Bedwetting in children 10 years old. Daytime enuresis in children: causes and treatment of incontinence

Childhood enuresis causes and treatment

In most cases, the child learns to use the potty independently by the end of the fourth year of his life. Diapers become unnecessary and the child’s parents breathe a sigh of relief. However, sometimes the situation changes and suddenly the child stops going to the potty on his own, wakes up wet and starts peeing in his pants. The child's parents are shocked and perplexed, not understanding what is happening.

There are daytime and nighttime forms of childhood urinary incontinence. Nocturnal enuresis is involuntary urination in a child over the age of five. Its cause most often occurs in organic lesions of the child’s central nervous system during the period of its intrauterine development. Also, the cause may be hidden in a neuroinfection that the child suffered and affected his ability to involuntarily hold urine at night.

Daytime urinary incontinence in a child occurs due to the influence of various factors of a psychological nature. Enuresis in such cases is the body's reaction to a stressful situation. If the situation is removed from the child’s subconscious, enuresis will disappear by itself.

Home treatment for enuresis in children

When carrying out home treatment of enuresis in a child, first of all, his general emotional state should be stabilized. Timely elimination of a traumatic situation for a child can in itself have a beneficial effect on the child and lead to a cure for the disease. You should discuss such a sensitive topic with your child as tactfully as possible, avoiding talking about it in the presence of strangers.

Medicines for childhood enuresis

Glycine, Piracetam, and Pantogam have good nootropic effects. They help facilitate the smooth flow of metabolic processes in the cells of the nervous system, which helps ensure healthy sleep. Valerian tincture, Novopassit, Persen have a high-quality sedative effect. These drugs are recommended for a child to take if there is a need to treat enuresis, due to their sedative effect. Tranquilizers such as Nitrazepam and Diazepam are good at returning sleep to normal and stabilizing the general emotional state. If it is definitely established that enuresis is due to an infectious disease, the child is prescribed a course of treatment with antibiotics.

It is recommended to use Driptan in cases where the cause of enuresis is a violation of the nervous regulation of the bladder. Especially if at the same time there is a predominance of muscle tone of its smooth muscles, which is why the volume of the bladder is reduced. Taking the drug helps to increase the volume of the bladder, and the spasm is relieved, the muscles begin to contract much less frequently.

Treatment of childhood nocturnal enuresis with homeopathy

Treatment of enuresis in a child with homeopathy shows excellent results and should be used primarily due to the absence of contraindications for use. If the cause of enuresis in a child is psychological or physical trauma, it is recommended to take Arnica to treat it. If enuresis appears due to severe fear or sudden fright of the child, it is recommended to prescribe Stramonium, Aconite or Opium for him to use. All of these products are available in free pharmacies and do not require a special medical prescription to purchase them. The selection of a homeopathic remedy for the treatment of enuresis should be carried out in accordance with the cause that caused it. The products can be used by children regardless of their age. All drugs have a natural base, which explains the absence of side effects from their use. After using drugs to treat enuresis at home, there are no cases of relapse of the disease.

Home treatment of enuresis in children by suggestion

If you correctly apply the method of treating enuresis using suggestion alone, you can achieve excellent results. The suggestion method involves conducting confidential conversations with the child. Under no circumstances should you scold him; this can only aggravate the problem. There will be no psychological, much less physical, harm to the child. If habitual ethical standards, life attitudes and upbringing present obstacles to the implementation of such a method, one should not rush to use it.

In a confidential conversation with a child, you should try to find out what worries him, what he is afraid of and what bothers him, why he does not control his feelings. You can’t put pressure on it, it will close and it’s unlikely that anything else will be done after that. The suggestion should be made in the morning, after the child once again wakes up on a wet sheet. If after several attempts the method does not work, it is better to delegate its implementation to a psychologist or neurologist. It has been noted that suggestion can produce excellent results; after this, the child stops peeing and the problem disappears forever. You just need to apply this method correctly.

