The child does not feel the urge to urinate. Urinary incontinence in children - causes and treatment of enuresis in a child. Drug treatments for enuresis in children

Bedwetting (the second name of this pathology is enuresis) is involuntary urination during sleep, at night. It is possible to establish such a diagnosis only at the age of a child over three years old - it is by this time that the control of the nervous system over the bladder is fully formed.

This disorder is not organic, but functional in nature, and is very common in children. Moreover, the highest incidence is observed in preschool children (15-18%), with age it gradually decreases, amounting to only 0.5-1% by the age of 18 and older. Boys are more likely to suffer from enuresis - they have this pathology one and a half times more often than girls.

You will learn about why bedwetting occurs and how it manifests itself, what are the principles of its diagnosis and treatment, including physiotherapy techniques, from our article.

Types of enuresis

Clinicians distinguish between two types of urinary incontinence at night - primary and secondary. Primary develops from an early age and appears regularly, without the so-called light gaps. They speak of secondary urinary incontinence when it was absent for some time (at least six months), and then resumed again. As a rule, four out of five patients suffer from the primary form of enuresis, while the secondary accounts for only 15-20% of cases of the disease.

Causes and mechanism of development

Researchers have not yet been able to figure out the reasons for the development of enuresis. It is believed that such a violation causes a combined effect on the child's body of predisposing factors, such as:

Delayed maturation of the central nervous system. In a healthy child, by the age of three, involuntary control of urination is formed - they have the ability to inhibit the urge and consciously urinate. In some cases, the formation of reflex control of urination is delayed, which causes involuntary urination at the age of over three years. If at the same time spontaneous remission occurs after a certain period of time, it is considered that involuntary control of urination has formed.
Change in the circadian rhythm of the production of antidiuretic hormone. In a healthy body, the level of this hormone during the day and night is different. If for some reason the circadian rhythm is disturbed, the volume of urine that is formed at night increases significantly - the bladder stretches. When this condition is combined with a violation of the nervous regulation of the urinary tract, involuntary urination occurs.
hereditary predisposition. It has been proven that if the parents of a child suffered from bedwetting in childhood, then the likelihood of developing this disorder in him is much higher than in children whose parents did not suffer from enuresis. In the latter, the risk of getting sick with it is 15%, and in children with aggravated heredity - 44%. If both parents suffered from bedwetting, then in 77% of cases the child also suffers from it.
Congenital malformations of the spinal cord. Enuresis can occur in association with spina bifida and meningocele, but this is uncommon.
Child behavior disorders. Psychological deviations, such as tearfulness, irritability, irascibility, impulsiveness, inattention, aggressiveness, and others, often lead to the development of bedwetting. There is also a feedback - the presence of enuresis and the wrong reaction of parents and other people around the child to it in many cases cause a change in his behavior.
Infectious diseases of the urinary tract. They can provoke the development of secondary enuresis. This fact is confirmed by the fact that in some cases, when adequate antibiotic therapy for infectious pathology is carried out, urinary incontinence also disappears.

Symptoms

Nocturnal enuresis can be combined with daytime urination disorders.

According to the nature of the course, enuresis is classified as complicated and uncomplicated. In uncomplicated cases, leakage of urine during the child's sleep is the only clinical sign of pathology. The frequency of leaks varies from two to three times a month to several in one night. The complicated form, in addition to urine leakage at night, is also accompanied by daytime disorders - daytime incontinence, increased urination, and false urges to them.

In addition to disorders in the urinary area, the child often has neurological disorders - neurosis, neurosis-like syndrome. He is emotionally labile, tearful, prone to feelings, quick-tempered.

Diagnostic principles

When parents with a child seek help from a pediatrician or neurologist, he will ask them in detail about how often episodes of urinary incontinence occur, whether there are other disorders of the urinary system, about the psycho-emotional state of his patient, about the peculiarities of his communication with peers, about psychological climate in the family, housing conditions, past illnesses and conditions of education. A carefully collected history often helps to establish the cause of enuresis, so that therapeutic measures in the future can be directed directly to its elimination. During the examination, the doctor will pay attention to the structure of the external genital organs of the child.

The next stage of diagnosis will be laboratory and instrumental research methods, in particular:

general urine analysis;
general blood analysis;
biochemical analysis of blood (special attention will be paid to indicators that allow assessing kidney function);
Zimnitsky test;
counting the number of normal urination and false urges to it;
Ultrasound of the kidneys and bladder;
neurological examination (assessment of tendon reflexes and other manipulations);
cystometry (allows you to diagnose a decrease in the maximum volume and involuntary activity of the muscular membrane of the bladder);
survey and excretory urography;
cystoscopy (you can detect a decrease in the volume of the bladder, the presence of partitions in its cavity - trabeculae, gaping of the neck);
radiography of the Turkish saddle (for the diagnosis of pathological changes in the pituitary gland);
survey radiography of the lumbosacral spine (in order to detect congenital non-fusion of the vertebral arches).

Treatment tactics

Therapy for bedwetting should be complex, combining three components: psychotherapy, drug treatment and treatment with physical factors, or physiotherapy.

Psychotherapy

Classes with a psychotherapist and an adequate reaction of parents to the problem help to cope with it.

