Enuresis diagnosis is made by adults and children over 5 years if they are faced with the problem of involuntary urination more than twice a month. This disease in children often occurs independently and does not affect their health. But enuresis seriously influences the child's self -esteem and his relationship with parents and peers, so they recommend the treatment of urine incontinence for 6 to 7 years.
What is enuresis?
Enuresis are the repeated episodes of urinary incontinence that occur 3 months or longer at least twice a month. In most cases, involuntary urination occurs at night. The examination of this problem has been involved in doctors since the time of the old Persian scientist Avicenna, and for the first time the term "enuresis" was introduced to medical practice at the end of the 18th century. Since then it has been possible to find very effective methods of treating the disease, but the mechanism of the occurrence has not yet been completely examined.
In most cases, children suffer from consumption, and in most cases the disease is in most cases.
Enuresis is more common in boys than girls
Experts recommend not ignoring this sensitive problem at a young age, since the child can develop diseases of the genitarian system due to the incontinence of urine and cause mental problems.
Studies have shown that in children with an enuresis in 70% of the cases that have been increased that has difficulty communicating with peers and dealing with conflicts in the family because they cannot control. The New Zealand judicial psychiatrist John Makdonald included enuresis together with zoosadism (brutal handling of animals) and Piruinia (passion for arson) in the "behavioral triad", which indicates cruel crimes. The formation of personality is not influenced by the episodes of Enorez, but a trauma associated with the mock and punishment of parents, friends, brothers and sisters.
At the age of 5, enuresis appears in 15–20%of children at the age of 7 to 12%and in 10 - in 5%. The disease is also found in 1-2% of young people and 0, 5–1% of adults.
In adults, enuresis usually develops after 45 years, women suffer three times more often from them than men. At this age, episodes of enuresis are usually symptoms of diseases of nervous and genitator system - and spontaneous healing as in children do not occur.
Causes of Enorez
Usually the urine process occurs as follows. The urine through the ureter moves from the kidneys to the bladder, but does not run out: the muscle ring (sphincter) is held with the bladder instead of the urethra. Gradually it collects on the walls of the bladder and annoys the receptors that transfer a signal about the need to urinate to the centers of the brain. The brain returns a signal that you can relax the sphincter of the urethra. Usually, a person with persistent calling up urine in sleep and can endure intentionally for some time.
In children under the age of 4, the control centers through urination in the brain are not finally formed, so that they cannot always control this process. "Wet Nights" up to 4 to 5 years are not considered a deviation from the norm. But after 5 years, Enuresis shows a malfunction in one of the stamina.
Causes of enuresis in children:
- The slow development of urine centers in the brain and other diseases of the central nervous system (central nervous system). In most cases, this is an individual feature of the body and when the central nervous system develops, the Enorez problem goes by itself. The risk of developing the disease for this reason is in children who during pregnancy and birth of toxicosis is the mother of toxicosis, in the umbilical cord, inappropriate display, etc. If they had an oxygen hunger (even insignificant).
- Polyuria is an excessive urine secretion. It can occur because the child drinks a lot of liquid at night or due to hormonal disorders. This includes diabetes mellitus, excessive activity of parathyroid glands (hyperparathyroidism), reduced production of a vasopressin hormone that regulates the sound of the muscles of the inner organs and controls the volume of urine. At night it is usually synthesized more active so that the urine forms less;
- Diseases of the genitarian. The inflammation of the urethra and the bladder, neoplasms, which the narrowing of the urethral canal, for example due to the growth of the connective tissue, can also lead to enuresis.
- Stress. Loss of a relative, move, to kindergarten often leads to a night continence to urine;
- A strong dream whose children do not wake up with urination.
Due to Enorez, the child often becomes the subject of ridiculousness. This significantly reduces self -esteem and leads to psychological problems
Causes of enuresis among young people and adults:
- Hormonal diseases: diabetes, hyperparathyroidism, reduction in vasopress;
- Inflammatory diseases of the genitator system: pyelonephritis, urethritis, cystitis, prostatitis, orchitis (egg inflammation);
- Regular alcohol abuse;
- Trauma of the spine, spinal cord;
- Congenital anatomical anomalies (for example too small bladder) or a weakening of the pelvic floor muscles;
- Stress.