Diet for treating enuresis at home

The selection of diet products for the treatment of enuresis at home is best done strictly under the supervision of the attending physician. It is recommended not to drink carbonated liquid at all; it is best to drink more natural-based juices. In addition, when creating a diet for the treatment of enuresis, you should include dishes with a low salt content. You should not drink liquid at night. Dinner should be as dry as possible; it is recommended to limit yourself to bread and two boiled eggs. There are many types of diets for the prevention and treatment of enuresis in children. The prerogative of a specific choice remains with the attending physician.

Enuresis in children: treatment with folk remedies

The method of treating enuresis in children using folk methods and means has been known for a long time. The means used are different and their choice depends on the severity of the situation and the age of the child.

Dill for enuresis

The following method for preparing dill is recommended as a treatment for enuresis. Dry dill seeds in a volume of one tablespoon are poured into a thermos. After this, boiling water in the volume of one glass is poured into the vessel. The thermos is carefully sealed and left overnight in a dry, dark place. In the morning, the composition must be filtered. If desired, it is recommended to use honey for sweetening. The composition should be taken in the morning on an empty stomach, one glass once before breakfast. The total duration of treatment is ten days. After this, you should take a break for ten days and then drink the composition again for ten days, one glass before breakfast. Statistical data indicate excellent results from using the described method. If the child does not have organic damage to the genitourinary system, the results of treating enuresis with dill will be excellent.

Millet for enuresis

The following method of using millet as a treatment for enuresis is recommended. Nine tablespoons of millet are washed to remove debris and litter. The water is then drained, and the millet is transferred to a one-liter glass jar, into which a glass of water at room temperature, previously boiled, is poured. The composition is infused for three hours, and it should be stirred periodically. After this, the infusion is filtered and given to the child in small doses. The process continues for three days, while the infusion is constantly refreshed and new portions are prepared. As a rule, the child wakes up on the second night when he wants to go to the toilet. Gradually the frequent urges stop. Millet for enuresis calms the child, puts the central nervous system in order, which begins to function normally. To completely eliminate the situation, a course of treatment lasting two weeks is recommended. If there were pain in the bladder and urethra, they stop immediately.

St. John's wort for enuresis in children

Teas based on St. John's wort are widely used as a means of treating enuresis in children. Various options for preparing infusions using this herb are recommended. With long-term use of tea based on St. John's wort, as a rule, the child is cured of enuresis.

A combination of St. John's wort with other herbs, such as centaury and horsetail, is recommended. When preparing infusions with a combination of different herbs, the proportions between them are chosen to be the same. A tablespoon of St. John's wort and any of the above herbs are poured into a glass of boiling water, after which you need to leave in a water bath for half an hour. Take one fourth of a glass three times a day.

Dates for enuresis

Dry, ground dates are used to treat enuresis in children. Two tablespoons of ground date powder should be poured into a thermos, then poured with a liter of boiling water and left to steep for eight hours or overnight. The thermos should be kept in a dry, dark place. After filtering the infusion, take half a glass three times a day before meals. The course of treatment is two weeks, after which a ten-day break should be taken. If necessary, treatment is repeated after this. As a rule, changes occur after the first course of treatment. In practice, the largest number of courses of treatment sufficient for cure were three courses.

Honey for enuresis

This method is recommended for the treatment of enuresis in children with honey. Every day for a month, before going to bed, you should bury your navel with honey and cover it with an adhesive plaster. You should also take a spoonful of fresh honey daily. The first results can be seen already in the second week of taking honey.

Enuresis in childhood is a fixed reflex, problems of physical or mental development, manifested in night (daytime) urinary incontinence after 4-5 years. Nocturnal enuresis in children is urinary incontinence while the child is sleeping at night, while daytime enuresis in children is incontinence during the child’s usual activities. Typically, male children suffer from nocturnal enuresis, and more often girls suffer from daytime enuresis. Bedwetting occurs in 70% of children, the remaining 30% are daytime and mixed types of enuresis.