The involvement of parents is very important in the treatment of enuresis. First of all, we are talking about an adequate response to a wet bed. It is strictly forbidden to punish a child for the inability to hold urine, to scold him for this, since such an approach further destabilizes the already unstable psyche of a child with urinary incontinence. The right approach is motivational psychotherapy, the essence of which is to reward the child for every night without “wet adventures”.

Psychotherapists also recommend an impact aimed at developing a conditioned reflex in the patient to wake up at night and then urinate. To do this, in the evening, three hours before bedtime, he is advised to refuse to eat and drink, immediately before going to bed they are offered to eat something salty (for example, herring) and wake up after three to four hours of sleep. After full awakening, the patient performs a full act of urination. Treatment is carried out in a course of 3 to 3.5 months, and over the next 12 weeks it is gradually canceled.

Medical treatment

The following groups of drugs are most effective in the treatment of enuresis:

anticholinergics (atropine, Driptan);
tricyclic antidepressants (imipramine);
nootropics (phenibut);
papaverine and the like;
synthetic analogue of antidiuretic hormone - desmopressin;
adaptogens (tincture of eleutherococcus, ginseng, magnolia vine).

Medicines increase the functional capacity of the bladder and reduce its activity at night. Their doses are selected depending on the weight and age of the child.

Physiotherapy

The Laskov apparatus helps to strengthen the voluntary urination reflex. The essence of the method is to combine, according to the principle of a conditioned reflex, the urge and urination itself with something unpleasant, here - with a faradic current. Instead of this current, intense light or sound stimuli were previously applied immediately after the child urinated into the bed.

Immediately after involuntary urination, a faradic shock follows - the nervous system combines these two moments into a single complex. As a result, the urge to urinate is perceived by the body as a conditioned signal, and the urge becomes so strong that it causes awakening.

The active electrodes of the device are placed in the perineum or above the pubis. When a child urinates under himself, the electrical circuit is completed and he receives an electric shock. To achieve the effect, as a rule, 10-15 procedures are enough.

An alternative to this method is the so-called "enuresis alarm". This is a device that has a small sensor that the mother puts the child in panties and when the first droplets of urine fall on it, the signal from the sensor is sent to the alarm clock, it rings, the child wakes up and goes to the toilet on his own.

No less effective method, allowing 97% to get a positive result, is through the rectum. The cylindrical electrode is placed in a gauze bag moistened with warm water and inserted into the intestine by 3-5 cm. An indifferent electrode is placed above the pubis through a pad moistened with warm water. The course of treatment includes 10 treatments performed daily. If a recurrence of the disease occurs, therapy can be repeated after a month.

Rectal electrodes are not used for children of preschool age, instead two external electrodes are used, which are installed on the thighs in their upper back region.

Also, persons suffering from urinary incontinence can be prescribed (two needles in the abdomen, lower back and medial-inner surface of the lower leg), and complexes of physiotherapy exercises.

The complex treatment of enuresis is more than effective - it helps to stop involuntary nighttime urination in 90% of children. The complete success of treatment can be noted if there are absolutely no episodes of enuresis within 24 months after stopping therapy.

Conclusion

Urinary incontinence at night, or enuresis, is a fairly common pathology among pediatric patients, which can occur due to the impact on the body of a number of reasons, ranging from psychological to organic diseases of the urinary tract and congenital pathology of the nervous and urinary systems. Treatment of this condition should be comprehensive and aimed primarily at eliminating the causative factor. An important role is played by psychotherapy, in which parents are obliged to take an active part. Equally important is the intake of special medications that help increase the functional capacity of the bladder and reduce its spontaneous activity. An important component of therapy is and, the methods of which allow you to develop a conditioned reflex of voluntary urination, when the body, even at night, in a dream, can control this process, preventing leaks.

In any case, if your child has such a problem, do not scold him and do not delay in going to the doctor. Of course, it is possible that the problem lies on the surface and the child himself will “outgrow” this condition, but if its causes are deeper, the doctor will help eliminate them as soon as possible.

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School of Dr. Komarovsky, issue on the topic "When and how to treat enuresis":

Enuresis(from Greek enureo to urinate) is a term for urinary incontinence. In children, the following forms of this disease are distinguished: nocturnal enuresis(occurs most often, and the article will focus on it) and daytime urinary incontinence. There is also permanent urinary incontinence, but this is a completely different disease associated with damage to the central nervous system as a result of injury or infection. Under nocturnal enuresis It implies that a child over 5 years of age has involuntary urination during a night's sleep. The formation of complete control over urination in a child occurs between the ages of 1 and 3 years and ends by the age of four. Depending on the age and the amount of liquid drunk, the number of urination normally ranges from 7 to 9 per day (no more and no less), moreover, during a night's sleep, there is a break in urination. However, in 10 - 15% of children aged 5 - 12 years this does not happen, and after a night's sleep they wake up wet. That is, they suffer. nocturnal enuresis. As they grow older, the prevalence of this disease decreases, but 1% of children “carry” it into adulthood. Moreover, in boys, enuresis occurs 1.5 - 2 times more often than in girls. There are two main types of nocturnal enuresis: primary nocturnal enuresis(PNE) - a disease in children who never woke up consistently dry; and secondary or recurrent (recurring) nocturnal enuresis, a condition in which patients repeatedly begin to urinate in the bed after a significant period of remission (no signs of the disease).

