Enuresis in adult women treatment. Causes and treatment of nocturnal and daytime urinary incontinence in children: folk remedies, pills and prevention of enuresis. Causes of the pathological problem and its types

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 severity of the problem with medical point from a social and psychological aspect: children suffering from enuresis have to face censure and punishment from adults, ridicule from their peers, and as they grow older, they themselves begin to experience pronounced psychological discomfort and difficulties in adapting to society.

Under 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 the wrong time and place in a child 5 years of age or older. Accordingly, enuresis is considered to be urination in bed during a night's sleep. But the age limit (5 years) is rather arbitrary, since neuropsychic maturation and the ability to control urination during sleep in children occurs in different dates and can vary widely (for several years - from 3 to 6-7). Therefore, it is more expedient to diagnose enuresis in a child who is already beginning to realize the unacceptability of urinary incontinence, who himself is concerned about nocturnal episodes of incontinence and is interested in their elimination.

Enuresis classification

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

Primary enuresis occurs with early age 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 wake 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 relationship between the occurrence of bedwetting and the effects of any diseases, stress, mental factors and other pathological conditions.

Isolated enuresis is called enuresis, in which there is no daytime urinary incontinence. With combined enuresis, there is a combination of nocturnal 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 dysfunction Bladder, congenital anomalies urinary system);
• neurological, psychiatric and psychological disorders;
• endocrine diseases.

Causes of enuresis

Enuresis can occur as a result of the following causes and provoking factors:

1. hereditary predisposition: more than half of the children with enuresis have close relatives with the same problem. According to statistics, if one of the parents suffered in childhood bedwetting, the likelihood of enuresis in a child is approximately 40%; if both parents suffered from urinary incontinence, then the likelihood of developing enuresis in their children rises to 70-80%. With genetically determined enuresis, there is a violation of secretion antidiuretic hormone(vasopressin), which normally provides reverse suction primary urine, or decreased sensitivity of the kidneys to vasopressin. As a result, children excrete at night a large number of urine of low concentration.
2. Low functional capacity of the bladder. Functional capacity is the volume of urine that a person can hold before an overwhelming urge to urinate occurs. In children under 12, 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 age norm. With a low functional capacity, the bladder is not able 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; head injury and spinal cord; ; urological diseases; in 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.

Diagnosis of enuresis

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

Criteria for the diagnosis of hereditary urinary incontinence are:

• history of enuresis in any of the close relatives of the child;
• constant urinary incontinence from the first years of life - without "dry nights";
• nocturia - the predominance of nocturnal diuresis over daytime - that is, at night the child develops large quantity urine than during the day;
• low specific gravity of nocturnal urine;
• thirst in the child in the evening;
• blood test data for hormones ( low activity antidiuretic hormone - vasopressin - at night);
• data genetic analysis(detection of gene mutation);
• absence of organic or neuropsychiatric disorders.

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

• consultations of a pediatrician, neurologist, nephrologist, urologist, endocrinologist, child psychiatrist and psychologist;
• a diary of urination must be kept for several days (it records how many times and how much the child wrote per day, and whether there were episodes of incontinence day and night);
• laboratory tests (general blood tests and, urine and blood tests for sugar, blood tests for hormones, biochemical analyzes 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);
• additional x-rays of the spine may be prescribed, excretory urography, voiding cystoureterography and other studies.

Enuresis treatment

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

Mode and diet

Seven tips for parents with enuresis in a child:

1. Create the most peaceful environment in the family. The atmosphere is especially important in the evening hours: exclude quarrels, punishment of the child in the evening, active games, a computer, watching TV are highly undesirable.
2. Never scold or punish a child for peeing on the bed - this will not solve the problem, but only develop complexes in the child.
3. Get it right sleeping place: baby bed must be even and sufficiently rigid. If a child sleeps on an oilcloth, it should be completely covered with a sheet that would not wrinkle or move when moving in a dream. The room should be warm, without drafts (airing only before going to bed), but not too stuffy, so that there is no desire to drink when falling asleep or at night. Teach your child to sleep on their back. A roll placed under the knees or a raised foot end of the bed helps prevent involuntary urination when the functional capacity of the bladder is low.
4. Going to bed should be done at the same time.
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 caffeinated drinks; juicy vegetables and fruits - watermelon, melon, apples, cucumbers, strawberries). For dinner, boiled hard-boiled eggs, crumbly cereals, stewed fish or meat, weak tea with a little sugar are recommended. Just 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 during the hour before going to bed.
7. Leave a source of soft light (night light) in your child's bedroom so that he is not afraid of the dark and calmly goes to the potty or toilet when he wakes up with a desire to urinate.

To wake up or not to wake up?

