not forget that the use of any folk recipe It is worth discussing with your doctor before trying its effect on the problem.

The use of folk remedies should be in combination with other activities. Advice for parents

• Try to protect your child from various stressful situations.
• Let the child go to bed at the same time every day, and 3 hours before this, the volume of fluid should be sharply limited.
• Avoid active games just before bedtime. At this time, you can read, draw, watch non-scary cartoons together.
• To relieve pressure on the bladder, you can place a cushion under your baby's mattress in the baby's pelvic area or under the baby's knees.
• Make sure your child does not have hypothermia. As soon as the baby's legs freeze, the bladder will fill reflexively.
• The child should definitely go to urinate before going to bed. If you wake your child to urinate at night, don't let him nap in the toilet.
• Buy a night light for the children's room so that the baby is not afraid to go to the toilet in the dark when he wants to.
• If you notice a wet sheet in the morning, do not swear or get upset in front of your child. Seeing your reaction, the baby will begin to think that he has a very serious problem. Tell your child that this often happens in children, but it goes away over time.
• Any treatment method will be effective if you instill in your child the confidence that he will succeed.

Enuresis - night urination, is a common disease in children 4-7 years old. Preschool children often pee at night. At first, parents do not consider this a problem. But we must not delay and waste the time to treat this not only physiological, but also emotional illness.

Both children and parents are ashamed to admit the disease and see a doctor. If your child wakes up in a wet bed, this is not normal and should be concerned.

A sensitive problem should be carefully discussed with the child. He is already suffering, and should not feel shame or fear of his parents, and should not hush up or hide traces of the night’s incident from adults. Your child must trust you completely and agree to be examined and treated by a doctor. Often the wrong position of adults leads to psychological trauma, sleep disturbance and the formation of an inferiority complex.

Classification

The ability to control the process of urination matures in the head. This happens at different times for different children. But by the age of five, 80% of children can sleep peacefully through the night and go to the toilet when they wake up in the morning. Daytime incontinence in preschool children is rare. We won't talk about him. Nocturnal enuresis is often a disease that requires contacting a urologist. Enuresis is several times more common in boys.

• Primary enuresis– when the child does not wake up to pee at night.
• Secondary enuresis– a consequence of severe mental or physiological trauma. In this case, involuntary urination can occur both at night and during the day.

The child learns to control the process of urination along with other skills and life processes. At the age of one and a half years, babies feel the filling of the bladder and express anxiety when the moment approaches to empty it.

The relationship between the brain and the center for regulating urination is formed by 4-5 years. When the bladder muscles in children contract, they push out the accumulated fluid, and the inlet muscles relax. Small children cannot control the relaxation of this muscle; the process occurs involuntarily.

By the age of three, the size of the bladder increases, the brain gives a command to keep the muscles in a tense state, as a result of which the process is inhibited. A 2-3 year old child is already asking for something “small”. During the day, the excretory system turns on 7-8 times, and at night the bladder is not disturbed by urges. The “adult” urination pattern is fully developed by the age of four. Before this, night “swimming” in children is not a pathology.

Prerequisites for the occurrence of enuresis

The causes of enuresis in girls and boys are not the same. The development of the body and behavioral patterns of each child are individual. Conditions of upbringing, habits, and hereditary traits can affect the formation of health.

How factors can cause enuresis in children?

State of brain development. Slow development of the central nervous system entails insufficient ability to control the process of urination. The reason for slow development may be an unsuccessful pregnancy or difficult childbirth. Children with this feature are easily excitable, nervous, and have difficulty concentrating. A calm environment and hardening of the baby’s body will help to avoid enuresis.

Daily routine with periods of sleep and wakefulness. Sleep disturbance is one of the common reasons night urination. This is restless superficial sleep or deep sleep (when the child does not remember when he is woken up at night).

Extremes in the system of raising children. If the baby is allowed everything and is not taught cleanliness and personal hygiene, then he does not pay attention to wet panties or bed. Or, conversely, if a child is too harshly reprimanded for every little thing, he is afraid to remind himself once again and ask to go to the toilet.

Causes of the disease:

• psychological situation at home;
• heredity. If there are cases of neuropathic diseases, enuresis in the family, this may be the cause of the disease;
• abnormalities in the formation of the genitourinary system. Insufficient bladder volume;
• inflammatory processes, untreated cystitis, consequences of injuries and operations;
• improper organization of the child’s sleeping place. The bed should be hard and warm. You should always wrap your lower back and legs tightly, wear warm pajamas at night and socks.

Another reason is the abuse of diapers, which can be convenient for mom. The child is warm and there is no need to constantly put him on the potty. But this leads to the fact that three-year-old children do not know the potty and urinate in their pants. A child should be potty trained as early as one year of age.

He must understand that discomfort from wet onesies or diapers occurs after urination. At the level conditioned reflexes the need to stay dry is formed. The child begins to worry at the right time, indicating that it is time to go to the potty. By the time the child arrives at the nursery, he or she must be able to cope without diapers during the waking period. Even up to one year old, you should not keep your baby in a diaper all the time. Only during a walk, visit or clinic.
Read more: weaning a child off diapers →

Nocturnal enuresis in boys

Boys always strive to establish themselves, they want to appear strong and independent. Not everyone can do this. If such a child lacks confidence and determination, he begins to feel defective. He develops complexes and becomes nervous.

This character most often develops when a child is exposed to strong pressure from adults. If a mother orders something to be done, often unreasonably prohibiting the child from doing things that are pleasant for the child, the baby cannot openly express dissatisfaction. Enuresis in such cases occurs as a reaction to rudeness or a protest against prohibitions.

By changing the way you communicate with your child, you can eliminate psychological reason diseases. The child needs a warm attitude, protection from loved ones, and their support.

We should talk about enuresis as a painful condition if the boy often urinates during the daytime. Associated symptoms include slow pulse, sluggish mental condition, pale legs and arms, low temperature. The child's behavior is characterized by extreme states. Either he is quick-tempered and impulsive, or he is withdrawn and depressed.

The boy behaves timidly, insecurely, his attention is scattered. Neurosis-like enuresis is successfully treated with complex therapy - sedatives, diet. Hypnosis, physiotherapy, reflexology, and acupuncture are also used.

Enuresis may be a consequence surgical intervention. Most frequent operations for boys - removal of an inguinal or umbilical hernia, circumcision and others. In any case, the sooner the disease is identified and treatment begins, the more effective it will be.

Raising a boy should be harmonious. Both parents should stick to the same line on this issue. Disagreements and contradictions between them lead to inappropriate behavior of the child. He takes the side of the parent who allows everything and does not scold under any circumstances. Therefore, a demanding mother or father, who teaches to restrain the urge and run to the toilet in order to stay clean, seems angry and unfriendly to the baby.

Protesting their demands, he pees his pants. He begins to enjoy angering and irritating the “right” adults. Full-fledged upbringing consists of attentive attitude towards the child, his needs and requirements. You need to establish contact and trust with him. The baby should feel that he is loved. Then he will want to respond in kind, to be good.