There are also primary types of enuresis, when the child initially could not control the bladder. In the secondary form, control over urination has been established (for at least 6-12 months), but for various reasons it is lost again. This usually happens between the ages of 5-7 years and 10-12 years.

Enuresis is classified as a pathology with a family predisposition; often the child’s parents themselves suffered from enuresis in childhood. Often, especially among girls, enuresis is provoked by the presence of genitourinary infections; incontinence is often one of the first symptoms of inflammation. This is especially typical for daytime enuresis.

One of the risk factors for the development of enuresis in children is stress, both psychological and physical. Moreover, it is psychological experiences that become a common cause of a wet bed. These factors include separation from parents, divorce in the family, the birth of younger children, moving, injuries, hospitalization and painful manipulations. Psychologists are confident that psychosomatics also plays a role in the occurrence of enuresis in children. Often children with unfavorable social conditions suffer from it - from boarding schools, from single-parent or asocial families, they usually have accompanying delays in speech and general development.

Enuresis often develops with late potty training and prolonged wearing of diapers, and there is also a theory that children with enuresis have hormonal characteristics in which they produce a lot of urine at night, which overstretches the bladder and leads to relaxation of the sphincter.

Special causes of enuresis may be abnormalities in the structure of the urinary system, urinary incontinence as the equivalent of epileptic seizures, as well as extremely deep sleep, in which the child simply does not respond to an impulse from the bladder.

Some children with enuresis have mental disorders, especially in the presence of daytime enuresis, mainly behavioral and emotional reactions. In some children, enuresis is provoked by severe psychological stress (attending school, violence). Many organic lesions of the brain and spinal cord also have urinary incontinence as one of their symptoms.

Symptoms

The main symptom of nocturnal enuresis is urinary incontinence during daytime or nighttime sleep after 5 years. Daytime enuresis also occurs during wakefulness in children over 5 years of age, and even a slight leak of urine into their panties will be considered enuresis. If children wet the bed or play around with wetting their pants during the day before they are 5 years old, this does not apply to enuresis; these are age-related characteristics of the child, and the bladder is not yet fully controlled. Symptoms of enuresis can occur either every night or in episodes, against the background of provoking factors, they can last up to 10-12 years.

Diagnosis of enuresis in a child

The basis of diagnosis is a detailed study of episodes of wet beds and the phenomenon of their connection with provoking factors. Sometimes keeping a bedwetting diary is necessary. Urinalysis is indicated - general, bacterial culture for flora, according to Nechiporenko and Zimnitsky, daily urine. If necessary, an X-ray of the urinary tract with contrast, voiding cystography, ultrasound of the kidneys and bladder with filling and emptying of the bladder, as well as, if necessary, an X-ray of the spine and many other research methods are performed.

Consultation with a psychologist, psychotherapist, neurologist and other specialists is indicated as necessary.

Complications

Usually, enuresis is treatable and goes away relatively quickly if all recommendations are pedantically followed. The prognosis may be unfavorable in case of organic lesions of the nervous system, in families with low social status, in the presence of concomitant pathologies. Enuresis often does not respond to treatment and then self-heals by puberty. However, it significantly affects the child’s psyche and causes him inconvenience.

Treatment

What can you do

The basis of treatment for uncomplicated enuresis is following a diet and drinking regimen, limiting fluids before bed, forced urination before bed, getting up to go to the toilet in the middle of the night or several times a night. You cannot scold your child for wet nights, but praise and encourage him for dry ones. Forbid your child to sleep in your bed if he wets his, help him make the bed and lie down again. It is useful to keep a schedule of dry and wet nights; this will help the child to tune in psychologically. It is also important to teach the child the method of controlled urinary retention, the ability to hold it longer and longer. An enuresis alarm clock that works to wake up the baby is also useful. He wakes him up to go to the toilet when it's time. There are many methods, a specific one will be selected by your doctor and psychotherapist together with you. Therefore, for enuresis in children, there is no need to self-medicate with medications such as minirin and melipramine.