About whether to wake up or not to wake up small child at night for urination, the opinions of doctors differ: some believe that artificial awakening with landing on the potty contributes to the development of a stable reflex, followed by independent awakening when the bladder is full, other experts are of the opinion that it is difficult to develop such a reflex in preschoolers, and it is quickly lost. But if you wake up a child, then wake up 2-3 hours after going to bed and be sure to completely - so that he wakes up, goes to the potty or the toilet himself and would come back himself. It is useless to show pity and carry a sleepy child in your arms to the toilet and back: this does not contribute to the development of a reflex to wake up, 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 into dry clothes (even better if he changes clothes himself), make the bed: these activities will form the child’s concept of comfortable sleep how about sleeping in a dry bed, and getting used to 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 scheme (“scheduled awakening”):

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

Scheduled wake-up treatment 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. Please note that "scheduled wake-up" violates normal flow night sleep of the child, and this leads to a serious burden on nervous system. As a result, the child will be tired, lethargic, capricious during the day, will not learn well. new information, because of this, his performance in school may decrease. Therefore, the method is desirable to use during the holidays.

Bladder training

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

motivational therapy

Good in the fight against enuresis positive effect gives the child the desire to succeed. Therefore, it is important for parents to encourage the child, praise for “dry nights” (but not punish if incontinence occurs), develop responsibility for his behavior (teach him to urinate before bedtime and not drink at night).

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

Exist non-drug methods treating enuresis with conditioned reflexes in children. A special alarm device (enuresis alarm clock) is placed near the child's bed, which reacts to a humidity sensor that is already sensitive to 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 linen - where the first drop of urine is likely to appear) - and at the very beginning involuntary urination the sensor responds, the device emits a loud signal.

On a 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 linen and put him to sleep again. This technique was invented in 1907 and is considered effective (it gives a positive result 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 moisture sensor is left in the child's underwear. If there is no effect within 2 months of using the enuresis alarm clock, the treatment according to the "urinary alarms" method is stopped.

Physiotherapy

In parallel with drug therapy, courses of physiotherapeutic measures are often prescribed: laser, acupuncture, electrophoresis, etc. But their effectiveness is rather low, and when used in isolation (separately from other methods), physiotherapy usually does not give positive results.

Other Methods

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

Medical treatment of enuresis

hereditary form

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

Enuresis on the background of neurogenic bladder dysfunction

Enuresis against the background of an overactive bladder, manifested by the presence of an "imperious" urge to urinate in a child that he is not able to restrain, is treated using several groups of drugs.

There are many things that a person, as a rule, gets rid of in childhood. However, it is very bad when such diseases and disorders begin to haunt adults. Enuresis in adults is not common, but still occurs, and its symptoms can appear in anyone. This is very annoying for many reasons. Also due to the fact that a person can suffer greatly from it emotionally: the appearance of new complexes, shyness, lowering the level of self-esteem - this is exactly what enuresis can lead to in adults (children, of course, are not immune from this either, although they experience it easier).

What is it and what are the reasons

The described disorder is understood as such a disorder of the human body, the most important symptom of which is what is happening, usually during sleep. Many children suffer from it, but not infrequently, adults (about two percent of all living people) also become victims.

In adults it is a very difficult problem. Through his fault, people become irritable, nervous, hysterical, and often withdraw into themselves. Making family and friends can be very, very difficult for them.

Not to be confused with frequent nighttime urge to urinate, as they are completely different problems.

The causes of enuresis can be both psychological and medical. AT medical cases Usually everything is connected with some infectious diseases urinary tract, prostate enlargement, diabetes, bladder cancer, or alcoholism.

To psychological reasons stress can be attributed poor nutrition, childhood trauma of the psyche, various kinds emotional problems.

It is also worth noting that enuresis in adults can also occur due to certain genetic abnormalities.

This ailment may be chronic or appear out of the blue. Some suffer from it since childhood: the symptoms disappear and then reappear completely unpredictably, while others discover it in themselves completely unexpectedly. Of course, those who did not encounter this trouble even in childhood are most surprised by him. Urination can in both cases occur every night, and from time to time (for example, when a person is too tired during the day or drank a large amount of liquid before bedtime).

Enuresis in adults: treatment

Some people who suffer from it have, in addition to symptoms and other things, there is another a big problem- they are so embarrassed about their illness that they cannot even bring themselves to see a doctor. In fact, you should not be afraid of a doctor, since you can’t surprise him with anything, and the treatment that he prescribes can be done in such a way that no one will know any details. Is it really better to wake up every night, realizing that everything happened again?

Of course, before starting treatment, it is necessary to establish the causes of its appearance, and for this it will be necessary to undergo a special examination. You will have to visit a urologist (gynecologist), as well as a neurologist. It is worth noting that the treatment process can be quite lengthy, and there is no magic remedy that would help cure immediately.

During treatment, the patient takes the funds that are needed in order to reduce or restore the bladder. It is also mandatory to accept all kinds of sedatives which are able to normalize the functioning of the nervous system.

Some in adults folk remedies. Such treatment can also be very effective, but it is also recommended to carry it out under the supervision of a doctor.