Enuresis in girls can also be associated with psychological problems.

Character changes in a child with enuresis

To start treatment, you need to persuade the child, who is ashamed, to admit his trouble even to his mother, and to go to the doctor. Children suffer greatly mentally from enuresis; the delicacy and patience of loving parents is of great importance. If a child feels ridicule or irritation, he will withdraw, avoid peers, and consider himself inferior.

Treatment. How to help a child cope with illness?

• Follow the doctor's instructions, monitor your sleep and diet.
• The child should fall asleep and wake up at the same time. Before going to bed, it is advisable to take a walk in the fresh air.
• It is better to exclude active games, TV and computer in the evening hours. They can be replaced with calm ones board games, by reading.
• The foot of the bed should be raised slightly.
• Don't scold your baby if the bed is wet again the next morning. Support him with a joke, cheer him up. Tell him that the illness will soon pass.
• Limit drinking in the evening. Kefir, milk, fruits have a diuretic effect. They can be replaced with salted nuts and a piece of cheese. Salt promotes water retention in the body.
• Do not deny your child trips, trips, and visits. Sometimes in another environment the child remains dry at night.

Some practical tips:

• if it is difficult for a child to go without drinking for 3-4 hours before bedtime, do not focus on this, do not prohibit drinking, just reduce the portions;
• Sometimes children don't get up at night because they are afraid of the dark. Place a potty next to the crib and leave the night light on in the nursery at night;
• If you wake your child up at night to go to the toilet, bring him fully conscious. Otherwise, the enuresis reflex will only become stronger;
• do not wear diapers at night;
• If the child is old enough, treat him like an adult. Let him himself, preferably without witnesses, make his wet bed, take a shower himself;
• Keep a diary with your child in which you will note dry and wet nights (draw the sun or a cloud there, if there are more and more “sunny” nights, praise him). The diary will be very useful for the doctor when choosing treatment methods.

Treatment of enuresis with medications

The issue of prescribing medications can only be decided by pediatrician. He will determine the cause of the disease and select drugs for treatment - adaptogens, antidepressants, nootropics.

Children do not like injections and pills. The medicine Adiuretin-SD is available in the form of nasal drops. It reduces the amount of urine and allows you to retain it until the morning. It is indicated for children whose rhythm of urine accumulation is disrupted. There is less of it during the day than at night.

Medicines are prescribed in courses. After finishing the treatment, the problem may return. The doctor recommends the duration and frequency of courses. This remedy must be taken by a child when he finds himself among strangers, at a children's camp or on a trip. He will feel more confident.

You cannot choose your own medicine to treat enuresis. The cause may be an inflammatory process, a cold, or an infection, which should be treated not with nootropics, but with antibiotics. Self-medication of enuresis is prohibited!

If the nervous regulation of the bladder is impaired and it is in good shape, then Driptan is used. It relaxes the walls of the bladder, thereby increasing its volume. This drug is combined with Minirin.

To activate the tone of the bladder muscles, the doctor prescribes Minirin + Praserin.

To activate processes in the brain, it is recommended to take Nootropil, Picamilon, Persen, Novopassit and a complex of vitamins.

Other treatments

Physiotherapeutic procedures include exposure to the bladder with ultrasound, currents, and heat treatment (paraffin or ozokerite).

Traditional methods of treating enuresis

Herbal infusions:

• mix hawthorn, horsetail, mint, St. John's wort in a ratio of 4:1:2:2. 3 tbsp. l. collection pour 0.5 l. boiling water and leave. Take 100 g 5 times a day;
• Mix knotweed, St. John's wort, chamomile, mint, and yarrow equally. Brew as described above;
• Lingonberry leaves, dill, and thyme are useful for preparing infusions.

Read more: Treatment of enuresis in children with folk remedies →

A set of special exercises

The exercises are aimed at developing control over the urination process. The child must learn to restrain himself when necessary. To find out the volume of the bladder, the child is asked to hold the process when he urges. Then measure the amount of urine. This will be the volume of the bubble. In the evening, ask your child to imagine that his bladder is full and he wants to go to the toilet. After that, send him to urinate.

It is better to accompany all procedures with jokes and perform them, if possible, in a playful manner. If something doesn’t work out or the child refuses to do the exercise, don’t insist. Return to it when the patient is in the mood.

Treating nocturnal enuresis in a child requires a lot of love and patience. Help your child cope with a serious illness. A positive attitude will speed up healing. And eliminate the obvious causes of the disease.

Useful video about the treatment of nocturnal enuresis in children

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Enuresis in children is periodic or constant involuntary urination during sleep or during strong concentration or passion, developing at the age when the connection between the cerebral cortex and the bladder should have been established - after 4 years. There are quite a large number of causes for this condition; they have some characteristics depending on gender and age.

Enuresis is called involuntary urination in children over 4 years old; at an earlier age this is still a variant of the norm

Enuresis is registered in every fifth to sixth child aged 5 years; this diagnosis is made in 12-14% of children of primary school age, and by the 12-14 year mark the number of patients is only 4%. Boys get sick 1.5-2 times more often.

The diagnosis of the causes of the disease is carried out by a pediatrician together with a pediatric urologist, neurologist, endocrinologist and psychologist; in some cases, the participation of a homeopath or psychiatrist is necessary.

Treatment is complex: behavioral therapy, diet, psychotherapy, and physiotherapeutic techniques are most often used; Occasionally, doctors resort to prescribing medications. Surgical treatment is used only if the cause of incontinence is operable diseases of the urinary tract or adjacent organs.

Classification of the disease

Warning! The diagnosis of enuresis is made if the child has signs of maturity of the bladder-cerebral cortex connections, which usually occurs after 4 years. The formation of this connection is evidenced by the fact that the baby can hold urine and first informs adults that he wants to go to the toilet.

Daytime enuresis indicates neurological diseases or abnormal development of the urinary tract

There are several classifications of the disease, taking into account various factors.

1. By mode of occurrence:
   • Night. It can appear every night after 4 years (constant form) or only periodically (intermittent form) - when the child has been either in a traumatic situation or has been subjected to intense physical or emotional stress.
   • Daytime urinary incontinence in children. It most often develops in children with urinary tract diseases, in those who have underdeveloped volitional sphere(when during monotonous activities he does not feel the urge). The daytime form of enuresis “starts” when the bladder is so full that, without waiting for a response from the cerebral cortex, it starts emptying itself.
   • Mixed, when a child can urinate involuntarily both during the day and at night.
2. Due to the fact that involuntary urination was always observed (after 4 years) or developed after a “dry” period, enuresis in children occurs:
3. primary (the most common type): always observed, there were no long “dry” periods;
4. secondary: for six months or more the child got up to urinate, then stopped doing so. The share of secondary pathology accounts for only 20-25%.
5. Symptoms accompanying urine leakage:
   • monosymptomatic - if the child is not bothered by pain when urinating, there is no pronounced urge;
   • polysymptomatic (it indicates complications) – when uncontrolled urination is accompanied by pain, frequent trips to the toilet, and urges that are difficult for the child to resist.