What does a doctor do

How does a specialist treat enuresis in children? Drug therapy is carried out for the very reason that caused the disorder, or desmopressin is used, which leads to a decrease in urine output at night. For enuresis in children, it is used in the form of a tablet or nasal spray, often combined with psychological and behavioral techniques. Also, for enuresis in children, drugs such as antidepressants are used in small doses for a short course. Anticholinergic drugs are also used for daytime enuresis. Often, healing occurs only with time and maturation of the body.

Prevention

The basis of prevention is careful monitoring of health, timely potty training and the development of neatness skills. Creating a favorable psychological environment in the family and protecting children from stress and mental trauma.

Urinary incontinence is a common problem in children. At the age of 5 years, about 15% of children do not always hold urine. Most of these children have isolated or monosymptomatic urinary incontinence - nocturnal enuresis.

Monosymptomatic, nocturnal enuresis is divided into primary and secondary forms:

Primary is a form of enuresis in which the child has no history of dry nights. Children who have a history of “dry nights” that lasted more than 6 months have a form called “secondary” enuresis.

Primary monosymptomatic nocturnal enuresis has a high rate of spontaneous resolution and is thought to be due to one or a combination of the following:

Secondary nocturnal enuresis is often thought to be caused by high levels of stress (divorce of parents, birth of another child in the family, etc.) during a vulnerable period in the development of the child's bladder control system. However, the exact cause of secondary enuresis remains unknown.

Treatment of secondary nocturnal enuresis involves finding the underlying stressor if one can be found, although most children with secondary enuresis have no obvious cause and are treated in the same way as primary enuresis.

Control of fluid intake

This method involves parents monitoring fluid intake throughout the day. For those patients who are found to consume disproportionate amounts of fluid during the evening hours, various restrictions may be recommended. Some authors recommend that patients consume 40% of the daily amount in the morning (from 7 a.m. to noon), 40% in the afternoon (from 12 to 5 p.m.), and only 20% in the evening (after 5 p.m.), and drinks consumed in the evening should not contain caffeine.

This scheme is fundamentally different from the complete ban on drinking in the evening, usually practiced by parents, to prevent enuresis. Complete restriction of evening and night drinking, without compensation in the morning and daytime hours, can be harmful to the child and usually does not achieve the desired goal.

On the contrary, the proposed fluid intake program allows the child to drink as much as he wants throughout the day. Adequate fluid intake in the morning and afternoon reduces the child's need for fluid in the evening. Additionally, it increases your daily urine volume and may help train your bladder.

Treatment of enuresis with “urinary alarm”

This method is the most effective in the treatment of nocturnal enuresis. A special device is used. The “alarm” is activated when a sensor placed in underwear or under a sheet comes into contact with moisture. The mechanism that wakes the child is usually an alarm clock and/or a vibrating belt or pager.

The method works through the creation of a conditioned reflex: the patient learns to either wake up to empty the bladder at night, or hold urination at night. When performing this method, sometimes the child is not able to wake up from the sound signal or vibration of the device, in which case, the parents must wake up the child themselves when the signal sounds.

The family should be instructed that the child is solely responsible for the warning device. Every night before going to bed, he personally checks the device, repeating the sequence of actions at night if the device works. This sequence is as follows: the child turns off the alarm, stands up, empties the bladder completely in the toilet

NB! Only a child should turn off the device.

He returns to the bedroom, wipes the humidity sensor with a wet and then a dry cloth (or replaces it, if provided for by the design), reboots the device and prepares for further sleep. Clean bedding and underwear should be prepared in advance at the bedside. If necessary, parents should help the child with changing bed linen. Should keep a diary of dry and wet nights. The system of rewarding the child's success should be applied in the same way as described in the previous methods.