How to cure enuresis in children /

Treatment of nocturnal enuresis in a boy by suggestion

The boy was already 3 years old, and at night he still wet the bed. One evening, the grandmother, putting him to bed, said: “Now we will close your pisyun with this key, and at night we will give the grandfather the key to keep it, and in the morning, when you wake up, we will open it for you.” She showed the child a key, twisted it around her grandson's tummy and gave the key to her grandfather. In the morning, when the grandson woke up, grandfather was already standing next to the key, turned it around the child's tummy and sent it to the toilet. The bed was dry that night. They did this for 8 days, until the grandson said that now he would close and open the lock himself. So we managed to get rid of enuresis (newspaper "Bulletin of healthy lifestyle" 2011, No. 14, p. 21)

Children's enuresis - aspen treatment

1 st. l. bark, aspen twigs pour 1 cup boiling water, boil for 10 minutes. Take 1/2 cup 3 times a day. The woman gave this remedy to her 7-year-old son. He drank a weak infusion of spring aspen bark instead of tea, but without sugar. Gradually nocturnal enuresis the boy passed. (HLS 2007, No. 10, p. 30)

Enuresis - folk treatment

Treatment of enuresis with bird cherry

The recipe is similar to the previous one, but instead of aspen bark and twigs, bird cherry bark is taken. The drink is not as bitter as the previous one, so children drink it more willingly. (HLS 2011, No. 8, p. 39)

How did you manage to cure nocturnal enuresis in a boy

The boy was already 6 years old, but every morning, if his parents did not raise him to the toilet in the middle of the night, the bed turned out to be wet. A relative managed to cure enuresis in a child simple method. Before going to bed, she dipped a cotton ball in water, squeezed it out so that it would not drip, and ran this wet cotton ball along the child’s spine and cervical vertebrae to the coccyx, back and forth 5-7 times. At this time, she read the prayer "Our Father". Parents asked the boy not to wake up at night. The bed was dry in the morning. Six months after nervous breakdown the child had a relapse. The method with cotton wool was repeated. 6 years have passed since then, the boy is doing well. (HLS 2009, No. 18, p. 9)

The same recipe was advised to the mother of a boy suffering from enuresis, a teacher kindergarten. Urinary incontinence in the child passed very quickly and forever. (HLS 2004, No. 14, p. 25)

Treatment of childhood enuresis with viburnum roots

It was time for the boy to go to school, but every night he wet the bed. Parents worried, treated him different means but all in vain. Once a gypsy woman came to them, who suggested a folk remedy for enuresis. Wash 15 pieces of viburnum roots 8-10 cm long, pour 2 liters cold water. Bring to a boil and simmer over low heat for 40-50 minutes, insist, strain. Drink warm half a cup, adding a little honey, 3-4 times a day. The boy managed to cure enuresis with the help of this drink (HLS 2008, No. 19, p. 30)

Birch buds

1 st. l. crushed birch buds, pour 1.5 cups of boiling water, cook for 5 minutes on low heat under the lid, leave for 1 hour, wrap well, strain, squeeze. Take half a glass 2-3 times a day 20 minutes before meals. The course of treatment of enuresis is 2-3 weeks. (HLS 2007, No. 4, p. 28; 2006, No. 9, p. 28-29)

Treatment of enuresis in a child with sugar, honey and sweets

The woman managed to cure a 10-year-old boy living in the neighborhood from enuresis, in an unusual way: in the morning on an empty stomach, the child should eat 1 teaspoon of granulated sugar, on the second morning - 2 teaspoons, etc. At 10 in the morning, you need to eat 10 tsp. and start reducing one spoon at a time: at 11 in the morning - 9 spoons, etc. You can’t drink sugar. The course of treatment is 1 cycle. (HLS 2007, No. 13, pp. 35-36)

There are many other examples confirming this method: children can be cured of nocturnal enuresis with the help of sugar, honey, caramels. These are the examples:

In the evening, when the child has already prepared for bed, let him suck on one caramel. You have to suck, not chew. In this case, the child should sit in bed, and not lie down. This should be done every evening for 2-3 weeks. The effect of the treatment will come necessarily. (2006, No. 5, p. 29)

To cure nocturnal enuresis in children, it is necessary to give them honey before going to bed, it is impossible to drink honey with anything, immediately go to bed. Children under three years old - 1 tsp. honey, from three to five - dessert, after five - a tablespoon. (2006, No. 17, p. 33).

If you want to cure a child from bedwetting, give him 2-3 days before bedtime for half a glass of water, stirring 1 tsp in it. honey (2002, No. 3, p. 19).

Enuresis in a girl and a hornet's nest

A girl under 7 years old suffered from nocturnal enuresis. They managed to cure it like this: they found a large wasp nest in the attic, 15-20 cm in diameter. They removed the dust from it, put it in an enamel pan, poured 3 liters of water and boiled for 1 hour. This decoction was given to the girl instead of water 4-5 times a day. When the decoction was over, the nest was again flooded with water, but they had been boiling for 3 hours. After the girl drank the second portion of the decoction, her nocturnal enuresis disappeared. (HLS 2007, No. 18, p. 33)

Treatment of cystitis and enuresis in a child with parsley

Boy for a long time suffered from cystitis and enuresis. He took a lot of medicines that did not help, but simple parsley helped.