Warning! In adolescents, the main form is nocturnal enuresis, which is secondary.

Causes of the disease

The most common urinary incontinence observed in children is:

• thin build;
• shy;
• shy;
• overly emotional;
• from large families;
• those exposed to excessive care from relatives;
• from low-income or disadvantaged families.

The etiological classification divides enuresis into the following forms:

1. simple: when examining a child, it is impossible to find the cause of this condition, but it is known that one or both parents suffered from enuresis in childhood. In this case, the risk of nighttime urination increases from 15% (in healthy children) to 44% (if only one parent was sick) and 77% (if pathology was observed in two parents);
2. neurotic: develops in fearful and shy children who are very worried about the fact of their enuresis;
3. neurosis-like: characteristic of children with a tendency to hysteria and neuroses;
4. epileptic: the causes of enuresis in children are the pathological activity of the areas of the cerebral cortex responsible for the control of urination;
5. endocrinopathic: enuresis develops as a result of diseases of the endocrine glands ( diabetes mellitus, hyperthyroidism, diencephalic syndrome).

There are other causes of the disease:

1. Intrauterine and birth causes: damage to the brain or pathways from the cortex through the spinal cord to the bladder due to:
   • gestosis;
   • intrauterine infection;
   • maternal hypertension;
   • feto-placental insufficiency;
   • umbilical cord entanglement;
   • diabetes mellitus in a pregnant woman;
   • brain or spinal cord injuries during childbirth.
2. Diseases that develop after birth, leading to oxygen starvation brain: heart defects, pneumonia, bronchial asthma, tuberculosis.
3. Infectious diseases of the central nervous system: meningitis, encephalitis, cerebral edema due to severe course of any viral or bacterial infection.
4. Non-infectious diseases of the central nervous system: epilepsy, hydrocephalus, developmental anomalies lumbar region spine.
5. Psychiatric pathology: oligophrenia, chronic intoxication with drugs or alcohol.
6. Urinary tract diseases: cystitis, adhesions in the urethra, neurogenic bladder, opening of the ureters in the wrong place in the bladder, which has a connection with the brain.

The causes of enuresis vary depending on the child's gender and age.

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For girls

Bedwetting in girls develops due to:

1. psychological trauma: moving, divorce, birth of a baby, transfer to a new school;
2. features of the nervous system that cause very sound sleep;
3. drinking plenty of fluids;
4. a decrease in vasopressin, a hormone that inhibits nighttime trips to the toilet;
5. urinary system infections;
6. injuries (including birth injuries) of the spine or spinal cord;
7. developmental delays.

Girls suffer from enuresis one and a half times less often

In boys

Bedwetting in boys has the following causes:

• the nerve pathways from the bladder to the cerebral cortex have not yet matured;
• the child is hyperactive;
• overprotection from relatives;
• stress;
• attention deficit;
• pathologies of the hypothalamus, leading to a lack of growth hormone and vasopressin;
• heredity;
• inflammation of the kidneys and bladder;
• allergic reactions;
• diseases leading to oxygen starvation of the brain;
• prematurity and trauma during childbirth.

In teenagers

Enuresis in adolescents develops due to:

1. spinal injuries;
2. congenital pathologies of the urinary system, due to which their infection develops;
3. stress;
4. mental disorders;
5. hormonal changes in the body;
6. disturbance of awakening.

Does everyone have the same pathology?

Urinary incontinence in children is manifested by the involuntary release of a certain volume of urine during sleep or wakefulness. Such episodes may occur with different frequencies, paroxysmal, sometimes several times a night. Urination can occur either in the first half of the night or in the morning; At the same time, the wetted child does not wake up.

If enuresis manifests itself as a consequence of other diseases, these symptoms will also be noted. Thus, a neurosis-like form will manifest itself as stuttering, fears, tics, and hyperactivity. If the cause is hypoxia of the brain due to diseases of the bronchi and lungs, there will be a cough, periodic shortness of breath, wheezing, fatigue and others. With the endocrinopathic form of incontinence, symptoms such as obesity or, conversely, thinness with a good appetite, a tendency to infectious diseases, swelling, and bulging eyes will come to the fore.

If bedwetting in children is complicated, then in addition to involuntary urination, one or more of the following symptoms will be noted:

• increased or decreased urination;
• pronounced urge to urinate or, conversely, lack thereof;
• painful urination;
• weak stream of urine.

How to find the reason

The following specialists diagnose enuresis in boys and girls:

1. pediatrician;
2. pediatric urologist;
3. neurologist;
4. endocrinologist;
5. psychiatrist.

Based on the examination and questioning of the child and parents, especially on the topic of deviations in the voluntary urination that they had in childhood, the pediatrician may suspect what form of enuresis occurs in the baby. To confirm his preliminary diagnosis, by referring the child to specialists for consultation, he can prescribe the following studies:

• general tests urine and blood;
• bacteriological examination urine;
• biochemical tests blood;
• Ultrasound of the urinary system;
• radiography of the spine and skull;
• electroencephalography;
• X-ray of the urinary tract with contrast (urography, cystography).

Treatment of the disease

Treatment of enuresis in children begins with treatment of the cause of this condition. At infectious diseases prescribe antibacterial, antiviral or antifungal drugs. If enuresis is caused by an endocrine disease, appropriate treatment with synthetic hormones or substances that suppress them is prescribed. For the epileptic form of incontinence, anticonvulsants are needed, for the neurosis-like form, sedatives are needed.

In addition, behavioral therapy is prescribed. It is that:

• before bedtime, limit intake of salty, sweet and liquid foods; You can and should drink water, but it is advisable that at least 15 minutes pass between going to bed and drinking;
• before going to bed they ask you to go to the toilet;
• waking up a child (not a teenager) in the first half of the night in order to take him to the toilet;
• if a child sleeps in his room, he may be afraid to get up to urinate, so parents can turn on a night light in it;
• You can use special gaskets associated with the moisture detector. They stick to underpants and wake up the child when the first drops of urine appear.

Diet

The child's diet should be rich in vitamins, protein and microelements. To treat enuresis, the Krasnogorsky diet can be used: at night the child eats a small piece of herring, bread and salt, washed down with sweet water.

Psychotherapy

Psychotherapists and child psychologists work with children over 10 years of age; before this age, methods such as motivational psychotherapy and autogenic training are used.

Physiotherapy

The following methods are well suited for the treatment of urinary incontinence in children:

• thermal procedures;
• laser therapy;
• electrophoresis;
• galvanization;
• acupuncture;
• magnetic therapy;
• electrical stimulation of the pelvic floor muscles;
• circular shower;
• massage.

Exercise therapy

Kegel exercises, aimed at improving the connection between the brain and the bladder, have a good effect. They are simple to perform - relax and tense the muscles of the perineum, but first the child must understand where these muscles are. To do this, ask him to stop urinating, and repeat this several times.