Most of the time, enuresis develops under the influence of several factors at the same time, and in some cases it is not possible to distinguish the main cause of incontinence at all.
Enorez classification
Enuresis is primarily divided when the problem has been preceded for the first time and complete control over the urination and a secondary period for six months or more, a controlled "dry" period was preceded.
In the clinical recommendations of the Ministry of Health in our country, the disease is defined as a night continent of urine that occurs during sleep. But in medical practice it is sometimes divided and mixed on night, day. The complicated and uncomplicated enuresis is also differentiated: in the first case, the syndrome is not associated with other diseases, in the second it is associated with pathologies of the central nervous system, infections and other problems with the urine system.
Symptoms of Enorez
The main sign of enuresis is the inability to control urination in night sleep. Rare - during the day. An unusual emptying of the bladder cannot occur not every night, but regularly. Enuresis is diagnosed if this happens two or several times a month for 3 months.
With an enure, a person can often urinate during the day, face involuntary leaks of the harshness, occur incorrect urination or, conversely, have the feeling that the bladder is not fully exhausted after visiting the toilet.
Children and adolescents with enuresis can be closed and irritated to sleep worse at night and reduce performance at school.
Which doctor treats enuresis
Enuresis cause a variety of reasons, so a large number of specialists are involved in diagnosis and treatment. Adult patients are recommended to contact therapists and urologists. If the child's enuresis are available, it is necessary to obtain the pediatrician who carries out an inspection and recommends narrow specialists. This can be a urologist, gynecologist, nephrologist, neurologist, psychotherapist, endocrinologist. General practitioners and close specialists collect a family history, listen to the patient's symptoms and examine. The diagnosis of enuresis is usually based on a clinical image, and tests and instrumental studies are prescribed to clarify the causes.
Laboratory diagnostics by Enorez
The evaluation of the general condition of the body and to identify the inflammation of the genitator system is supported by a general urine analysis and urine analysis by Nechiporenko.
In some cases, an analysis is prescribed to determine the degree of vasopressin (anti -diuretic hormone). It controls the water level in the body and influences the intensity of urination.
Instrumental diagnosis of enuresis
With an enure, the doctor can prescribe an ultrasound of the bladder. This study can be replaced by magnetic resonance or computer tomography of the bladder and other urine system organs.
Ultrasound helps to evaluate the work of the bubble and find out how much urine remains after urination
If the results of ultrasound are not sufficient to determine the cause of the enuresis and prescribe the treatment, the patient is aimed at a cystographic examination. For this process, a catheter is inserted into the bladder and fills the organ with a contrasting medication or oxygen, according to which you take photos of filled and gelerer bladder.
Evaluate the speed and volume of urine flow during urination enables Uroflowetry method. During the study, the patient urinates the funnel recipient of the Urofloumeter apparatus. This study gives you information about the speed of urine flow and fluid volume, select indicators (markers) from deviations from the standard. This data is entered in the operating system with regard to the processed sensor and the results are shown in graphic form on the computer monitor. The doctor withdraws the results.
If the patient has had injuries in the past or the doctor suspects anomalies of the structure of the lumbosacral department, which can also provoke enuresis, X -rays can prescribe this spine.
In children and adolescents, enuresis often does not develop due to injuries or infections, but on the basis of the late development of the central nervous system and stress. In this case, you are recommended by examining a neurologist and psychotherapist.
Enorez treatment
In adults and adolescents, enuresis is most often a symptom of infections, endocrine illnesses or injuries. Therefore, it is initially necessary to identify this pathology as early as possible and to start treatment.
Commitment to children is treated by correcting behavior (motivation therapy), medication, physiotherapy, psychotherapy or combinations of these methods.
Drug treatment
If the main cause of enuresis is violations of the nervous system, medication that helps to normalize their work can be prescribed to the child. These are vitamins of group B, nootrope medication, glutamic acid and glycine. Antiuretetic drugs are also prescribed and in some cases tricyclic antidepressants. However, the latter are used less frequently because they have a more pronounced side effect.
Medicines are prescribed separately or as part of the complex therapy that normalize the work of the muscle cover of the bladder - detruzor. If enuresis are associated with infectious disease, you can prescribe a course of antibiotics.