The device should be used continuously until 21 – 28 consecutive dry nights are achieved. This usually occurs between 12 and 16 weeks with a range of 5 – 24 weeks. The child should be examined by a doctor one to two weeks after starting to use the device and after 8 weeks of use. If necessary, urinary alarm therapy can be started again (more than 2 episodes of nocturnal enuresis within 2 weeks).

Approximately 30% of patients discontinue urine alarm therapy for a variety of reasons, such as skin irritation, anxiety from other family members, and/or parental refusal to get up to see the child at night.

Children who, due to increased episodes of enuresis after the end of alarm therapy, are forced to resort to using the device again, have much higher rates of success in the second course of such therapy, due to the creation of the initial effect of the first course.

Alarm clocks

It is also possible to train the child for planned night urination using an alarm clock. Studies have shown the sufficient effectiveness of this simple method, which allowed the study authors to recommend the method as a treatment option.

Drug treatment of enuresis in children

Self-medication and errors in drug dosages are unacceptable and can cause serious harm to the child, even threatening life.

So. There are two main groups of drugs used for nocturnal enuresis.

1. Desmopressin preparations (minirin, etc.). It is a synthetic analogue of antidiuretic hormone and, through a number of mechanisms, reduces urine production for several hours after administration. Injected only internally

IMPORTANT: The FDA banned the use of intranasal desmopressin in 2007 due to rare but extremely severe complications of this drug when administered in the intranasal form.

Important! While taking the drug, the child must certainly limit fluid intake in the evening (see below)

Desmopressin preparations are very expensive and many families simply cannot afford them.

In addition, for their effectiveness, sufficient bladder volume is necessary (that is, exercises aimed at increasing bladder capacity should be applied before the drug is prescribed). The drug must be carefully “titrated”, that is, the dose must be increased individually, starting with small doses and selecting the optimal dose for a particular child. The dose is changed by the doctor approximately once every 10 days; a complete dose selection takes about a month.

If a child, say, is planning a trip to a children's camp, and the problem with nocturnal enuresis is acute, parents should consult a doctor (pediatric urologist) at least 6 weeks in advance, so that the required dose is correctly selected and has maximum effect.

What is the effectiveness of the drug? With the correct dose selection, 25% of patients completely get rid of episodes of nocturnal enuresis while taking it, and 50% significantly reduce its frequency. However, as with tricyclic antidepressant therapy, drug withdrawal causes a return to the previous frequency of enuresis in 70% of patients.

Side effects of proper desmopressin therapy are rare. The most serious side effect is diluent hyponatremia, which occurs when a child drinks a lot of fluids before bed. Therefore, the child should take no more than 240 ml of water per evening and not take liquid at night. If the child forgets, or for objective reasons takes a large volume of water in the evening (ARVI, intestinal infection...), then treatment with desmopressin must be interrupted.

2. Tricyclic antidepressants. (imipramine, amitriptyline, etc.)

The mechanism of action of these drugs is:

reducing sleep time
stimulation of the secretion of vasopressin (antidiuretic hormone)
relaxation of the detrusor (bladder muscle, which slightly increases the “working” volume of the bladder)

The dose of the drug is selected by the doctor gradually. This may also take 4-6 weeks. If after selecting an adequate dose (or the maximum age dose) no clinical improvement is visible within three weeks, the drug is discontinued.

What is the effectiveness of TAD therapy?

Varies in different studies. Approximately 20% of children have complete clinical improvement (measured as 14 or more dry nights in a row), while the remaining children experience a decrease in the frequency of episodes by an average of 1 wet night per week. After discontinuation of TAD therapy, symptoms return to baseline in 75% of patients.

Side effects of this therapy?

Approximately 5% of children treated with TAD have neurological side effects: irritability, personality changes and sleep disturbances.
These drugs are particularly monitored by the FDA because of their potential to increase the risk of suicide, especially in adolescents with depressed mood.
The most severe side effects can develop from the cardiovascular system: impaired contractility and conduction of the heart muscle, especially in case of overdose.