Parsley roots should be washed, chopped and dried. 2 tbsp. l. roots pour 1 liter of boiling water, boil for 2-3 minutes. Insist 40 minutes. Give this decoction to the child instead of some water. The boy drank about half a liter a day, that is, the portion was enough for 2 days. It took only a month for the child to sleep peacefully. The cystitis also went away. (2005, No. 10, p. 30)

Parsley also helps - young children with urinary incontinence are given a decoction of the leaves, it is also useful to eat in the summer, as much fresh parsley as possible. (HLS 2005, No. 11, p. 28)

Belarusian folk remedy for enuresis

Take the bladder of a pig (but not a boar), soak it in salt water for several days, changing the water. Then soak in water baking soda. Then boil the bubble slightly, scroll through the meat grinder, add minced meat, stick cutlets, freeze. In the morning, fry 1-2 cutlets and eat on an empty stomach. Eat a slice of bread. The course of treatment is 9 days .. (HLS 2001, No. 5, pp. 18-19)

Children's enuresis - treatment with thyme

Thyme brewed and drunk like tea is a very effective folk remedy for enuresis. The woman took a foster child in the orphanage. The boy was 12 years old and suffered from enuresis. She began to give the child tea from thyme, after three months the disease was gone. True, the woman woke him up during treatment 3 times a night at the same time. (HLS 2001, No. 16, p. 2)

goat milk treatment

The boy suffered from enuresis from birth. He was treated by a neurologist, in children's sanatoriums, but nothing helped. A familiar nurse advised to give the child fresh goat's milk, by that time he was already in the 5th grade. They began to take milk from a neighbor, in the morning and in the evening. The boy did not want to drink at first, but then he got used to it and began to ask for it himself. They drank milk for a year, and everything went away. (HLS 2000, No. 15, p. 19)

Enuresis in adolescent and adult men

It often happens that nocturnal enuresis in boys does not go away for a long time, and even as teenagers and adult men they continue to wake up in a wet bed 1-7 times a week. In this case, they can help folk remedies above: aspen or bird cherry bark, dill seeds, parsley decoctions. Enuresis alarm clocks are very effective in the treatment of nocturnal enuresis in adolescents.

clay treatment

This recipe helps with enuresis in children and adolescents, as well as involuntary leakage of urine in the elderly.

Somehow she came across a book where it was written that even cancer can be cured with clay. She began to make clay compresses for her son - she put hot clay on napkins, put one napkin with clay on the bladder area, the other on the lumbar region. When the clay cooled, I used two more napkins with fresh hot clay. Changed napkins until 20 minutes were up. Already after the fifth procedure, the teenager's pants became drier, he did not urinate in bed. In total, it took 10 procedures to completely cure enuresis in a teenager. (HLS 2008, No. 20, pp. 9-10)

Enuresis in men - herbal treatment

The most reliable remedy for urinary incontinence folk healers considered tea from a mixture of St. John's wort and centaury, taken in equal proportions. The man had an urge to go to the toilet every 30 minutes, after he started drinking tea from these herbs, the time increased to 1.5-2 hours.
Here is another recipe for enuresis: pour 100 g of galangal root into 500 ml of vodka, leave for 7 days. Take 1 tbsp. l. 2 times a day. (HLS 2009, No. 4, p. 32)

Enuresis in adult men

This method can be used to treat both children and adults, pre-conscripts were also treated. At young man until the age of 17 there was nocturnal enuresis, neither pills nor procedures helped. And this folk remedy helped to cure the disease.

A few minutes after the child went to bed, you need to approach him with a piece of herring and feed him. After that, say with him: “I won’t write to bed today.” Do this procedure every evening. The course of treatment is 10-15 days. (HLS 2005, No. 6, p. 32)

Enuresis in men - treatment with horsetail

This recipe helped to get rid of enuresis to the author of the letter, besides, it was tested on relatives and friends. It is necessary to put in a half-liter jar 2 tbsp. l. horsetail, pour boiling water, insist 1-2 hours. Drink warm 20 minutes before meals. daily rate- 500 ml. The course of treatment is 7 days. (HLS 2005, No. 7, p. 31)

Enuresis in older men

Treatment of urinary incontinence with herbs

In older age, enuresis in men has some other causes than in adolescents and young men. It is connected with age-related changes genitourinary system, muscle atrophy, problems with the prostate gland. In men, with age, the size of the prostate increases, the lumen of the urethra narrows, frequent urination is replaced by difficulty, the bladder is not completely emptied, it stretches, and the muscle “dries out”. In the last stage of this process, urine drips or oozes from an overflowing bladder.

If enuresis is accompanied by inflammation of the mucous membrane of the bladder (this often happens with prostatitis in men), then for treatment it is necessary to choose folk remedies that, along with the treatment of enuresis, relieve this inflammation. It must be remembered that bacteria causing inflammation, die in acidic environment, rosehip teas, or a mixture of centaury and St. John's wort, or from corn silk, infusion of marshmallow roots (6 g per glass of cold water, leave for 10 hours), decoctions of viburnum bark, infusion of berries and lingonberry leaves in half with St. John's wort, infusion of dill seeds - this is widely known means from enuresis

For nighttime urinary incontinence, the following recipe will help:

Take 2 parts of parsley seeds, 2 parts of horsetail, and 1 part of heather, hop cones, lovage root, bean wings. 1 st. l. brew the mixture with 1 glass of boiling water, drink during the day
(HLS 2013, No. 10, p. 33)

Urinary incontinence in men after removal of prostate adenoma

An elderly man had an adenoma of the prostate removed, after which he suffered from urinary incontinence for several years. On the reoperation on the correction of the neck of the bladder, he did not agree, he turned for advice to the newspaper "Herald Healthy Lifestyle".