Reasons for the development of enuresis

The causes of bedwetting are varied. One of the main factors is damage to the fetal brain during the pathological course of pregnancy and childbirth due to hypoxia (insufficient oxygen supply to the brain) or trauma. These pathologies contribute to a delay in the maturation of the central nervous system of the child and a violation of the production of hormones, including vasopressin (see below), which leads to the development of enuresis. Chronic infections of the urinary system, disorders of the nervous regulation of the bladder, congenital anomalies of the genitourinary system, and a delay in the development of neatness skills are also considered prerequisites for bedwetting. Exacerbations of nocturnal enuresis are possible, developing against the background of acute respiratory viral infections, hypothermia, which provokes an infection of the urinary system. Often this happens in autumn and spring, that is, during periods of unstable weather. Stressful situations in a child's life can also cause repetition of the disease. The mechanism of development of primary nocturnal enuresis (PNE) is not completely clear. It is believed that an important factor in the development of the disease is a genetic predisposition. Certain genes responsible for this pathology have been identified. If one of the parents suffered from bedwetting, then the risk of developing enuresis in a child is 45%, and if both, this probability increases to 75%. In recent years, convincing evidence has emerged that the main cause of PNE is a violation of the rhythm of secretion of a hormone synthesized in the brain (in the hypothalamus) vasopressin. Its other name is antidiuretic hormone, from which the main function becomes clear: reducing the excretion of urine by the kidneys. Antidiuretic (or antidiuretic) action of the hormone is necessary to maintain water-salt metabolism in the body. Normally, the concentration of vasopressin in plasma depends on the time of day: at night it is higher than during the day. Therefore, at night, the kidneys excrete a smaller volume of urine, but with a higher concentration. That is, in healthy people at night, small portions of urine enter the bladder, but do not overfill it, and there is no urge to urinate. In primary enuresis, nocturnal vasopressin secretion is reduced, resulting in increased production of loose urine. Its amount exceeds the physiological capacity of the bladder, it overflows, and involuntary urination occurs. Often parents, apparently out of a desire to justify themselves, associate this with a sound sleep of the child. However, it turned out that the nature of sleep children suffering from nocturnal enuresis do not differ from other peers. Another cause of nocturnal urinary incontinence may be disturbances in the nervous regulation of the bladder with a predominance of increased tone of smooth muscles, and then frequent urination in small portions or abundant infrequent urination, as well as daytime urinary incontinence, join enuresis. If the tone of the bladder is reduced, then the child urinates rarely, in large portions, the bladder overflows, and involuntary urination occurs. A situation has also been noted when children, due to attending various classes and sections, almost fail to drink normally in the first half of the day, and at home, before going to bed, they drink the daily norm of liquid and do not hold urine at night. Sometimes this is also regarded as enuresis.

Necessary examinations

There is an opinion that there is no need to contact a nephrologist (or pediatrician) with the problem of nocturnal enuresis: they say, the child will “outgrow” and everything will go away on its own. But this point of view is wrong. When examining children with bedwetting, various pathologies of the kidneys and urinary system are often detected. Therefore, first of all, it is necessary to establish the cause of the disease. For this, specialists prescribe certain examinations: a blood test, various urine tests, an ultrasound examination of the kidneys and bladder; study the rhythm and volume of urination, do electroencephalography. Often, a wider examination of the urinary system is also required: cystography, intravenous urography, nephroscintigraphy, cystoscopy, urofluometry. Based on the results of the examination, the nephrologist, if necessary, can refer the child for a consultation with other specialists, for example, a neurologist, a psychologist, or for an additional examination in the nephrology or urology department. Only after the cause of enuresis has been established can the correct treatment be given.

Treatment

Convincing data on disturbances in the rhythm of vasopressin secretion in primary nocturnal enuresis served as the basis for the use of synthetic analogues of this hormone - MINIRIN (DESMOPRESSIN). Doses of the drug for the treatment of PNE in children from 5 years of age are selected by the doctor individually, the medicine should be given at bedtime. In the treatment of primary nocturnal enuresis, a special drinking regimen should be observed - the last fluid intake should be at least 2 hours before bedtime. At the same time, the child should receive enough liquid throughout the day. It is unacceptable to use vasopressin analogues on their own, since nocturnal enuresis in a child can be associated with a completely different pathology, for example, with an infection of the urinary system. And this requires the appointment of antibiotic therapy, after which the phenomena of nocturnal enuresis disappear. If the cause of enuresis is a violation of the nervous regulation of the bladder, with a predominance of increased tone of its smooth muscles, leading to a decrease in the volume of the bladder, DRIPTAN is used. It increases bladder capacity and reduces spasm, making spontaneous muscle contractions less frequent and eliminating urinary incontinence. In some cases, treatment with MINIRIN in combination with DRIPTAN is indicated. With a reduced tone of the bladder, it is recommended to adhere to the regime of forced urination every 2.5 - 3 hours during the day. It is important that the child emptys the bladder before going to bed. As a therapy, MINIRIN AND PRAZERIN are prescribed, which increase the tone of smooth muscles. To improve metabolic processes in the brain, as well as in neurosis-like conditions, such drugs as NOOTROPIL, PIKAMILON, PERSEN, NOVOPASSIT are recommended. In addition, courses of vitamin therapy (B6, B12, B1, B2, A, E) are shown. The complex of treatment of enuresis includes physiotherapy, in the form of effects on the bladder with various currents, ultrasound and thermal procedures (paraffin or ozocerite), which regulate the functioning of the nervous system. A general strengthening massage and therapeutic exercises are also used, aimed at strengthening the muscles of the pelvic floor. The treatment of nocturnal enuresis is a long process, it takes months and sometimes years, so parents need to be patient. In order to prevent the disease, it is better to teach the baby to use the potty in a timely manner and to ensure that the child regularly and completely empties the bladder. Compliance with the drinking regimen is a must. It is unacceptable for a child to get used to drinking before bedtime and at night. A child suffering from bedwetting should not be forced to wake up to empty his bladder. The baby needs to sleep at night. He must be treated, and then he himself will be able to control his body, and the phenomena of enuresis will disappear. The right psychological attitude in the fight against any disease is no less important than the course of medication. And in the case of children's nocturnal enuresis, this moment is of particular importance. The more correct and attentive adults are to the baby, the less painful the problem will be for the emerging personality of the child.