The advantages of this therapy are its relatively inexpensive cost.

Much less effective and have less evidence base

other methods of drug therapy:

3. Indomethacin suppositories.

One small randomized controlled trial found that indomethacin suppositories increased the number of dry nights in children over six years of age with primary nocturnal enuresis after a three-week course of treatment. There were no side effects identified in the study. Proposed mechanism of action: the drug removes the physiological inhibitory effect of prostaglandins on the production of vasopressin and improves bladder function.

often very difficult for the family financially

has a number of side effects

requires the child to take it regularly and be particularly attentive to the dosage, as well as dietary measures

accordingly, it requires clear and stable motivation from the child himself, and not just the wishes of the parents

In no case is it a replacement for other non-drug approaches; on the contrary, a full effect can only be achieved when used together with several non-drug treatment methods that are most effective for a particular child.

and of course, it can only be prescribed by a doctor and requires constant communication with the doctor throughout the entire treatment.

Complementary and alternative treatments for enuresis

Research into complementary and alternative treatments for primary nocturnal enuresis, such as hypnosis, psychotherapy, and acupuncture, shows that benefit is observed in a very limited number of cases.

CONCLUSIONS:

Monosymptomatic nocturnal enuresis is a common pediatric problem with a high rate of spontaneous resolution. Most cases do not require initiation of therapy before age 7 years.

Various therapies are available, but none of them used alone are effective (reflecting the multifactorial nature of the pathogenesis). Any therapy must begin with the child's willingness to participate and the parents' awareness that episodes of enuresis are completely unconscious and unintentional on the child's part. Treatment should be structured so that its potential harm does not exceed the expected benefit.

Simple behavioral methods (such as motivational therapy, bladder training) are usually used initially, but more serious methods need to be used when the child experiences social pressure and his sense of self-esteem suffers.

Urinary alarm therapy is the most effective and long-term method. Monitoring fluid intake and bladder training may be useful complementary techniques. Drug therapy may be effective in the short term, allowing the child to schedule social interactions with peers, such as attending a camp or sleepover with friends.

The above recommendations apply to the treatment of children with primary monosymptomatic nocturnal enuresis. Parents of children under 7 years of age who, based on the results of an examination, are recognized by a doctor as unable to accept the responsibility of treatment, should be reassured of the very likely spontaneous cure of enuresis. As soon as the child is able to take on some of the responsibility for bedwetting treatment, it is recommended that simple treatments be started. These include keeping a record of dry nights, bladder training and monitoring your fluid intake (see above).

Urinary alarm or drug therapy should be used in children who do not respond to 3 to 6 months of behavioral therapy. Urinary signaling is preferable to pharmacotherapy because the effect lasts long after treatment is stopped and because this method is associated with a lower risk of adverse reactions.

Oral desmopressin is an effective short-term alternative to urinary signaling when the latter is ineffective. It can be used as an addition to an alarm system or as a short-term method for use at a children's camp or overnight stay. Fluid intake should be limited 1 hour before and 8 hours after taking desmopressin.

Tricyclic antidepressants are effective short-term treatment for nocturnal enuresis. However, the high relapse rate and potentially serious side effects make them less attractive than urinary alarm or desmopressin therapy. Nocturnal enuresis can usually be treated by your local pediatrician. However, children with intractable enuresis should be consulted by a pediatric urologist and nephrologist.

Enuresis- This is urinary incontinence. Nocturnal enuresis means that a person is unable to control the process of urination during sleep. Simply put, he wets the bed while he sleeps.

Daytime enuresis is much less common. It appears after suffering severe psychological trauma, which caused a malfunction of the nervous system.

The problem of bedwetting is as old as humanity itself. Even doctors in Ancient Egypt were looking for ways to control the bladder. Since then, medicine has advanced significantly, but experts do not give a 100% guarantee that you will get rid of this problem.