Doctor med answered him. Sciences Kartavenko V. V., who advised the patient to cope with enuresis, using gymnastics aimed at strengthening the rectus abdominis muscles and long back muscles. Strengthening these muscles helps strengthen the walls of the bladder.

To strengthen the rectus abdominis muscles, you need to lie on your back, fix your legs and lift upper part torso. To strengthen your back, you need to do the same, but only lie on your stomach (HLS 2011, No. 21, p. 14)

Walking on the buttocks treats frequent urination and adenoma in men

Frequent urination in the elderly is found in a large number men. There is an easy way to get rid of this problem - walking on the buttocks.

The man got up at night to go to the toilet every 30 minutes, because he had an adenoma. After he included walking on the buttocks in the exercises, he gets up only 1-2 times at night.

In addition to enuresis, this exercise - walking on the buttocks eliminates constipation, treats prolapse internal organs, hemorrhoids, strengthens the muscles of the abdomen and back. (HLS 2002, No. 16 p. 7)

Unfortunately, such a pathological condition as enuresis resolves on its own in only 15% of cases. This means that it requires specialized treatment, which should include not only drug exposure, but also different techniques psychiatric care.

The treatment of enuresis in children requires a special approach to each patient, because the success of the therapy depends on it. It is not always easy to cure enuresis, especially if this process has remained long time without diagnostics.

When a child has problems with urination, parents simply have to show it to a specialist. Only a doctor is able to determine whether bedwetting in a baby is a variant of the age norm, or whether this condition requires immediate treatment.

I mark it so important to treat enuresis in a timely manner?

Some parents believe that since their child is not bothered by any unpleasant symptoms, except for episodes of nighttime urination, then nothing needs to be done. This is a big misconception, as enuresis in boys and girls can cause the following problems:

• suffering overall quality life (for example, the child is deprived of the opportunity to go somewhere on vacation, in summer camp etc.);
• if you do not get rid of enuresis in time, then there is a threat of the onset of complications, such as nephropathy (against the background of constant reflux of urine);
• enuresis in adolescent males turns into problems with age sexual in nature, problems with potency begin.

Such children are socially maladjusted, they do not get along well with their peers, they stop doing well at school, study poorly, begin to withdraw into themselves.

Patient management

Only a doctor knows how to treat enuresis, but only half of the success depends on the measures taken by him, the other half belongs to the efforts of the child himself and his parents. This means that the therapy requires the participation of not only a specialist of the relevant profile, but also psychological support mother and father, as well as the desire of the baby to recover and follow all the recommendations.

Mode and principles of nutrition

For the treatment of enuresis in children, it is very important to be able to properly plan the level of their physical and mental load during the day. You can not overload the child with information, force him to learn something from morning to night, or go to sports sections every day.

The baby's body must learn to "rest" not only at night, but also during the day. It is best to allow the child to choose his own activity to his liking, and not force him to do something.

The best way to distract a child from unpleasant thoughts is to engage him in his favorite thing.

Such children need a good night and day rest. The duration of sleep depends on the age of the child, as shown in the table below:

Treatment of nocturnal enuresis is also impossible without following the principles proper nutrition. You must adhere to the following recommendations:

• the last meal should be 3-4 hours before bedtime, so as not to burden the body with work during sleep, including filtration processes in the glomerular apparatus of the kidneys;
• all foods that can have an exciting effect on the functioning of the nervous system are excluded from the diet (cocoa, carbonated drinks, coffee, fatty and fried foods, smoked meats, spices, etc.);
• It is not recommended to drink liquid in large volumes, especially 3-4 hours before bedtime.

The motor activity of the child should be sufficient, because it is necessary for normal development all body systems (muscle apparatus, joints, ligaments, etc.).

All children suffering from nocturnal enuresis are recommended to perform daily physiotherapy exercises and morning exercises and spend time outdoors

Immediately before going to bed, you need to make sure that the baby goes to the potty, that is, his bladder is completely empty.

During sleep, the child should not freeze, so he is covered with a blanket. The temperature in the room should be as comfortable as possible.

For the treatment and control of enuresis, the “alarm clock” method is widely used, that is, interrupting sleep artificially (the baby is awakened 3-4 hours after falling asleep and asked to urinate in a potty or go to the toilet).

A set of special exercises

There are exercises that will help in the fight against pathological process(subject to their regular and daily performance). Let's consider some of them:

• If there is a desire to urinate, it is necessary to lay the baby on his back. After that, dull to soft pressure on his stomach (in the projection of the bladder), about 10-12 times. At the same time, it is necessary that the child tell his parents about his feelings, whether the urge has increased or not, whether he can control it, etc.
• To strengthen the external sphincter of the bladder, the child is asked to stop the stream during urination. The girls are seated on the toilet, and they try to interrupt the act of emptying the bladder without moving their legs, while the boys must do this while standing.