Illness and character

In many children, regardless of age, enuresis, like any long-term illness, causes a feeling of inferiority. Even the smallest ones have a hard time with this problem. Ashamed of their healthy peers, they often seek solitude, withdraw into themselves in order to avoid ridicule and the squeamish attitude of others. The feeling of insecurity often appears or worsens in kindergarten or at school age and can lead to the development of low self-esteem, self-rejection, up to a complete inability to learn and realize themselves in various areas of life. Children who have urinary incontinence for a long time, under the influence of experiences, in some cases change in character. Some become more aggressive, while others become more timid, indecisive, withdrawn, and isolated. There are also those who, at first glance, do not worry about their illness, but they may experience various changes during adolescence.

Forms and causes of the disease

Urinary incontinence, as a result of a delayed formation of control over urination or the destruction of an already formed function due to organic and infectious diseases or traumatic lesions of the nervous system, is called neurosis-like. The presence of neurosis-like enuresis, caused by an organic lesion of the child's nervous system even in the period of intrauterine development, does not depend on unrest and other psychological factors, but increases with overwork, physical ailments, and hypothermia. With the destruction of an already formed function, urinary incontinence does not appear at an early age, but after an injury (for example, concussion) or infection (for example, meningoencephalitis - inflammation of the membranes and brain substance). At the same time, enuresis is, as a rule, monotonous, monotonous in nature. In cases where the rate of onset of compensation is slow or there are additional negative factors that interfere with recovery, neurosis-like urinary incontinence can last for years and sometimes leads to pathological personality formation in adolescence. In such cases, the doctor may recommend long-term sessions with a psychologist against the background of drug treatment. The function of urination can also be destroyed under the influence of various psychological reasons (due to acute mental trauma). In this case, one speaks of neurotic enuresis. This form of the disease can be both short-term and longer-term. For example, if a child has involuntary urinary incontinence from fear. Usually a neurotic reaction with enuresis lasts for several hours or days and disappears as the mental stress disappears. In those cases when emotional excitement persists for several weeks and months, and painful manifestations are fixed, they speak of a neurotic state. Its reasons may be:

family moving from one place of residence to another, where the child is acutely experiencing the loss of friends and buddies and is faced with the need to adapt to a new kindergarten or school;
death of close relatives or friends;
the birth of a brother or sister in the family;
long-term chronic illness of loved ones;
chronic conflicts in the family;
divorce of parents or pre-divorce and post-divorce situation;
death of a pet - cat, dog, parrot

In such cases, the child is having a hard time with internal conflict and his protracted illness. A clear dependence on the mental state leads to the fact that the neurotic course of enuresis, unlike a neurosis-like disorder, may manifest itself inconsistently - either disappear or intensify depending on the emotional state of the child. Such enuresis can be flickering in nature and last from several weeks to several months. But the force of the child's experiences is very intense. In these cases, a qualified psycho-correction of his internal conflict is effective.

What adults can do

It is important for parents to know that enuresis, like any disease, is different for each child. To date, more than 300 independent methods of its treatment are known. Correct recognition of the disorder and individual selection of appropriate methods for each specific baby guarantees a full recovery in the shortest possible time. And the implementation of all the recommendations of a specialist and the prescribed procedures, coupled with the connection of psychological family resources, quickly leads to a lasting positive effect.