Drug therapy

Medicines for the treatment of enuresis are prescribed quite rarely - non-drug methods usually have an effect. But if the above methods do not give effect within 6-8 weeks, the following are prescribed:

• vasopressin hormone analogues;
• a special type of antidepressant;
• anticholinergic drugs;
• nootropics (they cannot be taken at night).

Operations

For the treatment of enuresis in children, operations can be used only in cases where involuntary urination is caused by abnormalities in the structure of the organs of the urinary system. Sling, let alone open, operations are not used in children.

But perhaps it would be more correct to treat not the effect, but the cause?

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The problem of urinary incontinence is one of the most important in pediatrics. Doctors have been studying and treating it for a very long time. There is even an International Children's Continence Society (ICCS). The significance of the disease is determined not only and not so much by the seriousness of the problem from a medical point of view, but by social and psychological aspect: children suffering from enuresis have to face reproach and punishment from adults, ridicule from peers, and as they grow older, they themselves begin to experience severe psychological discomfort and difficulties in adapting to society.

By the term “enuresis,” nephrologists and urologists mean urinary incontinence at night, and the term “ daytime enuresis"is considered not entirely correct. In this article we will talk specifically about bedwetting.

The ICCS defines urinary incontinence as urination at inappropriate times and places in a child 5 years of age or older. Accordingly, urination in bed during night sleep is considered enuresis. But the age limit (5 years) is quite arbitrary, since neuropsychic maturation and the ability to control urination during sleep in children occurs at different times and can vary widely (for several years - from 3 to 6-7). Therefore, it is more appropriate to diagnose enuresis in a child who is already beginning to understand the unacceptability of urinary incontinence, who himself is concerned about nocturnal episodes of incontinence and is interested in eliminating them.

Classification of enuresis

Enuresis can be primary and secondary, isolated and combined, monosymptomatic and polysymptomatic.

Primary enuresis occurs from an early age of the child, when there is no so-called period of “dry nights”, there are no symptoms of the disease or psycho-emotional stress. Secondary enuresis is diagnosed if urinary incontinence occurs in a child who has already begun to control night sleep and woke up to urinate. Secondary enuresis occurs after a period of “dry nights” that lasted at least six months, and in children there is a clear connection between the occurrence of bedwetting and the effects of any diseases, stress, mental factors and other pathological conditions.

Enuresis is called isolated enuresis, in which there is no daytime urinary incontinence. With combined enuresis, there is a combination of night and daytime incontinence.

Monosymptomatic enuresis is diagnosed in the absence of symptoms of other diseases and disorders. Polysymptomatic enuresis is defined in the presence of:

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

Causes of enuresis

Enuresis may occur as a result of the following reasons and provoking factors:

1. Hereditary predisposition: more than Half of children with enuresis have close relatives with the same problem. According to statistics, if one of the parents suffered from bedwetting in childhood, the probability of enuresis in the child is approximately 40%; If both parents suffered from urinary incontinence, then the likelihood of developing enuresis in their children increases to 70-80%. With genetically determined enuresis, there is a violation of the secretion of antidiuretic hormone (vasopressin), which normally ensures the reabsorption of primary urine, or a decrease in the sensitivity of the kidneys to vasopressin. As a result, children excrete large amounts of low-concentration urine at night.
2. Low functional bladder capacity. Functional capacity is the volume of urine that a person can hold before an irresistible urge to urinate arises. In children under 12 years of age, functional capacity is calculated using the formula: 30+30 × child’s age (in years), and is considered low if it is less than 65% of the age norm. With low functional capacity, the bladder is unable to hold all the urine produced during the night.
3. Polysymptomatic enuresis can develop against the background of various pathologies: residual effects after perinatal encephalopathy, head injuries, neuroinfections; lesions of the brain and spinal cord; ; urological diseases; with some allergic diseases (severe forms, eczema); endocrine diseases (and). And in such situations, enuresis is regarded not as a separate condition, but as one of the symptoms of the disease.

Possible reasons enuresis

Diagnosis of enuresis

It is not difficult to establish enuresis in a child: this is done on the basis of complaints of constant or frequent episodes of urinary incontinence at night in children over 5 years of age. However, to successfully eliminate urinary incontinence in children, it is necessary to find out the form and causes of enuresis, since for drug treatment, for example, hereditary (monosymptomatic) enuresis and enuresis against the background of an overactive bladder (polysymptomatic), fundamentally different methods are used.

The diagnostic criteria for hereditary urinary incontinence are:

• a history of enuresis in one of the child’s close relatives;
• constant urinary incontinence from the first years of life - without “dry nights”;
• nocturia - the predominance of nighttime diuresis over daytime - that is, at night the child produces more urine than during the day;
• low specific gravity of night urine;
• the child is thirsty in the evening;
• blood test data for hormones (low activity of the antidiuretic hormone - vasopressin - at night);
• genetic analysis data (detection of gene mutation);
• absence of organic or neuropsychic disorders.

In the process of diagnosing enuresis, the following is carried out:

• consultations with a pediatrician, neurologist, nephrologist, urologist, endocrinologist, child psychiatrist and psychologist;
• be sure to keep a diary of urination for several days (it records how many times and in what volume the child urinated per day, and whether there were episodes of incontinence day and night);
• laboratory tests (general blood tests and blood tests, urine and blood tests for sugar, blood tests for hormones, biochemical tests of blood and urine to exclude kidney pathology);
• Ultrasound of the kidneys and bladder;
• uroflowmetry (study of urinary flow rate during the entire time of voluntary urination);
• Additionally, X-rays of the spine, excretory urography, voiding cystoureterography and other studies may be prescribed.

Treatment of enuresis

A calm atmosphere in the family, adherence to the correct regime and daily routine will help to cope with the problem.

In the treatment of all forms of enuresis paramount importance have non-drug measures: regimen, diet, bladder training, child motivation.

Regime and diet

Seven tips for parents if their child has enuresis:

1. Create the most peaceful environment in your family. The atmosphere in the evening hours is especially important: avoid quarrels and punishing a child in the evening, which is extremely undesirable active games, computer, watching TV.
2. Never scold or punish a child for peeing in the bed - this will not solve the problem, but will only develop complexes in the child.
3. Organize your sleeping area correctly: your child’s bed should be smooth and fairly rigid. If a child sleeps on an oilcloth, it should be completely covered with a sheet that does not wrinkle or move when moving during sleep. The room should be warm, without drafts (ventilate only before bedtime), but not too stuffy so that you don’t feel the urge to drink when falling asleep or at night. Teach your baby to sleep on his back. A cushion placed under the knees or an elevated foot end of the bed can help prevent involuntary urination when the functional capacity of the bladder is low.
4. Going to bed should be at the same time every day.
5. Dinner and drinks should be given no later than 3 hours before bedtime. This excludes products that have a diuretic effect (dairy products; strong tea, coffee, Coca-Cola and other caffeine-containing drinks; juicy vegetables and fruits - watermelon, melon, apples, cucumbers, strawberries). For dinner, hard-boiled eggs, crumbly porridge, stewed fish or meat, and weak tea with a small amount of sugar are recommended. Immediately before bedtime, the child can be given a small amount of food that promotes fluid retention (a piece of salted herring, bread with salt, cheese, honey).
6. Make sure your child pees at least 3 times in the hour before going to bed.
7. Leave a source of dim light (a night light) in your child's bedroom so that he is not afraid of the dark and can calmly go to the potty or toilet when he wakes up with the urge to urinate.