Psychological help in the fight against enuresis in a child

Highly importance in the treatment of nocturnal enuresis in children psychological aspects which are determined by parental support, understanding from brothers and sisters, warm family relationships etc.

The child must feel that he is loved and that he is no worse than other children. In no case should you punish the baby for a wet sheet, this will not bring absolutely any positive changes, but will only close him in himself (the psychological attitude is important).

Doctors recommend rewarding the child for several "dry" nights in a row, for example, some pleasant trifle or going to the movies. So, the baby develops motivation and self-adjustment for success, which will certainly bear fruit.

Parents should protect such children from any stressful situations and nerve strain, because he should feel as protected as possible

Physiotherapy treatments

Among the methods of physiotherapy, the following should be distinguished:

• Electrophoresis with medication(Diclofenac, Cortexin and others). Thanks to this procedure, the drug is delivered directly to the tissues of the bladder, which can affect its contractile activity.
• Electrosleep is a method that allows you to influence the structures of the brain using electrical impulses. At the same time, it changes functional activity nervous system of the patient, the process of sleep is normalized, the brain "learns" to fully rest.
• DENAS-therapy. Thanks to the procedure, electrical stimulation of brain neurons, namely reflexogenic zones, occurs. Artificial impulses enter the cells of the organ, which helps in the fight against the pathological process.

The advantage of DENAS-therapy is the possibility of its implementation at home.

Methods of drug treatment

cure children's enuresis, without using medicines, almost impossible. Therefore, it is very important to contact a specialist in a timely manner, who will prescribe the necessary drug therapy for the child.

Only the doctor determines which drug to prescribe to a particular patient, because each of them has its own side effects and limitations in use.

Use medications from the following pharmacological groups.

Analogues of antidiuretic hormone (synthetic origin). These include: Desmopressin, Minirin, Presineks and Adiurekin SD.

The mechanism of action of these drugs is compensatory replenishment natural hormone vasopressin, which normally reduces the formation of urine at night.

These bedwetting pills have more pronounced effect on kidney tissue than their "natural" counterpart. They are approved for use only in children whose age has reached 6 years. The course of treatment lasts 3 months, if necessary, it is repeated.

Quite often, in children taking synthetic analogues of vasopressin, there are such unwanted effects like diffuse headache night sweats and severe pain in a stomach

Drugs with anticholinergic effect. These include: Levzin, Detrol, Belladonna, Atropine, Driptan, detrusitol, Spasmex.

The mechanism of their action is reduced to a decrease in the sensitivity of the receptor apparatus in smooth muscle cells located in many organs, including the walls of the bladder. This helps to increase its volume and improves reservoir function. This affects the striated muscle fibers located in the sphincter, which improves its contractile function.

Such a drug for enuresis, like Driptan, refers to drugs latest generation, because it is able to have a selective effect on the tissues of the bladder, while there is practically no "systemic" effect.

When taking anticholinergics, it is very important to follow the regimen and the recommended dosage, since non-compliance with them threatens to develop a number of undesirable effects.

Among side effects medicines from this group, it is worth highlighting the following: sensation constant dryness in the mouth, redness of the face, blurred vision (decrease in acuity), mood swings, and others.

Drugs that can have a stimulating effect on metabolic processes in the cells of the nervous system. These include: Glycine, Pantogam, Piracetam, Picamilon and others.

Let's take a closer look at some of them:
Pantogam is a drug that can increase the resistance of brain cells to a lack of oxygen and exposure to toxic substances. It improves metabolic processes in the neurons of the brain, has a mild calming effect. It has a positive effect on physical and mental activity. Decreases the frequency of urination. Similar action has a drug with a similar mechanism of action and composition - Pantocalcin.

Piracetam is a drug that positive influence on most metabolic processes in brain cells. It improves the nutrition of neurons and the relationship between them, by expanding blood vessels and accelerating blood circulation. The drug helps in the fight against intoxication and damage to brain structures. However, the desired effect comes gradually, which requires a fairly long time to take it.

Patients have a significant increase in mental activity, irritability and all manifestations asthenic syndrome(lethargic mood, lethargy, drowsiness, etc.)

Picamelon is a drug that is widely used in the practice of doctors involved in the treatment of patients with urinary incontinence. It is effective in the fight against manifestations vegetative dystonia, raises the level of mental and physical activity in the daytime, improves mood, positively affects the process of falling asleep and normalizes sleep.

Phenibut is a drug that improves the transmission of nerve impulses between neurons, improves metabolic processes and blood flow in large and small vessels. It has a mild psychotropic effect, restores sleep, relieves the feeling of fear and unreasonable anxiety.

prostaglandin inhibitors. These include: Diclofenac, Acetylsalicylic acid, Indomethacin and others.

Drugs in this group are able to influence the formation of urine at night, by reducing the level of prostaglandins, which are synthesized in the tissues of the kidneys. This increases the sensitivity threshold of the bladder, which increases its reservoir capacity.