When enuresis suddenly arises, first of all, it is necessary to eliminate the situation that traumatizes the child's psyche. Ensure maximum peace in the family, remove the conflict atmosphere, and normalize the psychological climate.
Chronic conflict in the family often leads to aggravation of the problem. The child needs to pay more attention: read books together, go for walks, especially in the evening.
Children suffering from enuresis are given a certain diet and fluid intake: 2 hours before bedtime, its amount is reduced or drinking is canceled altogether. It is important to follow these rules and teach the child to new dietary patterns, for example, to limit salty and spicy foods, which increase thirst. You can replace juices, tea, compote with a slice of orange, apple. If the baby persistently asks for a drink, you can distract him with something, give a small spoonful of the drink. Gradually, this diet becomes familiar to the child and does not cause difficulties in compliance.
If the baby categorically refuses to sleep during the day, do not make a stressful situation out of laying down. The kid can spend the afternoon in an armchair, listening to a familiar fairy tale or tape.
During treatment, it is important to reduce or temporarily abandon long-term television viewing and computer games, which greatly affect the child's fragile nervous system. The book in this case can replace the TV.
Before a night’s sleep, it’s a good idea to ritualize classes as much as possible, that is, in the same order every evening, perform the same actions with the child. For example, put toys away, swim, tell a fairy tale or a spontaneously invented story with sequels, follow the doctor's evening recommendations.
Jealousy for a younger brother or sister is also often the cause of enuresis in an older child. In this situation, parents need to analyze their attitude towards the elder, to reconsider, if necessary, his role in the family. A mother, even if she has a newborn in her arms, needs to pay a little more attention to the firstborn. Perhaps it is difficult for him to play the role of an older brother or sister assigned by adults. Or maybe he is not emotionally involved in the relationship between parents and the baby, which causes burning jealousy. The child wants to feel small, unique and loved again. Some parents take their enuretic child to bed with them to wake him up at night or take him to the toilet. It is strictly not recommended to do this, since the presence of adults does not allow him to develop the habit of waking up on his own at night. The baby and parents should sleep in different beds and in different rooms. This contributes to a restful sleep of the child and gradually accustoms him to control his sphincters or wake up at night with the urge to go to the toilet.
In the evening, it is better to refrain from active, energetic games so that the child does not overwork. Before going to bed, it is better to play board games, such as lotto, mosaic, dice, or a designer. They not only develop the baby, but also stabilize his nervous system.
Drawing has a beneficial effect on the psyche of the baby. The younger the child, the more interesting it is for him to draw with gouache paint with thick brushes on large sheets of paper of various shapes, white and colored. Many children like to create pictures with their fingertips or the whole palm. Parents do not always welcome such creativity, dooming kids from an early age to stamps and patterns. But if we are talking about the treatment of enuresis, it is necessary to liberate the child’s thinking as much as possible and relax his body. And in drawing with paints with fingers and the whole palm, children most fully reflect their emotional state.

The power of suggestion

It is quite affordable for parents to conduct an autogenic training aimed at relieving the child's muscular and nervous tension, at creating an atmosphere of calm and relaxation, and setting him up to relieve the problem of enuresis. Here is one of the options for conducting such a training for preschool children in a poetic and soft playful form. This game is not difficult for either parents or children. Classes should be done every night before bed. The duration of the workout varies from 15 to 30 minutes. The words of auto-training should be read to the baby in a calm, slow and quiet voice. Over time, when the child learns them by heart, he can conduct a lesson every evening on his own, without the participation of an adult. Before starting training, you need to learn with the child the name of all parts of the body. Conducting an evening lesson, an adult needs to take care of his inner mental balance. If mom or dad is overstressed or upset, then the lesson should be entrusted to someone close, since in a relaxed state, induction (transfer of an emotional state) from one person to another is very strong, and as a result, the opposite result may turn out: the baby will not only not calm down , but on the contrary, it will be overexcited. All words should be pronounced in a soft, calm voice, slowly, with long pauses, and when naming parts of the child's body, gently touch them with the palm of your hand (head, knees, feet, and so on). Separate suggestion formulas are repeated 2-3 times with a change in logical stress. With a properly performed autogenic training, the baby relaxes and can even fall asleep.

Game "Magic dream"

(autogenic training for preschool children in poetic form). Now I will read poetry, and you will close your eyes. A new game "Magic Dream" begins. You will not fall asleep for real, you will hear everything, but you will not move, but you will relax and rest. Listen carefully to the words and repeat them to yourself, in your inner speech. No need to whisper. Rest easy with your eyes closed. Attention, the "Magic Dream" is coming...
Eyelashes fall...
Eyes are closing...
We rest in peace (2 times)…
We fall asleep with a magical dream ...
Breathe easily...evenly...deeply...
Our hands rest...
Feet rest too...
Rest ... fall asleep ... (2 times) ...
The neck is not tense and ras-weak-le-on ...
Lips slightly open...
Everything is relaxing wonderfully ... (2 times) ...
Breathe easily ... evenly ... deeply ... (A long pause is made and words are spoken aimed at correcting the problem): I sleep dry today ...
Tomorrow I'll wake up dry
The day after tomorrow I'm dry
Because I'm dry...
When I feel, wake up
I will definitely wake up! - Your body is relaxed, but you know that you sleep dry... Tomorrow you will wake up dry... - If you want to go to the toilet at night, you will feel it and wake up, you will definitely wake up... - In the morning you will wake up dry. You are the master of your body and it obeys you. - Well done, you sleep dry. If you want to go to the toilet, you will wake up, you will definitely wake up and go to the toilet. Your bed is dry. You are doing great, you will succeed. "Adults should understand that the elimination of enuresis in a child is a painstaking and sometimes lengthy process, but a positive result can only be achieved with the active participation of specialists and the family. Parents require special tact and respect for their baby After all, in the end, enuresis is cured, you just need to be patient.I would like to draw special attention to parents: you should not try to independently correct the mental state of the child with any psychological games.The problem of enuresis in children is quite complex and complex, even if it is not noticeable at first glance Therefore, it is better to turn to specialists.Inept actions of parents can lead to a complication of the situation - the disease will worsen and require more time to heal.

Urinary incontinence in children at night or in the daytime- an unpleasant symptom observed as a manifestation of urinary tract disease, and in somatic and neuropsychiatric diseases.

Moreover, urinary incontinence during wakefulness and sleep with undisturbed, regular urination indicates an anomaly in the development of the urinary tract with ectopia of the mouth of the ureter outside the bladder. Daytime urinary incontinence in combination with nocturnal enuresis indicates chronic inflammation of the bladder (cystitis).