To wake up or not to wake up?

Doctors have different opinions about whether or not to wake up a small child at night to urinate: some believe that artificial awakening with putting him on the potty helps to develop a stable reflex followed by independent awakening when the bladder is full, other experts are of the opinion that such a reflex can be developed It’s difficult for preschoolers, and he quickly gets lost. But if you wake up your child, then wake him up 2-3 hours after he goes to bed, and be sure to wake him up completely - so that he wakes up, goes to the potty or toilet on his own, and returns back on his own. Showing pity and carrying a sleepy child in your arms to the toilet and back is useless: this in no way contributes to the development of the awakening reflex, children do not realize what they are doing, and in the morning they usually do not remember that they were woken up. But if the child has already wet himself, it is definitely necessary to wake him up, change him into dry clothes (even better if he changes his clothes himself), and remake the bed: these activities will form the child’s understanding of comfortable sleep, as about sleeping in a dry bed, and teach the need to keep your bed and clothes dry.

It is recommended to wake up older children (schoolchildren) at night, and this is done according to a certain pattern (“scheduled awakening”):

• the first week the child is woken up every hour after falling asleep;
• in the following days, the interval between awakenings is gradually increased (they wake up after 2 hours, then after 3, then only once at night).

Treatment with “scheduled awakening” continues for a month. If after a month the effect is not achieved (episodes of enuresis are repeated more often than 1-2 times a week), you can repeat the course once, or proceed to other methods of combating enuresis. It should be borne in mind that “waking up on a schedule” disrupts the child’s normal nighttime sleep, and this leads to serious stress on the nervous system. As a result, the child will be tired, lethargic, capricious during the day, and will have difficulty learning new information, because of this, his performance at school may decrease. Therefore, it is advisable to use the method during the holidays.

Bladder training

The method gives positive result only in children with low functional bladder capacity. The essence of the method: during the day, the child is given a lot of liquid to drink and asked not to urinate for as long as possible.

Motivational therapy

In the fight against enuresis, a good positive effect comes from the child’s own desire to succeed. Therefore, it is important for parents to encourage their child, praise him for “dry nights” (but not punish him when incontinence occurs), and teach him responsibility for his behavior (teach him to urinate before bed and not drink at night).

Development of conditioned reflexes to awaken with a full bladder (“urinary alarms”)

There are non-drug methods for treating enuresis using the development of conditioned reflexes in children. A special alarm device (enuresis alarm clock) is placed at the child’s bed, which responds to a humidity sensor that is sensitive to just a few drops of urine. The sensor in the pad is placed in the child's underwear (in modern alarm clocks, sensors can be attached to the outside of the underwear - where the first drop of urine is most likely to appear) - and at the very beginning of involuntary urination, the sensor reacts, the device emits a loud signal.

At the signal, the child wakes up and goes to the toilet. If the child is under 10 years old, then the parents must also get up: they help the child change into clean underwear and put him to bed again. This technique was invented in 1907 and is considered effective (it gives positive results in more than 70% of children with enuresis), but relapses are possible after its use. Success can be achieved after about a month of using the signal method, and for another two weeks after the cessation of enuresis, the humidity sensor is left in the child’s underwear. If there is no effect within 2 months of using the enuresis alarm clock, treatment using the “urinary alarm” method is stopped.

Physiotherapy

Parallel drug therapy Physiotherapeutic courses are often prescribed: laser, acupuncture, electrophoresis, etc. But their effectiveness is quite low, and when used in isolation (separate from other methods), physiotherapy usually does not produce positive results.

Other methods

In older children (from about 10 years old), psychotherapy (including family therapy) and auto-training are widely used in the treatment of enuresis and produce good results - the child is taught to independently tune in to “dry nights” and awakening when the bladder is full by repeating phrases every night before bedtime like “I want to sleep in a dry bed. I’ll definitely feel it if I want to go to the toilet and I’ll definitely wake up,” etc.

Drug treatment of enuresis

Hereditary form

To treat a hereditary form of enuresis, desmopressin (minirin) is prescribed at night in courses of 3 months with breaks of 1 month. The drug is a synthetic analogue of vasopressin and leads to relief of nocturia, and subsequently enuresis. During the period of treatment with minirin, strict drinking regime: liquid is strictly limited in the evening and at night (the child is given drinks only to quench thirst).

Enuresis due to neurogenic bladder dysfunction

Enuresis due to an overactive bladder, which is manifested by the presence in a child of an “imperative” urge to urinate, which he is unable to restrain, is treated using several groups of drugs.

Many parents are concerned about the topic bedwetting in children. In medicine this disease is called enuresis. It’s normal for a child 1 to 2 years old to wet the bed at night from time to time, but when he suffers from bedwetting child 4, 6, 8, 10 years old, adults are already beginning to wonder what to do?

Causes of urinary incontinence (enuresis) in children

Bed-wetting can be caused by a number of reasons: y one baby it happens due to latent epilepsy, in another - due to a congenital defect (spina bifida), in a third - due to increased excitability of the bladder.

Children who are not accustomed to neatness from early childhood also suffer from bedwetting; Such children sometimes urinate involuntarily during the day when they are playing. The cause of childhood enuresis (urinary incontinence) can be Not correct mode day and improper nutrition of the child: food with copious amounts of liquid (some children drink a lot of water uncontrollably), insufficient exposure to air, overfatigue (improper alternation of sleep, rest and activities).

During this disease, higher nervous activity is disrupted. When a person sleeps, the work of his nervous system is inhibited - the body rests. But the work of the cerebral cortex is not completely inhibited. Wakeful foci remain in the cortex - “sentinel points” that continue to function. Thanks to these “guard points” we feel the urge to urinate at night. In children suffering from urinary incontinence, the functioning of the “sentinel point” is disrupted and its response to irritation coming from the bladder is absent; therefore, the child does not feel the urge to urinate, urinates involuntarily and wakes up only when the bed is already wet, and sometimes even in this case does not wake up.

Frequent bedwetting hereditary factor, so it will be useful to remember, especially for grandparents, what it was like in childhood with the baby’s parents. You should be concerned in this situation if the parents did not have such problems in childhood, and in the family a 3-year-old child does not pee at night, and a 5-year-old suffers from enuresis.

A child has enuresis: what can and cannot be done?

Some parents believe that bedwetting is not a disease and blame the child for this defect, which leads to gross mistakes in handling such sick children. In one family, a boy was punished every time he wet his bed at night. The boy, fearing punishment, fought against sleep and tried to stay awake. The result was the most deplorable: the boy did not get enough sleep regularly, his general condition worsened, his nervous system was upset, and this caused the illness to drag on.
In another family, two sick girls were put to sleep without mattresses on bare boards. All this traumatized the children. They became unsociable, withdrawn, and the disease progressed.