Tricyclic antidepressants. These include: Amitriptyline, Imipramine (Melipramine).

The drugs of this group were previously very widely used for the treatment of patients with different form urinary incontinence, however, at present, their use has significantly decreased, which is associated with high level getting used to them.

Antidepressants activate the work nerve cells, have a positive effect on sleep, improve the patient's mood, increase psycho-emotional resistance to stressful situations. They also reduce the sensitivity and excitability of the bladder, increase muscle tone its sphincters and stimulate the production of vasopressin at night.

The appointment of antidepressants and their choice is carried out only by a psychiatrist

Means from other pharmacological groups. Quite often, as adjuvant therapy prescribed the following medications:

• Enuresol, the so-called "five", which includes several components at once (belladonna extract, calcium gluconate, Securinin, Ephedrine and vitamin B1). In combination with each other, they have a good general tonic and firming effect. Help in the fight against urinary incontinence.
• Cortexin is a drug with high metabolic activity. Improves and restores the relationship between the hemispheres of the brain and metabolic processes in neurons. Given medicine treats hyperactivity syndrome in a child with attention deficit, improves the patient's memory and concentration abilities.

Phytotherapy

In the treatment of patients with enuresis, phytocollections are used, from which decoctions and infusions are prepared.

At daily use herbal collections, the well-being of patients improves, but only on condition that all components of the collection are selected correctly

Phytotherapy is used as helper method treatment, it aims to combat inflammatory process eliminates pain and spastic syndrome, and also gently calms the nervous system and reduces the excitability of the walls of the bladder.

Decoctions and infusions are prepared as follows:

• A decoction of dill seeds. For him, you need to take 2 tbsp. l. dried seeds and pour them with 0.5 liters of boiling water, then leave to infuse for 3-4 hours. Take a decoction of 250 ml twice a day 30 minutes before meals. The course of therapy is 2-3 weeks.
• A decoction of cherry branches and cherry stems. A bunch of branches and stems is placed in an enamel bowl and poured with boiling water. Infuse it for 30-40 minutes and consume 300 ml 3 times a day 1-2 hours before meals. The course of treatment is 5-6 weeks.
• A decoction of berries and leaves of lingonberries and St. John's wort. You need to take 2 tsp. dry substrate and pour 100 ml of boiling water, let it brew for 10-15 minutes. Drink the resulting volume of liquid during the day (several times in small sips). The course of treatment is 5-6 weeks.

Psychotherapy

Methods of psychotherapeutic influence, such as hypnosis, self-hypnosis and behavioral techniques, help to cure the disease.

The main task of a psychotherapist is to form in the patient's mind a reflex to controlled urination. This takes a long period of time, sometimes several months or years.

Thanks to self-control, the patient learns to “listen” to his body, control his desires, his body and bladder

Conclusion

It is very important to understand that it is not easy to treat enuresis in children, but it is necessary. This is the state that requires great attention on the part of parents and doctors, because only their joint efforts can achieve the desired effect of therapy.

Enuresis refers to pathological condition, which is treated by doctors of several specialties at once (pediatricians, psychiatrists, neurologists, physiotherapists and others), because the approach to treating such patients should always be complex.

Enuresis is uncontrolled urination day or night. With the appearance of this pathology, the quality of life of patients is significantly reduced. Adult patients hide their problem from relatives and doctors for a long time. Enuresis in adult men occurs with pathology prostate.

Therapeutic measures for enuresis give positive results thanks to integrated approach. This allows the patient to return to normal life.

Etiology of enuresis in adults

The causes of enuresis in adults differ from those in children.

In childhood, enuresis is provoked stressful situations(divorce of parents, death of relatives, severe fright).

In adults, they secrete the following reasons diseases:

• infectious diseases of the urethra, bladder;
• congenital or acquired malformations of the genitourinary system;

• operations in the pelvic organs;
• trauma;
• endocrine diseases ( diabetes and obesity)
• sexually transmitted infections;
• nervous tension;
• drugs that can cause enuresis;
• muscle weakness pelvic floor;
• neoplasms of the prostate gland in men;
• postpartum period, menopause in women;
• hereditary predisposition;
• alcoholism.

Elderly patients are more susceptible to the incidence of enuresis, as there is a decrease in the concentration of sex hormones and the contractile function of the pelvic floor sphincters. In elderly patients, it is provoked by brain tumors, Alzheimer's disease. As well as the causes of pathology are diseases of the central nervous system.

Men are more likely to suffer from enuresis. Scientists have proven the existence causation between children and adult forms enuresis.

Varieties and symptoms of enuresis

Doctors distinguish three classifications of enuresis:

enuresis symptoms

The disease is manifested by the presence of urinary incontinence in the patient at night or during the day,. The patient becomes less sociable and secretive. Patients experience leakage of urine before the urge, pain in the lower abdomen.

Associated symptoms:

• heart rhythm disturbance (bradycardia);
• bluish, cold extremities;
• hypothermia or hyperthermia;
• weakness, drowsiness;
• cloudy urine, the presence of blood clots in it.