Urinary incontinence often occurs in a person due to various reasons, in this article, we will take a closer look at the causes and treatment of urinary incontinence in a child of 3, 4, 6 - 10 years old at home with folk remedies. This painful disorder brings a lot of anxiety, worries and troubles to parents and children.

Urinary incontinence in children of any age, for example, 3, 4, 6, 10 years old, is facilitated by the presence of pinworms, adenoids, inflammation of the palatine tonsils, bacterial infections of the urinary tract, phimosis, balanitis, onanism, vulvitis, etc. . diseases.

Bedwetting can be observed in overly excitable, impressionable children with lack of sleep, overwork. It is necessary to avoid provocative factors in the life of such children. In addition, you should limit the consumption of water, tea, milk before bedtime.

Treatment of bedwetting in children 3, 4, 6, 10 years old

Enuresis and related symptoms

Bedwetting (enuresis) is observed in 5-28% of children, more often in boys. Up to 3 years of life, enuresis is physiological in nature, at an older age it is considered as a pathological phenomenon.

Enuresis as an independent clinical disease can be a manifestation of neurosis (neurotic enuresis) or a neurogenic disorder associated with residual organic brain damage of infectious, traumatic, intoxication etiology (neurosis-like enuresis).

The study of the neuropsychic state of a person suffering from enuresis helps to clarify the diagnosis and determine the tactics of treatment. The etiology of urinary incontinence is established by X-ray urological and other research methods.

There is a functional form of enuresis (due to psychogenic factors, educational defects, mental trauma, infectious diseases; sometimes reflex factors that occur in diseases of the genitourinary system) and organic (changes in the spinal cord with developmental defects).

Nocturnal involuntary urination is regarded as the result of the absence or insufficiency of conditioned reflex connections that control the act of urination in sleep. Sometimes there is an increase in urges, frequent imperative urges. Vegetative symptoms are often detected - bradycardia, cyanosis of the extremities, hypothermia.

Neurotic disorders are noted - irascibility, secrecy, depression, shyness. In the organic form, a change in muscle tone, tendon reflexes, light pyramidal signs, and a violation of sensitivity are detected.

Treatment of bedwetting in children: drugs, medications, procedures

Treatment consists in the exclusion of mental trauma, the correct water-hygienic regimen is prescribed with fluid restriction in the afternoon.

Sedative, restorative and tonic agents are used (glutamic acid 2-3 months, glycerophosphate, calcium gluconate, phytin, cerebro-lecithin, arsenic, strychnine, bromine, vitamins, elenium, melipramine, securine, adiurecrine, dibazol, ephedrine). Physiotherapeutic procedures are prescribed: darsonvalization, quartz, galvanic collar according to Shcherbak, coniferous baths, wiping. Sanitation of foci of chronic infection (adenoids, tonsillitis) is of great importance.

Treatment of folk remedies for urinary incontinence in children at home

St. John's wort(flowers and grass) 40 g dried herbs with flowers per 1 liter of boiling water. Insist, wrapped, for 2-3 hours. Take without norm instead of tea and water. A glass of infusion taken at bedtime keeps the child and adult from urinating in bed (involuntary) during sleep.

Salvia officinalis. 40 g of grass per 1 liter of boiling water. Insist 1-2 hours. Take 100 to 200 ml 3 times a day.

yarrow. 10 g of herb with flowers in 1 glass of water. Boil for 10 minutes on low heat. Insist 1 hour, strain. Take 1/2 cup 3 times a day.

dill(seeds). 1 st. l. dill seeds to 1 cup boiling water. Insist 2-3 hours, strain. Drink the whole glass in 1 dose 1 time per day. It is believed that infusion can cure urinary incontinence in people of any age for a short time. There were cases of complete recovery.

Common lingonberry:

1) 2 tbsp. l. brew a mixture of leaves and berries with 2 cups of boiling water and boil for 10 minutes over low heat, cool, strain. Half drink during the day in several doses, the second - drink before bedtime.

2) 2 tbsp. l. mixture (leaves and berries) and 2 tbsp. l. St. John's wort brew 3 cups boiling water, boil for 10 minutes over low heat, cool, strain. Drink the broth in sips, starting at 4 o'clock in the afternoon and ending with going to bed.

Yarrow: 2 tsp brew herbs with 1 cup boiling water, leave for 1 hour, strain. Drink 1/4 cup 4 times a day.

blueberry eating fresh berries.

Rose hip. Crushed fruits - 4 tbsp. l., bone berries - 1 tbsp. l., boil in 1 liter of water for 30 minutes over low heat. Before removing from heat, add 2 full tablespoons of rose hips. Let it boil slightly. Remove from fire, strain. Take cold 1 glass 2 times a day.

by the most a reliable means from urinary incontinence was considered a mixture of 2 herbs: Hypericum and centaury. They must be taken in the same amount (1: 1), brewed and drunk like tea, 1 tsp. appointment.

With frequent urge to urinate, celery, watermelons, very ripe grapes and asparagus should be excluded from the diet until the bladder complications are completely gone.

Kinds

Depending on the time of formation of the "watchdog" 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 resolves on its own without therapy.
Secondary. The child has already learned to control the bladder in the past and has had a dry bed for more than 6 months.