In modern medicine, nocturnal enuresis is not considered a disease, but rather a stage in development when a person is just learning to control the functions of his body and develops reflexes. Normally, a child should learn this by age 6. But in practice, 10% of six-year-olds do not know how to do this. Over the years, the problem recedes. At 10 years of age, 5% suffer from enuresis, and at 18, only 1%. Among adults, one in 200 people periodically loses bladder control while sleeping. Thus, among those who suffer from this phenomenon, almost 94% of children, 5% of adolescents and 1% of adults.

It is observed 2 times more often among boys than among girls. But in old age, bedwetting is more common in women.

Short, thin children are more likely to suffer from enuresis. Infections of the kidneys and bladder also play a major role in the onset of the disease. Often incontinence in children is a way of psychological protest. It may be the result of a lack of attention or, conversely, a reaction to increased parental care. Enuresis occurs in shy and fearful children. Most patients with this disorder come from disadvantaged, low-income or large families.

Many specialists treat enuresis: pediatric neurologists, endocrinologists, pediatricians, urologists, nephrologists, psychiatrists, homeopaths, physiotherapists. They offer more than 300 comprehensive techniques to combat this problem. Among them there are also quite exotic methods: acupuncture, hypnosis, dolphin therapy.

Types of enuresis

There are several types of enuresis. Depending on the extent to which the child has developed a “guard” reflex, which makes him wake up when the bladder is full, there are:

Primary– the child has never been able to control his bladder in his sleep. This option is considered the easiest. In 98% of cases it goes away without treatment.
Secondary– there was a period of at least 6 months in the child’s life when the bed remained dry every day.
There are also complicated and uncomplicated nocturnal enuresis.
Uncomplicated. – apart from the fact that the child urinates in his sleep, he has no other health problems.
Complicated– accompanied by deviations in mental or physical development, inflammation of the kidneys or bladder.
They also distinguish between neurotic and neurosis-like enuresis.
Neurotic– found among shy and fearful children. They often have light, shallow sleep. Such children are very worried about their “wet” nights and are often afraid to fall asleep for this reason.
Neurosis-like– noted in nervous children who often throw tantrums. They are not too worried about urinating at night. This continues until adolescence. Then the picture changes, and the problem begins to depress them greatly. Such teenagers become withdrawn and gloomy, and they may develop neuroses.

Why does enuresis occur in girls?

Girls are less likely to suffer from enuresis. They potty train faster and learn to control their bladder. And if such a problem arises, then it is better treatable. This is due to the peculiarities of the functioning of the nervous system. But let's figure out why there is still a malfunction in the regulation of the bladder.

The girl has not yet learned to control her reflexes. This is due to the fact that her nervous system is not yet fully debugged. This happens even to those girls who do not lag behind their peers in other indicators.
Psychological trauma, stress. Often the problem appears after a second child appears in the family, after a move, transfer to a new school, or parental divorce. In this case, enuresis is a subconscious protest or an attempt to return to childhood.
Very sound sleep . The child sleeps soundly and does not feel that the bladder is full. This may be a congenital feature of the nervous system or the result of the girl being very overtired. In the latter case, wet sheets do not happen often, but after eventful days.
The child drinks a lot of liquid. Often girls like to have tea parties in the evening. Especially if during the day they ate salty foods (chips, crackers). This often happens during colds, when parents try to give the baby more water.
A large volume of urine is produced at night (nocturnal polyuria). Normally, the body produces 2 times less urine at night than during the day. This feature of the body is regulated by the hormone vasopressin, which is produced at night. But in some girls the amount of this hormone may temporarily decrease.
Heredity. Scientists have found that if both parents encountered this problem in childhood, then the probability of developing enuresis in the child is 75%. If only one of the parents is a carrier of this gene, then the risk that the girl will have enuresis is 30%.
Infections of the urinary system. Due to the fact that girls have a short and wide urethra, infection from the genital organs easily penetrates into it. Then the microorganisms rise higher into the bladder and cause inflammation (cystitis). This disease is accompanied by frequent urination, which the girl cannot always control.
Damage to the spine or spinal cord. Often such injuries appear due to a complicated pregnancy or injuries received during childbirth. As a result, the nerve impulse from the bladder does not travel well to the brain.
Developmental delay. If a girl has a delay in mental or physical development, then her biological age is significantly less than the calendar age. In this case, she has not yet developed the necessary reflex.

