Incontinence in a child, treatment of enuresis inchildren

Update: October 2018

Под энурезом у children понимают комплекс симптомов, основным
manifestation of which becomes involuntary urination during
time to sleep. The disease is based on many reasons.

The main defect that leads to such violations is
abnormalities in the innervation of the bladder and cortical insufficiency
control the process of urination. In the physiological process
regulation of urination, there are two mechanisms: involuntary and
arbitrary.

The first is due to the fact that the obturator muscle of the bladder
relaxes whenever the bladder stretches
a certain amount of urine. This is a reflex that manifests itself in response to
stimulation of receptors embedded in the mucous membrane of the bladder and
reacting to mechanical stretching. Second locking mechanism
controlled by the brain and allows you to urinate only in
cases where it is permissible or convenient, refraining from
involuntary urination. This mechanism is formed in the child.
in the period from one to four, as the myelin nerve matures
fibers, which are nerve impulses.

Fully this mechanism is formed by four years. Therefore, before
this age, the child urinating involuntarily, the diagnosis of enuresis is not
is exposed. Enuresis treatment можно начинать с 4- 5 лет, но и в 7
years of doing it is not too late.

Causes of enuresis in a child

Наследственный фактор — Около двадцати процентов children,
suffered from enuresis, were born from parents who had in childhood
similar problem. Probably not the disease itself is inherited, but
features of metabolism in neurocytes of certain sections of the trunk and
hypothalamus, tissue susceptibility to certain neurotransmitters
(serotonin and vasopressin) or the speed of myelination of nerve
fibers, with the delay of which the conditional watchdog is later formed
mechanism of urination.

Pathological course of pregnancy and childbirth – Barrel damage
brain, giptplamy and nerve paths due to oxygen
fasting nevrvnoy system:

  • intrauterine – gestosis, feto-placental insufficiency,
    IUGR and intrauterine infection in the fetus, diabetes mellitus and
    mother hypertension
  • in childbirth – hypoxia, entanglement with umbilical cord, premature detachment
    placenta, long anhydrous period, birth trauma to the fetus

All this leads to postnatal encephalopathy,
characterized by certain motor delays and
disintegrative processes in the brain affected in
the result of a lack of oxygen. Indirect confirmation of this
fact becomes a big commitment to the enurese of boys whose
adaptive capacity in the period of prenatal and early
Infant periods are lower than girls. Maximum
CNS injuries are accompanied by severe birth trauma in the form of
brain contusions, hemorrhages and cerebral
paralysis.

Infectious Diseases – Various Brain Damage
during infancy and early childhood infections: Incontinence in a child, treatment of enuresis in children

  • meningococcal meningitis
  • staphylococcal sepsis
  • viral encephalitis and meningitis
  • swelling of the brain as a result of toxic shock of different
    of origin
  • severe dehydration due to intestinal infections

Also somatic diseases with violation of the central nervous system
oxygen:

  • pulmonary – bronchiectasis, severe bronchial
    астма, отек легкого разного of origin, частые пневмонии,
    pulmonary tuberculosis
  • heart – congenital and acquired defects, myocarditis and
    endocarditis, accompanied by circulatory failure
  • Endocrine pathologies – diabetes, diencephalic syndrome,
    hyperthyroidism

Neurological pathologies – Intracranial hypertension (see
increased intracranial pressure in a child), pyramidal
disorders, epilepsy is an incomplete list of neurological problems,
which can be combined with enuresis.

Psychiatric Diseases – Against the backdrop of a general underdevelopment of higher
cortical functions (oligophrenia, imbecility or debility)
the child may be incontinent. Also frustration
associated with chronic intoxication on the background of addiction,
alcoholism can cause violations in arbitrariness
urination.