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 reaction of the child to the problem, the following types are distinguished:

Neurotic. This form of incontinence is typical for a shy and very shy child with shallow sleep. The baby is very worried about failures at night, which leads to sleep disturbance.
neurosis-like. This form of enuresis occurs in children with hysterical behavior. The 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. At the same time, about 10% of children who are 6 years old have not mastered such control. Over time, the problem becomes rarer. By the age of 10, incontinence at night is noted in 5% of children, and by the age of 18 - only 1%. Boys are twice as likely to have the problem.

The reasons

Boys

Incontinence is more common in boys. It is driven by the following factors:

Birth injury, affecting the spinal cord or brain.
Prolonged formation of a conditioned reflex. In some boys, the development of such a reflex occurs later than in peers.
stressful situations. Enuresis can occur as a result of severe fright, constant quarrels of parents, school changes, moving and similar factors that have greatly influenced the psyche of the child.
Heredity. If incontinence was noted 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 such a 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.
Prolonged use of diapers. The child gets used to the fact that after urination the bed is not cold and not wet.
Hormonal disorders. With insufficient production of hormones that affect the functioning of the bladder, the volume of urine released and its concentration, the child develops incontinence.
Hyper-care. It is often observed in an incomplete family, when the boy is brought up by his grandmother or mother. Due to too much custody, the child subconsciously behaves like a baby, because he has a feeling that he is small.
Hyperactivity. When a child is highly excitable, the activity of the processes in the brain prevails over the signals of the bladder. And the brain simply does not “hear” the urge to urinate at night.
Lack of parental attention With such a deficit, 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 with bronchial asthma, episodes of enuresis are a fairly common problem.

Girls

Due to the peculiarities of the nervous system, girls learn to control the functioning of the bladder faster and start going to the potty earlier, so the problem of enuresis occurs much less often, and if it does occur, 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 reflexes later than their peers.
As a result of stress or psychological trauma. The girl may be affected by the divorce of her parents, the appearance of a second child in the family, a change of residence, a transfer to a new kindergarten, and similar factors.
With very deep sleep. It can be a sign of either congenital features of the girl's nervous system, or overwork.
If the 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 the production of urine at night. Lack of this hormone can be transmitted 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 girl's risk of enuresis rises to 75%.
With injuries of the spinal cord and spine. They disrupt the pathways for impulses from the brain, as a result of which they do not reach the bladder.
If there is a delay in development. When a girl lags behind, 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.

Teenagers

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

The main reasons due to which incontinence in a teenager is possible are:

Stress. The child may overly perceive the tense situation at school or family, suffer from physical punishment, conflicts with peers, moving, loss of a loved one and other stressful situations.
Mental illness. Neuroses and depressive states can lead to incontinence, which is further aggravated by feelings and adolescent complexes.
Congenital pathologies. They can be both in the nervous system and in the organs of the urinary system.
hereditary tendency. As at a younger age, enuresis in adolescents may be due to such a problem in his parents.
Injuries. They can lead to a violation of the urination reflex.
Hormonal reorganization. Hormone levels change during puberty, so there may be a failure in the production of hormones that affect urination.

Psychological problems

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

The child feels inferior, closes, seeks to avoid contact with other children, seeks solitude. This can leave an imprint on the character - in children with incontinence there is anger, indecision, aggressiveness, insecurity, which are carried over into adulthood.

Especially often, such changes occur when the child is ridiculed by parents, if the baby 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.

Diagnostics

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

Treatment

There are quite a few ways to eliminate incontinence, but the effectiveness of their impact 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 detecting inflammatory and infectious processes, antibiotics are prescribed.
If the development of the nervous system is delayed, the child may be prescribed nootropics.
With violations of 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

This is a very effective technique for dealing with incontinence, which consists in using a special alarm clock. A sensor is connected to it, which is placed in the child's panties. At the first droplets of urine that hit the sensor, it is also triggered by sending 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.

Other Methods

Physiotherapy is recommended to improve the functioning of the bladder and nervous system. The child can be prescribed magnetotherapy, electrophoresis, therapeutic shower, acupuncture, electrosleep, a course of therapeutic baths and other methods of physiotherapy. Remedial gymnastics and massage are also recommended.

Note the effect and application of psychotherapy. The psychologist will teach the child to relax and use the technique of self-hypnosis. Keeping a diary helps many people, in which dry nights are designated by suns, and for a certain number of such suns in a row, the child is rewarded.

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 adequate intake of vitamins in the children's diet.

Folk recipes

One of the excellent means to treat enuresis is popularly considered honey. It is advised to eat it before going to 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 stalks. After insisting 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 in 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. Drink this remedy should be before meals for 14 days twice a day.
Infusion of centaury and St. John's wort. Each plant in a dry crushed form is taken in half a glass and brewed with 500 ml of boiling water. After insisting 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. Drink this tea twice a day.
Tea from dried berries and leaves of cranberries and dried St. John's wort. Plants are taken in a ratio of 1 to 1, 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 dinner).
Balls of crushed egg shells and honey. The components are mixed 1 to 1, make balls with a diameter of 2 centimeters and give the child 4 pieces daily for a month.

At the same time, do not forget that the use of any folk recipe should be discussed with a doctor before trying out its effect on a problem.