It also happens that parents do not change their child’s wet underwear. He got wet, so let him lie there wet; If he doesn’t like it, he’ll stop urinating. Such parents do not take into account that the child himself, even a preschooler and especially a schoolchild, is seriously oppressed by this disease. Sometimes a child walks around during the day in “dried” underwear and constantly feels that he smells of urine. His friends also notice this, and they start teasing him. That's straight the result of the wrong approach adults to children suffering from urinary incontinence. That, what to do no way. And isn’t it clear that, first of all, parents must not only be sensitive to these children themselves, but are also obliged to warn kindergarten teachers and school teachers about their child’s illness, so that they, in turn, also spare the patient’s nervous system, warn and stop any attempts to tease him or talk about his illness out loud, “in public.”

Bedwetting usually affects children of preschool and primary school age, most often boys. By puberty, the disease mostly goes away on its own. Urinary incontinence in children, like any other disease, you can prevent and treat.

How to treat urinary incontinence in children?

In order to prevent illness, teach your child to be neat from a very early age. As early as four months, you can hold the child over the potty and pronounce the appropriate sounds, and from six months, sit him, supporting him, on the potty. Plant several times a day: before feeding, some time after feeding, before and after sleep (daytime and nighttime), before and after a walk. Such regular, systematic “planting” of the child every day at the same time creates in him a strong (for life) habit of urinating at a certain time.

Properly raised children, already in the second year of life, always ask to go to the potty and almost never urinate spontaneously, either day or night. By this time, the child’s “guard points” begin to work. By teaching a child to be neat (“ask”) from an early age, we thereby educate, train “guard points,” and teach them to quickly feel the urge to urinate.

That is why proper education is very important to prevent this unpleasant and long-lasting disease - bedwetting.

In warning and treatment of childhood enuresis The overall strengthening of the child’s body is of great importance. From the first days of life, teach children to sleep outside during the day and with the window open at night. From the age of 4 months, begin physical education classes: first, passive movements of the child’s arms and legs with the help of adults, and later, active exercises that the child performs at the direction of adults and under their control.

A preschooler and a schoolchild can, together with adults, do morning exercises followed by dousing and wiping. At school age, gymnastics and sports are compulsory. Strictly follow the correct diet for your child. Some parents overly “feed” their children milk, which not only spoils their appetite, but overloads the work of the heart and kidneys, leading to frequent urination.

Many parents do not control the amount of water their child drinks, forgetting that excessive consumption of water, like milk, overloads the heart and kidneys and can lead not only to frequent, but also spontaneous urination.

A child suffering from bedwetting should under no circumstances be given not only water or milk, but also liquid food in general in the afternoon.

Give your child dinner 1-1.5 hours before bedtime. A “salty” sandwich is recommended for dinner: bread with butter and caviar or with a piece of herring, ham, or 50 grams of thick sugar syrup with lemon, cranberry juice, jam without tea. The patient's food should be rich in vitamins, especially groups C and B.

Under no circumstances should you wake up a sick child at certain hours; this will lead to nothing. No matter how many times you wake up your child, he will still wet himself again when he falls asleep. So not only does this not help treatment of bedwetting in children, but, on the contrary, worsens the condition of the nervous system, since the patient does not get enough sleep.

Systematically waking up a child every night at the same time creates long years the habit of waking up and urinating at night during these hours. We need to ensure that the child sleeps peacefully all night, without waking up, and that he does not have the urge to urinate: the whole body must rest at night.

What then should parents do?

Immediately change your child's wet underwear if he wakes up and you hear it. When changing clothes, treat your child kindly and tell him: “Don’t ask for tea in the evening, don’t drink a lot of water, and your bed will always be dry.”

Medications are also used to treat the disease. Depending on the variety of causes causing the disease, the treatment is varied. There cannot be one recipe for all patients, as some parents think in search of an answer to the question, how to treat bedwetting in children.

It is necessary to treat not just a disease, but a child with bedwetting. Without knowing the child, neither the general condition of his body, nor the cause of the disease, nor the course of the disease, it is impossible to treat him in absentia. Some patients are helped by treatment with injections of strychnine or novocaine, others are temporarily helped by blowing adiurecrine powder into the nose, some are treated with galvanization, faradization and, finally, suggestion (hypnosis). Treatment can only be prescribed by a doctor who can accurately determine on the spot the cause of your child’s illness and can examine in detail the general condition of his body and nervous system. And treatment depends on all this.

Do not treat the child yourself; strictly follow the doctor’s advice. The success of treatment depends largely on good relationships between parents, other adult family members and the sick child.

With the joint efforts of the doctor, parents and the patient himself, in many cases it is possible to cure this disease before the onset of puberty.

Video: Doctor Komarovsky on the treatment of enuresis in children

Basic information: In the video program, Doctor Komarovsky says that up to 6-7 years we are talking about pharmacological treatment enuresis does not occur. Modern medicine believes that bedwetting in children cannot be cured with pills until they are 6-7 years old. But even in this case, medications do not give 100% results. It is impossible to cope with enuresis without the intense desire of the child himself. This is mostly a psychological problem. Until the child himself or with the help of his parents realizes that it is difficult for him to live with enuresis, there will be no success. The doctor recommends waiting until it “ripens” genitourinary system, we will strengthen the child’s nervous system. But you can speed up this process only when the child wants it more than you yourself. It is important to act carefully and delicately (this was already discussed earlier in the article). More details in the video:

Urinary incontinence is a pathological condition that is quite common in older children. The medical name of the disease is enuresis. Characterized by the inability to control one's urination during sleep, as well as in other situations. What is urinary incontinence in children, its causes and treatment should be considered in more detail. After all, this disease brings a lot of psychological problems to the child.

Related articles:

Causes of bedwetting in children

The appearance of enuresis is most often associated with an abnormal structure of the bladder. The disease also occurs in the following situations:

sudden urge to urinate; reduced bladder capacity; regular constipation contributes to decreased bladder function; frequent stressful situations; genetic predisposition to the disease.

Bedwetting in children is a fairly common ailment among school and preschool children. Timely contact with a specialist will help avoid chronic incontinence.

Causes of daytime incontinence

Daytime urinary incontinence is most often observed in girls. It is associated with the following factors:

a strong urge to urinate; uncontrolled urination when laughing; the entry of residual urine into the girl’s genital organ promotes spontaneous excretion of urine.

A single case of incontinence in a child is not dangerous.

Types of disease in children

Depending on the cause of spontaneous urination, the following types of this disease are distinguished:

Urgent incontinence. It occurs in children with an overactive bladder, which causes a strong urge to urinate. Stress urinary incontinence in children. Appears during physical activity child, as well as during reflex actions such as sneezing or coughing. A baby with this form of the disease experiences weakness of the pelvic floor muscles and urinary and fecal incontinence. Reflex incontinence. It is a complication after injuries to the spinal cord and lower back. This species the disease is usually preceded by prolonged urinary retention. Bladder fullness. Occurs as a result of prolonged urinary retention. In this case, urine comes out in drops gradually. The child cannot control this process. Complete incontinence. Characterized by total uncontrolled urine output at any time of the day. It is a consequence of certain diseases of the renal and genitourinary systems.

