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Enuresis is a state at which at children is more senior five years at night or there is an involuntary urination in the afternoon. Enuresis is widespread among children rather widely, with this illness very often address specialists. The fact that symptoms of enuresis are accurately expressed, and the diagnosis is established easily, sometimes makes impression that it is possible to cure an illness easily and quickly. However actually such disturbance demands an individual approach to treatment, in each case other reasons can provoke an illness. Therefore parents and children have to realize that treatment of enuresis continues rather long period, and its successful completion requires many efforts and patience from all family members. Attempts of non-systematic treatment quite often become unsuccessful.
Types of enuresis
Today it is accepted to distinguish enuresis primary and secondary, and also day and night. Primary enuresis is a state at which at the child from the birth the urine incontience is observed. Therefore, if such manifestations take place only in the afternoon, then it is about day primary enuresis. At bed wetting it is necessary to speak about night primary enuresis. Such states can be combined.
Secondary enuresis is diagnosed if the child during a certain period which made not less than half a year was "dry" then he began to suffer from an urine incontience again. As well as in the first case, secondary enuresis at boys and girls happens day, night or two of these forms are combined.
At day enuresis frustration in functioning of muscles of a bladder become the reason of an incontience. If these muscles are excessively excited, then at the child define a hyper reflex or neurogenic bladder. If excitement of muscles insufficient, then the speech already goes about a hyporeflex bladder.
At night enuresis the urine incontience during the night period occurs owing to a delay of maturing of certain centers of a brain which are responsible for control of function of a bladder. Today among children night enuresis is more widespread. In case of primary night enuresis very often there comes spontaneous independent treatment.
Features of enuresis
This illness was described still by Avicenna in the work "Canon of Medical Science". Today this disease meets rather often: according to the statistics, about 15-20% of children at five-year age, about 10% in seven years, 5% of ten-year-old children and 3% twelve-year-old cannot control work of a bladder. Besides enuresis occurs also at adults: on different data, has this illness from 1% to 3% of adults. Enuresis occurs at boys approximately twice more often than at girls.
If the child develops normally, then gradually he finds ability to control own bladder, and in 2-3 years children learn to control an urination consciously. However at many children this process can be late that is considered norm option. Therefore, parents can not sound alarm to five-year age of the child. However if on the sixth year of life the child cannot control this process, then in this case it is already necessary to visit the doctor.
All types of enuresis described above at children arise under the influence of the different reasons. The emotional stress is considered the most important factor which influences developing of day and secondary enuresis. At the same time display of primary night enuresis, as a rule, happens owing to a delay of maturing of the centers of a brain or vasopressin shortage.
Also it is necessary to consider that the general factor influencing emergence of all types of enuresis is the factor genetic. About seventy percent of patients with this illness have relatives who also had enuresis.
Day enuresis, and also secondary night enuresis at boys and girls is shown as a result of a certain disbalance of activity of a nervous system. This disease develops under the influence of an emotional stress: initially at the child the balance in work of a nervous system because of what there is a disorder of functioning of a bladder is broken. There are many moments which can become for the child a source of a severe stress: it both death of close people, and divorce of parents, and emergence in a family of one more child.
Specialists consider as one more origin of day enuresis the wrong approach to schooling of the child to a pot. In certain cases this process begins in a family too early, perhaps, parents show excessive severity or approach a question inconsistently.
Besides, behavioural problems of the child, and also small volume of a bladder (an inborn problem) can be the reasons of the specified types of enuresis.
Primary night enuresis at children is shown as a result of a delay in maturing of the centers of a brain which are responsible for control of functioning of a bladder. Owing to a similar delay at the child very sound sleep and disturbances in ability to wake up for an urination independently is observed. The brain of the sick child is not reached by impulses from a bladder. As a result, the signal to wake up does not occur.
One more reason of night enuresis – insufficient production of vasopressin in the child's organism. Urine is produced in an organism constantly, round the clock. In order that at night the person did not have a requirement to rise in a toilet several times, the organism produces hormone of a back share of a hypophysis — vasopressin. Under its influence the producing urine stops at night. At children with enuresis sometimes this hormone is not produced in the necessary quantity. As a result, for night they have to empty a bladder with the same frequency, as well as in the afternoon. Most often enuresis at children arises as a result of existence of several factors.
In more exceptional cases existence of enuresis can demonstrate development in an organism of the child of an organic disease. It can be defects of lumbar vertebrae, the inborn or acquired damage of a lower part of a spinal cord, a syndrome of a night apnoea, epilepsy, sugar or not diabetes mellitus. To exclude these diseases, it is necessary to visit the specialist who will appoint all necessary inspections in a specific case. Having found out the enuresis reason, the doctor will appoint the correct and effective therapy of a disease.
Besides, disturbances of urological character become the urine incontience reason sometimes: diseases, and also anomalies in a structure of bodies of system of urination.
Diagnosis of enuresis
In case of night enuresis the diagnosis is made, generally being guided by complaints of patients, and also studying of the anamnesis, both individual, and family is carried out. Today there are researches, confirmatory that if episodes of enuresis took place at the father or mother, then the risk of development of a disease in the child increases approximately three times.