Try to protect the child from various stressful situations.
Let the child go to bed at the same time every day, and 3 hours before that, the volume of fluid should be sharply limited.
Avoid active games right before bed. At this time, you can read, draw, watch scary cartoons together.
To reduce pressure on the bladder, you can place a cushion under the baby's mattress in the baby's pelvis or under the baby's knees.
Make sure that the child does not have hypothermia. As soon as the baby's legs freeze, the bladder will fill reflexively.
The child must certainly go to urinate before going to bed. If you wake your child up at night to urinate, do not allow him to doze off 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.
Noticing a wet sheet in the morning, do not swear or be upset in front of the 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 with time.
Any method of treatment will give an effect if you inspire the child with confidence that he will succeed.

Urinary incontinence is a completely natural situation for a small child. All systems of a growing organism continue to develop and form their main functions and are not yet able to cope with all of them.
One of these functions is the control of urination. The baby's bladder is small and weak at first. Signals from the nerve endings in the urinary system to the brain are also weak. But gradually the child grows, the bladder increases, its walls become stronger, it can already hold more fluid for a longer period of time, etc.
By the age of three, most children are already potty trained, although they still cannot do without nightly “incidents”. Even later - by the age of four - the baby almost knows how to control the bladder, goes to the potty on his own, warns his mother in time, and there are fewer and fewer cases of wet sheets.
As a rule, by the age of five, children completely get rid of incontinence.
However, it also happens that the baby "outgrows" the five-year threshold, but the incontinence remains. In this case, we speak of enuresis. Enuresis is called bedwetting in children 5 years of age and older. Of course, these should not be one-time situations of incontinence, but regular episodes of uncontrolled urination during sleep.
The causes of enuresis can be different. Among the most common are an underdeveloped bladder, psychological trauma (severe fear, etc.), lack of the hormone vasopressin, which reduces the production of urine in the body at night.
Only a specialist can find out the reason why a child of 5 years old urinates in the bed at night. To make a correct diagnosis, he needs to collect an anamnesis, conduct tests, hardware diagnostics, and even schedule a consultation with a child psychologist.

What to do if a 5-year-old child urinates at night?
If a 5-year-old child has enuresis, parents and the doctor should become one team that will physically and mentally help the baby overcome the illness.
The disease itself is not dangerous, but it significantly impairs the quality of life. Senior preschool age is a time of big changes for the baby. At this age, children usually already go to preparatory courses for school, study in sections and circles, go to camp. Enuresis limits the child's leisure and opportunities and makes life difficult for parents. They cannot leave him to spend the night with relatives or send him to the same summer camp. Therefore, timely treatment of enuresis is vital.
How to treat enuresis in children 5 years old?
To begin with, take to a pediatric urologist who will conduct an examination and find out the cause. Depending on it, the doctor will select the appropriate medication, physiological procedures, therapeutic massage and gymnastics, if necessary.
Parents should monitor the baby's nutrition - diuretic, spicy, smoked should be excluded from the diet. Let your child drink water in the morning. In the second, the amount of fluid consumed should be reduced, and a couple of hours before bedtime, the child should not drink at all.

The family must maintain a friendly atmosphere. No matter how tired mom is from nighttime awakenings and wet sheets, her annoyed look will only hurt the baby, who already feels guilty. It is necessary to instill in the child that enuresis is a disease, and not its shameful feature.

It is necessary to develop in the child the habit of controlling urges. You can buy an enuresis alarm clock for him, which awakens the baby with soft vibration at the very first drops of moisture - the alarm sensor reacts to them. It is better to put the pot near the bed, leaving a subdued light so that the baby is not afraid to get out of bed.

It is necessary to monitor the child's drinking regimen and keep a schedule of "dry" and "wet" nights - this will greatly facilitate the work of the doctor and help him understand the nature of the course of the disease.
Today, young mothers have the opportunity not to keep a diary manually, but to use the special application for smartphones "Dry Nights - Happy Days". A cloud in the application means a “wet” night, and the sun means “dry”. The application also helps to calculate the rate of excreted fluid in the child's body and calculate its ratio with the proportions of the bladder.

Urinary incontinence in a child of 5 years during the day and fecal incontinence, which mothers often ask about, are not related to enuresis. These diseases should be studied and treated separately. The attentive attitude of parents to the health of the child will prevent the development of other diseases in time.

The child does not feel the urge to urinate. Urinary incontinence in children - causes and treatment of enuresis in a child. Drug treatments for enuresis in children

Types of enuresis

Causes and mechanism of development

Symptoms

Diagnostic principles

Treatment tactics

Psychotherapy

Medical treatment

Physiotherapy

Conclusion

Reasons for the development of enuresis

Necessary examinations

Treatment

Illness and character

Forms and causes of the disease

What adults can do

The power of suggestion

Game "Magic dream"

Treatment of bedwetting in children 3, 4, 6, 10 years old

Enuresis and related symptoms

Treatment of bedwetting in children: drugs, medications, procedures

Treatment of folk remedies for urinary incontinence in children at home

Related videos

What should not be done if the child has enuresis: Dr. Komarovsky

When and how to treat enuresis: Dr. E. O. Komarovsky

Elena Malysheva: bedwetting in children

Causes of bedwetting in children

What to do

How parents should behave

How to deal with urinary incontinence in children

Kinds

At what age is this normal?

The reasons

Boys

Girls

Teenagers

Psychological problems

Diagnostics

Treatment

medicines

urinary alarm

Other Methods

Folk recipes