Important to remember! Regardless of the form of the disease, immediate treatment of the baby is required! After all, this disease causes a lot of suffering, both physical and psychological.

Features of the disease

Child incontinence is not dangerous or alarming until the age of 4 due to the fact that the bladder is not yet fully formed. That is, a child at 4 years old already begins to have physical ability control urination even during sleep.

Spontaneous urination is considered a pathology from the age of 6 years. At this age, the child should clearly respond to his urges even at night. If incontinence continues at this age, then this factor is the reason for visiting a doctor.

A child of 8 years old may suffer given by disease as a result of a disorder of the central nervous system. Due to such abnormalities in the body, children may experience incontinence.

As for the disease in children 10 years of age and above, it most often occurs due to psychological factors. Thus, incontinence in adolescence manifests itself in the following situations:

strong emotional overstrain, stressful situations; excessive care or lack of attention from parents, as a result of which the teenager, on a subconscious level, wants to feel like a small child; weakened pelvic muscles; sound sleep occurs due to the innate characteristics of the nervous system; infectious diseases of the genitourinary system;

Urinary incontinence in adolescence usually occurs at night during sleep.

Treatment of the disease

How to treat enuresis? In order to determine the correct and most effective method of treating a child, you need to consult a specialist. He will carefully examine the child and prescribe the most effective therapy. Most often, the doctor prescribes complex treatment, which includes:

Tablets for children. Drug therapy is aimed at relieving excessive activity and stress before bedtime. This will help ensure complete and quality rest. If spontaneous urination is associated with an infectious disease, then babies or older children are prescribed a course of antibiotics. Generally medications are aimed at normalizing the functioning of the nervous system, which will promptly signal the urge. The most common medications: Radedorm, Pantogam, Glycine, Melipramine, etc. Physiotherapy. For the normal functioning of the bladder, procedures such as electrophoresis, acupuncture, magnetic therapy, and massage are used. Psychotherapy. The essence of this method of influencing the disease is to communicate with a psychotherapist who will teach you how to cope with the disease using specific relaxation techniques and self-hypnosis. Maintaining a daily routine. It is necessary to allocate time for the child for physical and mental activity and ensure sufficient rest. You should also try to protect him from stressful situations and emotional experiences. Monitor your child's fluid intake throughout the day.

Exercises to combat enuresis

This treatment can be carried out at home. The essence of gymnastics is to strengthen the pelvic floor muscles and normal functioning of the bladder. Most effective exercises are:

In order to enlarge the bladder, you should delay the process of urination after the first urge. This procedure repeat several times a day. Thus, gradually the baby’s body will learn to hold urination during sleep. To strengthen the muscle fibers of the bladder, you should stop this process several times at the time of urination. This helps the child learn to control the process of urine excretion. Before going to bed, gradually relax your body. Children can be asked to do this exercise in a playful way.

In this way, the baby will learn to control the urge to urinate.

Treatment with folk remedies

Since ancient times, enuresis has been treated with traditional medicine, which is still used in modern times. The main advantage of this effect on the disease is the absence of contraindications and side effects. There are many recipes that can help you relieve your child of urinary incontinence.

Dill

To prepare the medicine you will need seeds of this plant in the amount of 1 tbsp. l. Pour 1 cup of boiling water and leave for 1 hour. After time, the broth should be filtered and taken 100 ml once a day, preferably in the afternoon.

St. John's wort

You should take 1 tbsp. l. St. John's wort leaves and 1 tsp. dried lingonberry fruits. Pour 1 liter of hot water over these medicinal plants and leave to infuse for 3 hours, covering tightly with a lid. After the time has passed, drink 1 glass of the resulting liquid 3 times a day.

Plantain

To prepare, you will need plantain seeds, which should be ground to a powder consistency. Use this powder in dry form, 1 tsp. Once a day, with plenty of water.

Sage

You will need 2 tbsp. l. given medicinal plant in dried form. Pour 1.5 glasses of boiling water, wait until the broth cools down and give the child 50 ml 2 times a day. Older children can double the dosage.

Very important role in drug treatment alternative medicine The baby’s individual intolerance to certain ingredients plays a role. Therefore, when choosing a specific recipe, you need to consult a specialist.

Enuresis in children is periodic or constant involuntary urination during sleep or during strong concentration or passion, developing at the age when the connection between the cerebral cortex and the bladder should have been established - after 4 years. There are quite a large number of causes for this condition; they have some characteristics depending on gender and age.

Enuresis is called involuntary urination in children over 4 years old; at an earlier age this is still a variant of the norm

Enuresis is registered in every fifth to sixth child aged 5 years; this diagnosis is made in 12-14% of children of primary school age, and by the 12-14 year mark the number of patients is only 4%. Boys get sick 1.5-2 times more often.

The diagnosis of the causes of the disease is carried out by a pediatrician together with a pediatric urologist, neurologist, endocrinologist and psychologist; in some cases, the participation of a homeopath or psychiatrist is necessary.

Treatment is complex: behavioral therapy, diet, psychotherapy, and physiotherapeutic techniques are most often used; Occasionally, doctors resort to prescribing medications. Surgical treatment is used only if the cause of incontinence is operable diseases of the urinary tract or adjacent organs.

Classification of the disease

Warning! The diagnosis of enuresis is made if the child has signs of maturity of the bladder-cerebral cortex connections, which usually occurs after 4 years. The formation of this connection is evidenced by the fact that the baby can hold urine and first informs adults that he wants to go to the toilet.

Daytime enuresis indicates neurological diseases or abnormalities of the urinary tract

There are several classifications of the disease, taking into account various factors.

By mode of occurrence: Night. It can appear every night after 4 years (constant form) or only periodically (intermittent form) - when the child has been either in a traumatic situation or has been subjected to intense physical or emotional stress. Daytime urinary incontinence in children. It most often develops in children with urinary tract diseases, in those who have an underdeveloped volitional sphere (when, during monotonous activities, he does not feel the urge). The daytime form of enuresis “starts” when the bladder is so full that, without waiting for a response from the cerebral cortex, it starts emptying itself. Mixed, when a child can urinate involuntarily both during the day and at night. According to the factor, involuntary urination was always observed (after 4 years) or developed after a “dry” period, enuresis in children is: primary (the most common type): always observed, there were no long “dry” periods; secondary: for six months or more the child got up to urinate, then stopped doing so. The share of secondary pathology accounts for only 20-25%. According to the symptoms accompanying urine leakage: monosymptomatic - if the child is not bothered by pain when urinating, there is no pronounced urge; polysymptomatic (it indicates complications) – when uncontrolled urination is accompanied by pain, frequent trips to the toilet, and urges that are difficult for the child to resist.

Warning! In adolescents, the main form is nocturnal enuresis, which is secondary.