In the course of collecting the anamnesis it is necessary to understand how education of the child is conducted and how at it there takes place forming of skills of neatness. In this case the doctor considers what frequency of cases of an incontience of urine, what type of enuresis, finds out character of an urination, checks whether were postponed by the child of an infection of urinary tract, whether takes place enkoprez or locks. Besides, it is important to define existence or absence of a night apnoea, attacks of epilepsy, allergy to food or drugs, urticarias, bronchial asthma, allergic rhinitis. All these diseases influence a condition of a bladder, doing it to more excitable.
Some medicines, generally tranquilizers and antikonvulsant, can have a side effect in the form of an urine incontience therefore it is important to find out whether the child accepted them earlier.
Also in the course of diagnosis the doctor performs physical inspection, paying attention to a structure of abdominal organs, closed glands, urogenital system. It is also important to estimate adequately physical development of the child and his psychoneurological status.
For an exception of pathology of urinogenital system laboratory researches of urine, ultrasonic research of a bladder and kidneys are conducted. In certain cases the doctor appoints other additional researches.
There is also a number of states with which to differentiate enuresis at children. These are epileptic attacks, some types of an allergy, some endocrine diseases, a night apnoea, by-effects as a result of drug intake.
Treatment of enuresis
Today treatment of enuresis is carried out by doctors who work in different spheres of medicine. Versatile approach to therapy of an illness is important effectively to remove all causes which conduct to enuresis at children
As methods of therapy of day and secondary enuresis the methods directed to training of muscles of a bladder and also psychological assistance are, as a rule, applied. Sometimes to children appoint reception of drugs-holinoblokatorov.
To treatment of night enuresis it is applied both the help of the psychologist, and influence of the special device "night alarm clock" who stimulates a brain to train to wake up at night. As medicamentous drugs appoint desmopressin, in more exceptional cases apply tricyclic antidepressants.
Medicamentous means also have versatile influence. Holinoblokatora lower a bladder tone, at the same time the frequency of desires to an urination decreases. Tricyclic antidepressants render other effect: they relax muscles of a bladder and do a dream to less deep. Imipraminum needs to be accepted for the night, it begins to influence a week later. This drug is used for three months, and gradually its quantity decreases. But very often after the end of reception of this drug enuresis is shown at the child again. Besides, Imipraminum can negatively influence a condition of heart of the child. Therefore important constantly to control its states, carrying out electrocardiograms.
Desmopressin is accepted by those children at whom night enuresis arises as a result of shortage in a vasopressin organism. This drug is its synthetic analog. Drug influences approximately in thirty minutes, action to last about 8-12 hours. After the end of reception of means the illness often renews.
Thus, therapy by means of medicamentous means often only temporarily eliminates displays of an illness, does not conduct to an absolute recovery. Medicines are recommended to be applied situationally, for example, in days of distant trips, etc.
However very often doctors, in view of a large number of cases of any treatment of enuresis at children, advise not to treat at all those children who quietly perceive this problem. It is necessary to treat night enuresis when children strongly worry because of this problem. The enuresis course of treatment, as a rule, lasts from two to six months and repeats twice.
Training methods are applied to patients with enuresis for the purpose of training of the child to control own bladder. Special exercises which learn to hold longer urine, to interrupt an urination by means of Kegel's exercises, gradually help to show to the child as it is possible to influence this process.
Besides, often doctors recommend to try a special technique of night awakenings. For a week of the child it is necessary to awake at night at the same time — after midnight in each hour. After the child it is necessary to awake repeatedly for night in certain time, trying to pick up these hours so that the child did not manage to obmochitsya. If repeated cases of enuresis are observed after that, then conduct a course again.
Besides, some specialists practice purpose of other methods of treatment relating to nonconventional therapy. It can be acupuncture, a magnetotherapy, a musicotherapy, etc.
In the course of treatment parents have to pay attention and to features of a diet of the child. It is important to limit considerably the liquid use, and also those products which promote a frequent urination. After a dinner, before going to bed reception of liquid needs to be limited to the maximum. Also special attention needs to be paid to control of the use of products which contain caffeine – they have the expressed diuretic action.
Besides, it is important to follow some general rules which will help to cope with a problem quicker. Parents and other family members have to treat most quietly and tolerantly the sick child. It is impossible to punish children for failures, at the same time it is important to inspire constantly in them belief that they will manage to cope with a problem.
The child having enuresis should not endure severe stresses and situations, disturbing from the emotional point of view. It is not necessary to allow strong overcooling of the child. Before going to bed, the child shall go to a toilet.
Prevention of enuresis at children
There are some measures of prevention directed to avoidance of night enuresis at children. Specialists advise in time to refuse diapers, both reusable, and one-time. As a rule, optimum time for refusal of a diaper – two-year age of the child. Considering a season and air temperature, parents have to control that how many liquids are used by the child. Besides, parents are obliged to pay special attention to sanitary and hygienic education of children, training them in rules of care of external genitals, etc.