Psychological problems – They can rather be attributed to different
kind of neuroses associated with external permanent psychotraumatic
factors:

  • unhealthy family or childcare setting
  • problems with peers or loved ones
  • experienced traumatic situations – accidents, injuries,
    crimes can also be a triggering mechanism for children
    enuresis

Urological Pathologies – Urological are a separate item
problems that can cause urinary incontinence. Modified
inflammation of the bladder mucosa may stop adequately
respond to stretching its walls. Smaller than before volume
urine may cause urination to urinate. Causes of incontinence
urine in children становятся нейрогенный мочевой пузырь и клапанные
malformations of the urethra. For today, urological causes by the majority
professionals are not regarded, as enuresis in its purest form.

The main pathological processes in enuresis

  • Dysfunctions in the area of ​​the brain bridge where anatomically
    the areas responsible for awakening and
    urination.
  • Dysfunction of the hypothalamus, producing vasopressin, with
    by the bridge.
  • Violation of the innervation of the bladder, including
    uncoordinated contractions of the muscles of the bladder.
  • Disorders in the production of serotonin, histamine, prostaglucin,
    affecting the bladder. This should also include a low level
    vasopressin at night that results in a lot of
    urine produced at night.
  • Neurosis.

Incontinence mechanisms

When enuresis, in addition to impaired reflex formation,
blocking involuntary urination, there are a number of processes
which explains the origin of the problem.

  • Sleep phase disorder

Lengthening deep sleep, prevents the launch of cortical
“Watchdog” at times when the bladder
urine stretches so much that the obturator relaxes
muscle. Также у children, как правило, нарушено засыпание и
awakening. There may be a phenomenon of sleepwalking (walking and
talk in a dream). Характерен энурез у children с храпом и эпизодами
sleep apnea (stops breathing). This is due to the fact that the phases
REM sleep and compensatory awakening occur in response to
choking, not filling the bladder. Also when raising
intrathoracic pressure is filled with blood the right atrium and
the release of sodium diuretic hormone increases,
diuresis.

  • Changes in motor activity during the daytime

The child can play so much that he will forget to turn to
the pot. This phenomenon is similar to the moments of trance, that is,
retardation that occurs in the brain during the daytime
wakefulness and related to his overworking monotonous
irritants – sounds, bright colors flickering
pictures.

  • Emotional-volitional violation

Various metabolic disorders in neurocytes, in relations between
they lead to the fact that the child with enuresis, as a rule,
more anxious, tearful, emotionally labile compared to
healthy peers. It is rather related states. That
there is, enuresis is not a consequence of emotional disturbances
manifestations, and along with them develops as a result of cortical
violations.

  • Inadequate treatment of such a problem.

The child is not able to independently affect the development
events. It is useless to scold or call for more
attention to the problem.

  • Spontaneous healing

It is noted that in the majority of patients enuresis is
without any treatment with medication or
psychotherapeutic techniques. Most likely, this is due to
high adaptive ability of the children’s nervous system. Even with
significant damage to the cortex adjacent areas are able to take on
themselves the role of damaged or dead neurons. By the way
объясняются и различные результаты реабилитации children и взрослых
after cerebral hemorrhage. Child who suffered damage in
age up to one year, fully restored by motor and
mental activity where an adult gets severe
disability.

Types of enuresis

  • Ночной энурез у children – классика жанра

The child, falling asleep, ceases to control himself and wakes up
described. Boys suffer from this form of the disease more often than
girls. There is a permanent form of the disease (the patient urinates
in a dream constantly), and intermittent (some nights the child remains
dry).

Sometimes a child responds with enuresis only in cases where
during the daytime, certain stressful factors (his
punished, offended, his parents argued with him) or
certain physical and emotional overload during the day
(I went to bed late, I ran a lot). Enuresis without daytime manifestations is called
night monosymptomatic.

  • Дневной энурез у children

It is the result of spontaneous inhibition of the cerebral cortex.
brain during waking day. Girls and boys suffer
this disorder is equally common. He is more prone to easily
tired and emotionally depleted children, as well as patients with
concomitant urological pathology.

On the one hand, a child with a weak volitional sphere, quickly
tired of the monotonous activity, loses arbitrary
control of urination. At this time in the bark
creates a focus of excitement, overwhelming all other departments. Not
trance mechanisms, that is, short-term outages, are also excluded.
hotel parts of the bark with fatigue or monotony
irritants.