Causes of the disease

The most common urinary incontinence observed in children is:

thin build; shy; shy; overly emotional; from large families; those exposed to excessive care from relatives; from low-income or disadvantaged families.

The etiological classification divides enuresis into the following forms:

simple: when examining a child, it is impossible to find the cause of this condition, but it is known that one or both parents suffered from enuresis in childhood. In this case, the risk of nighttime urination increases from 15% (in healthy children) to 44% (if only one parent was sick) and 77% (if pathology was observed in two parents); neurotic: develops in fearful and shy children who are very worried about the fact of their enuresis; neurosis-like: characteristic of children with a tendency to hysteria and neuroses; epileptic: the causes of enuresis in children are the pathological activity of the areas of the cerebral cortex responsible for the control of urination; endocrinopathic: enuresis develops as a result of diseases of the endocrine glands (diabetes mellitus, hyperthyroidism, diencephalic syndrome).

There are other causes of the disease:

Intrauterine and birth causes: damage to the brain or pathways from the cortex through the spinal cord to the bladder due to: gestosis; intrauterine infection; maternal hypertension; feto-placental insufficiency; umbilical cord entanglement; diabetes mellitus in a pregnant woman; brain or spinal cord injuries during childbirth. Diseases that develop after birth, leading to oxygen starvation of the brain: heart defects, pneumonia, bronchial asthma, tuberculosis. Infectious diseases of the central nervous system: meningitis, encephalitis, cerebral edema due to severe course of any viral or bacterial infection. Non-infectious diseases of the central nervous system: epilepsy, hydrocephalus, developmental anomalies of the lumbar spine. Psychiatric pathology: oligophrenia, chronic intoxication with drugs or alcohol. Urinary tract diseases: cystitis, adhesions in the urethra, neurogenic bladder, opening of the ureters in the wrong place in the bladder, which has a connection with the brain.

The causes of enuresis vary depending on the child's gender and age.

For girls

Bedwetting in girls develops due to:

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Readers' opinion... » psychological trauma: moving, divorce, birth of a baby, transfer to a new school; features of the nervous system that cause very sound sleep; drinking plenty of fluids; a decrease in vasopressin, a hormone that inhibits nighttime trips to the toilet; urinary system infections; injuries (including birth injuries) of the spine or spinal cord; developmental delays.

Girls suffer from enuresis one and a half times less often

In boys

Bedwetting in boys has the following causes:

the nerve pathways from the bladder to the cerebral cortex have not yet matured; the child is hyperactive; overprotection from relatives; stress; attention deficit; pathologies of the hypothalamus, leading to a lack of growth hormone and vasopressin; heredity; inflammation of the kidneys and bladder; allergic reactions; diseases leading to oxygen starvation of the brain; prematurity and trauma during childbirth.

In teenagers

Enuresis in adolescents develops due to:

spinal injuries; congenital pathologies of the urinary system, due to which their infection develops; stress; mental disorders; hormonal changes in the body; disturbance of awakening.

Does everyone have the same pathology?

Urinary incontinence in children is manifested by the involuntary release of a certain volume of urine during sleep or wakefulness. Such episodes can occur with varying frequency, paroxysmally, sometimes several times a night. Urination can occur either in the first half of the night or in the morning; At the same time, the wetted child does not wake up.

If enuresis manifests itself as a consequence of other diseases, these symptoms will also be noted. Thus, a neurosis-like form will manifest itself as stuttering, fears, tics, and hyperactivity. If the cause is hypoxia of the brain due to diseases of the bronchi and lungs, there will be a cough, periodic shortness of breath, wheezing, fatigue and others. With the endocrinopathic form of incontinence, symptoms such as obesity or, conversely, thinness with a good appetite, a tendency to infectious diseases, swelling, and bulging eyes will come to the fore.

If bedwetting in children is complicated, then in addition to involuntary urination, one or more of the following symptoms will be noted:

increased or decreased urination; pronounced urge to urinate or, conversely, lack thereof; painful urination; weak stream of urine.

How to find the reason

The following specialists diagnose enuresis in boys and girls:

pediatrician; pediatric urologist; neurologist; endocrinologist; psychiatrist.

Based on the examination and questioning of the child and parents, especially on the topic of deviations in the voluntary urination that they had in childhood, the pediatrician may suspect what form of enuresis occurs in the baby. To confirm his preliminary diagnosis, by referring the child to specialists for consultation, he can prescribe the following studies:

general urine and blood tests; bacteriological examination of urine; biochemical blood tests; Ultrasound of the urinary system; radiography of the spine and skull; electroencephalography; X-ray of the urinary tract with contrast (urography, cystography).

Treatment of the disease

Treatment of enuresis in children begins with treatment of the cause of this condition. For infectious diseases, antibacterial, antiviral or antifungal drugs are prescribed. If enuresis is caused by an endocrine disease, appropriate treatment with synthetic hormones or substances that suppress them is prescribed. For the epileptic form of incontinence, anticonvulsants are needed, for the neurosis-like form, sedatives are needed.

In addition, behavioral therapy is prescribed. It is that:

before bedtime, limit intake of salty, sweet and liquid foods; You can and should drink water, but it is advisable that at least 15 minutes pass between going to bed and drinking; before going to bed they ask you to go to the toilet; waking up a child (not a teenager) in the first half of the night in order to take him to the toilet; if a child sleeps in his room, he may be afraid to get up to urinate, so parents can turn on a night light in it; You can use special gaskets associated with the moisture detector. They stick to underpants and wake up the child when the first drops of urine appear.

Diet

The child's diet should be rich in vitamins, protein and microelements. To treat enuresis, the Krasnogorsky diet can be used: at night the child eats a small piece of herring, bread and salt, washed down with sweet water.

Psychotherapy

Psychotherapists and child psychologists work with children over 10 years of age; before this age, methods such as motivational psychotherapy and autogenic training are used.

Physiotherapy

The following methods are well suited for the treatment of urinary incontinence in children:

thermal procedures; laser therapy; electrophoresis; galvanization; acupuncture; magnetic therapy; electrical stimulation of the pelvic floor muscles; circular shower; massage.

Exercise therapy

Kegel exercises, aimed at improving the connection between the brain and the bladder, have a good effect. They are simple to perform - relax and tense the muscles of the perineum, but first the child must understand where these muscles are. To do this, ask him to stop urinating, and repeat this several times.

Drug therapy

Medicines for the treatment of enuresis are prescribed quite rarely - non-drug methods usually have an effect. But if the above methods do not give effect within 6-8 weeks, the following are prescribed:

vasopressin hormone analogues; a special type of antidepressant; anticholinergic drugs; nootropics (they cannot be taken at night).

Operations

For the treatment of enuresis in children, operations can be used only in cases where involuntary urination is caused by abnormalities in the structure of the organs of the urinary system. Sling, let alone open, operations are not used in children.

But perhaps it would be more correct to treat not the effect, but the cause? We recommend reading the story of Olga Kirovtseva, how she cured her stomach... Read the article >>