Physiotherapy
Processes are prescribed as an independent type of treatment or in combination with medication. Paraffin applications on the lower abdomen and back in the area of the lumbosacral department, physiotherapy exercises, electrophoresis, magnetotherapy have a good effect.
For a comprehensive treatment of enuresis, gymnastics and physiotherapy, are used
psychotherapy
In cases where enuresis have developed as a result of stress or neurotic disorder, a psychotherapist prescribes treatment. When a child suffers with an enure, a good effect is given by family psychotherapy meetings and sedatives that are suitable for a small patient according to age. But it is all the more important to create a cheap atmosphere for him at home to show that adults will help him to cope with this problem on his side. Under no circumstances should you scold and shake the child: it is least the fault of his illness. Pressure and aggression mean that the symptoms do not disappear, but increase. In adolescents and adults, enuresis can also be caused by psychological causes, and in this case you can recommend individual therapy.
Experts do not recommend using diapers with an enure that hide the unpleasant sensations and compensate for the problem - it is better to protect the bed with adhesive or disposable diaper. There are special devices - reinforced alarm clocks that are attached to pajamas or underwear and react to the first dropped drops of urine with a sound signal. This gradually gets used to a person to react to the urge to the body and to wake up in good time to go to the toilet.
Compliance with the day of the day and regular visits to the toilet play an equally important role. Before going to bed, it is better to go to the toilet twice: until evening hygiene methods (washing, brushing, showering) and after them. During the day you have to drink enough water, but an hour or two before going to bed, it is worth limiting the use of liquids and products that are irritating to the bladder, primarily citrus fruits and juices. Young people and adults also have to give up alcohol, tea, coffee, energy and other drinks that contain caffeine.
Prognosis and prevention
Summer treatment, compliance with the recommendations of the doctor, the daily routine and above all the adequate and benevolent reaction of parents and other relatives provide good results and enable you to completely get rid of the problem of involuntary night ling.
It is impossible to prevent enuresis, but the risk of its development is reduced when the expected mother carefully monitors her health during pregnancy: refuses bad habits, leads to a healthy lifestyle, observes the daily routine and follows the doctor's recommendations to avoid complications during pregnancy and birth.
If the child has already come across the problem of Enorez, the cheap environment in the family and children's team will help prevent his repetition. It is worthwhile to make every effort to avoid stressful situations that can cause the disease to relapse. Adults are recommended to carefully monitor their health and to identify and treat infections of the genitarian system during the time and to use condoms during sex to avoid sexual transmission of infections.
Frequent questions
What is enuresis?
Enuresis is involuntary urination in adults and children over 5 years, which occurs more often in sleep twice a month. This disease in children often occurs independently and does not affect their health. But enuresis seriously influences the child's self -esteem and his relationship with parents and colleagues, so that many experts recommend the treatment of urine incontinence of 6 to 7 years.
Why was an adult described in a dream at night?
Night -urincontinence can cause infections of the genitarian, hormonal mistakes, trauma of the spine and spinal cord, the weakening of the pelvic floor muscles and even serious experiences. This can also happen if a person is in alcohol or anesthetic poisoning. If involuntary urination occurs regularly at night, you must consult a doctor who can determine the cause of this sensitive problem and prescribe treatment.
How can you get rid of enorez?
The cause of enuresis can be infectious diseases, stress and hormonal malfunctions. In children, urine's nighttain continent is often associated with the characteristics of the development of the central nervous system. The treatment is prescribed depending on what exactly caused a night continent from urine. Mostly combine medication (synthetic hormones, sedatives, tricyclic antidepressants) and physiotherapy methods - electrophoresis, gymnastics, magnetic and laser therapy. If enuresis is associated with a neurotic disorder or chronic stress, it is recommended to seek help from a therapist.
Which doctor treats enuresis?
Enuresis cause a variety of reasons, so a large number of specialists are involved in diagnosis and treatment. Adult patients are recommended to contact therapists and urologists. If the child's enuresis are available, it is necessary to obtain the pediatrician who carries out an inspection and recommends narrow specialists. This can be a urologist, gynecologist, nephrologist, neurologist, psychotherapist, endocrinologist.