Nocturnal enuresis in adults is manifested by uncontrolled nighttime urination. With this type of pathology, the patient loses the awakening reflex when the bladder is filled.

Diagnostic measures

The first link in the diagnosis of urinary incontinence is an examination by a general practitioner, gynecologist or urologist. The doctor collects a detailed medical history. He specifies the time, frequency, nature of urination, the presence of pain. And also finds out the amount of fluid drunk per day and before bedtime.

The doctor records information about heredity and childhood illnesses, and also palpates the prostate gland in men. The gynecologist performs an examination on the chair, takes swabs from the vagina and. The patient gives a general analysis of blood and urine, keeps a diary of urination.

The next step in the examination of the patient is uroflowmetry. During the procedure, the rate, time of excretion and volume of urine are recorded.

The patient is being ultrasound procedure to determine the amount of residual volume in the bladder, provoking spontaneous urination during the next call. The doctor directs to ultrasound of the kidneys and prostate gland (for men).

If necessary, the doctor prescribes x-ray examination kidneys, bladder contrast agent to determine their excretory function.

To assess the condition of the mucosa and identify formations in the bladder, ureters and pelvis, use endoscopic method diagnostics.

Enuresis treatment

Therapeutic measures include conservative and surgical methods. To conservative treatment refer drug therapy, psychological help, medical physical culture, diet therapy, healthy lifestyle life, physiotherapy.

Diet therapy and healthy lifestyle

In order to improve general condition The patient's doctor recommends a diet. The patient is obliged to drink at least 2 liters of water per day, do not drink before going to bed and walking.

It is necessary to exclude drinks that stimulate the excretion of urine: tea, coffee, sweet carbonated drinks, and also give up alcohol (especially beer).

Do not get involved in salty foods, spicy, fatty, fried foods. Nutritionists recommend eating more fruits, vegetables, herbs, bran bread, cereals.

General principles of treatment and care of patients

The patient needs to change behavioral habits. Therapy of enuresis in adults, the causes of which non-patients cannot immediately determine, involves practice controlled urination. The patient must empty the bladder forcibly every hour, if necessary every half hour. Gradually, the intervals between urination increase to 3-4 hours.

Before walking and sleeping, you need to empty your bladder. Actively use urological swimming trunks, linings. In bedridden patients, these funds should not be used constantly, as this can lead to skin irritation, which is quite difficult to cure.

Methyluracil ointment, Bepanten cream helps with diaper rash.

To protect the mattress from getting wet, special moisture-resistant mattress covers are on sale.

Physiotherapy

Exercise therapy is necessary to strengthen the muscles of the pelvic floor. For this, a special set of exercises was created - Kegel gymnastics. The essence of the technique is rhythmic contractions of the sphincters of the pelvic floor (10 seconds for contraction, 10 seconds for relaxation, 10-15 repetitions).

And also in an attempt to stop the stream of urine during urination. These exercises do not require special efforts from the patient.

Physiotherapy

Physiotherapy for enuresis in an adult is designed to reduce the intensity of contractions of the bladder during its overflow, as well as strengthen the muscles of the pelvic floor.

Actively use:

• electromagnetic effect on the pelvic floor;
• darsonvalization of the walls of the bladder;
• mud treatment.

Apply electrical stimulation of the pelvic floor muscles, which mimics Kegel exercises.

Medical therapy

Includes the use of drugs. These include a group of anticholinergics and M-anticholinergics. These medicines have a positive effect only in conjunction with general activities.

The drug Oxybutynin, Tolterodine, Solifenacin, Darifenacin are widely used in the treatment of enuresis. They possess long-term action applied 1-2 times a day.

Oxybutynin is available both in tablet form and as a patch. The patch needs to be changed every two weeks. These drugs relax the detrusor (the muscle lining of the bladder that contracts to cause urination).

Gynecologists and urologists prescribe the following drugs:

• Minirin;
• Driptan;
• Vizikar.

With nocturnal enuresis in adult women and men, Miridin, Driptan are suitable. The presence of persistent enuresis requires the use of a group of drugs.

Other treatments

With inefficiency medical measures doctors are moving to invasive methods: surgical treatment and stimulation of the sacral and tibial nerve.

Surgical treatment is indicated for patients with tumor-like formations urinary system, hypertrophy of the prostate gland, preventing the discharge of urine.

If it is not possible to remove the tumor, a stent is placed inside the urethra, which prevents the walls of the urethra from closing. In most patients, after surgical intervention enuresis is eliminated almost immediately.

At severe course diseases use a minimally invasive stimulation method through injections at level 3 sacral vertebra and in the region of the tibial nerve.

And also these methods strengthen the sphincter of the bladder. Sessions are held once a week. The course of treatment must be observed within 3-4 months. Additionally, the patient is implanted with a neurostimulating implant.

Enuresis in adults is treated successfully thanks to an integrated approach. Great importance in treatment has the behavior of the patient. Urination training and Kegel exercises greatly increase the chance of a cure. Subject to all the recommendations of doctors, patients can completely get rid of the disease.