On the other hand, in a shorter period of time, urinary
the bubble fills with the volume of fluid that runs
involuntary urination mechanism. That is, to daytime enuresis
more often lead to neurological or anatomical problems.

  • A mixed form of enuresis involves a combination of night episodes.
    and daytime incontinence. This form of pathology often suffer
    girls.

There are also primary and secondary (after six months of dry
nights) enuresis.

A modern view on the problem of incontinence urine in children

Faced with the fact that all treatments for nocturnal enuresis have
children may not be effective, some experts suggest
refuse his treatment, focusing on eliminating the main
somatic or mental disorders of the child, against which
there is enuresis.

Expectant tactics are practiced with nocturnal enuresis. She is
based on the hope of independent maturation of cortical structures
and myelination of nerve fibers that are likely to linger in
children with enuresis.

A large percentage of authors today agree that
involuntary urination is one of the compensatory mechanisms,
helping your baby to adjust the phases of sleep and wakefulness. From that
the moment these phases become constant, the need for enuresis
disappears.

Enuresis and the army

Patients with enuresis in the army to serve do not take. Neither urgent
service, or under contract. So, depending on preferences,
you must either carefully collect the medical records for this
problem from a very early age child without giving up
medical examination and hospitalization, or do nothing else,
How to cure enuresis in a child and start observation in a new clinic
with a “clean” outpatient card.

Enuresis treatment

Before treating children with enuresis, they should be examined in
urologist and neuropathologist. The first will prescribe urine and blood tests, when
of necessity – cystoscopy and intradual urography, as well as ultrasound
pelvic organs and kidneys. Neurologist will recommend
electroencephalography and psychological level testing
self-assessments (the results of which indirectly indicate the relevance
initiation of therapy).

Children who have reduced self-esteem and are aware of enuresis as
a problem that must pass in addition to the drug,
psychotherapeutic treatment. Дневное недержание urine in children
Inorganic origin is treated only by psychotherapy.
The low efficacy of therapy in children who are not aware of their
defect. If they have only monosymptomatic nocturnal enuresis
therapy is not carried out.

Starting treatment of nocturnal enuresis with the “alarm control” system, then
there is a forced wake up at night. Under all conditions and
high interest of family and child, success of treatment
enuresis in children ranges from fifty to eighty
percent.

There are several conditions that must be met:

  • It is important that the parent sleeps in the same room with the child and helps
    he get up on an alarm bell.
  • The application of the technique should be continuous, with medical
    control and assistance in solving technical problems (consultation
    possible by phone).
  • If after six to eight weeks effect is achieved, the therapy
    continue up to two weeks of dry nights. If there is no effect, then therapy
    is terminated.

Drug treatment is carried out using Desmopressina in
spray in the nose or sublingual forms. Dosages are selected by a doctor.
(from 5 to 30 mcg / day). Usually the drug is prescribed at night.
недержании urine in children перед сном. With inefficiency over
two weeks, the drug is canceled.

Prescribe anticholergics for urinary incontinence in
baby on the background of a neurogenic bladder. This drugs Driptan
and spasmex.

Antidepressants such as Impramine or
Amitriptyline. With a combination of enuresis with neurosis and anxiety
Dosulepin is shown.

Nootropics are today recognized as drugs with unproven
action, however, in practical neurology when enuresis is prescribed
Picamilon, Pantogam and Pantokalcin.

Folk treatment of enuresis

Лучшим народным лечением недержания urine in children становятся
creating a child of a normal psycho-emotional environment and
forced wake-ups for night urination.

You can also recognize the appropriate use of a diet with
limiting fluid at bedtime and reducing consumption
products with diuretic effect (watermelons, melons, celery,
parsley, zucchini, cucumber), which is peculiar
prevention of enuresis in children.

The use of various decoctions and infusions of herbs and rhizomes
with a sedative effect does not give effect, since the same valerian
in children can lead to a decrease in heart rate, more
rare breathing and potentiation of enuresis is similar to night sleep apnea.

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