Why does enuresis occur in boys?

Enuresis in boys is quite common. Up to 10% of boys under the age of 15 experience it. For almost everyone, this problem resolves itself and wet sheets become a thing of the past. What is the cause of enuresis in boys?

The development of the conditioned reflex has not been completed. Each person's nervous system has its own characteristics. Some people get used to controlling their body earlier, while for others this process is completed later.
Hyperactivity– the child’s activity and excitability greatly exceed the norm. In boys, this condition is noted 4 times more often. Active processes in the cerebral cortex seem to suppress the bladder’s attempts to talk about its problem. And as a result, the urge to urinate remains “unheard” by the brain.
Stress and strong emotions. Some situations that are accompanied by nervous tension or fear can cause enuresis. The child may be afraid of the dog, upset because of the parents' quarrel, or because he was left alone. Therefore, if possible, avoid situations that could cause psychological trauma to your baby.
Overprotection and attention deficit. Enuresis often affects boys who grow up in single-parent families without a father. Often in this case, the mother and grandmother overprotect the child. He feels “small” and subconsciously behaves accordingly. For children who experience a lack of parental attention, the situation is the opposite. They really want to return to childhood and feel cared for. Therefore, in their sleep they behave like little ones.
Disruption of the endocrine glands and hormonal balance. Thin, small boys whose height is not appropriate for their age are deficient in growth hormone. But the fact is that at the same time the amount of other hormones that are responsible for controlling the bladder and the amount and concentration of urine decreases. These are vasopressin and atrial natriuretic hormone.
Birth injuries. Boys' brains develop somewhat later than girls'. Therefore, they are more likely to be injured during childbirth. These injuries to the spinal cord and brain cause enuresis in boys.
Inflammatory diseases of the kidneys and bladder. Inflammatory processes in the kidneys and bladder very often cause urination problems. They can be easily identified by a general urine test. If a boy has congenital features of the urinary tract, they can also affect the formation of the reflex.
Hereditary tendency. In 75% of cases, parental genes are to blame for the boy's enuresis. If mom or dad suffered from this problem in childhood, then the probability that the boy will repeat their fate is 40%.
Diaper habit. Recently, diapers have been increasingly blamed for the occurrence of enuresis in boys. The child gets used to the fact that he can pee in his pants without getting wet and cold. That’s why it’s so important to stop wearing diapers before age 2.
Allergic reactions and bronchial asthma. The mechanism that links allergies and the occurrence of enuresis is not fully understood. But boys with allergies are more likely to urinate in their sleep. It is possible that the brain is starved of oxygen and copes with its functions worse.

Why does enuresis occur in teenagers?

In adolescence, enuresis is somewhat less common than in children. It can be secondary, that is, appear after injury or stress. Or it has been going on since infancy. Let's take a closer look at the reasons for this problem.

Congenital disorder of the nervous system which are responsible for the formation of a conditioned reflex.
Sentinel reflex disorders due to injury. This reason is especially often observed in teenage boys who have increased activity.
Heredity. The tendency to enuresis is inherited. This happens especially often if both parents had this diagnosis in childhood.
Congenital pathologies of the kidneys, bladder and urinary tract. They often cause inflammatory processes (cystitis and nephritis). During these illnesses, controlling urination is much more difficult.
Mental disorders. At this age, depression and neurosis often appear. They can contribute to the fact that problems long forgotten in childhood will become relevant again. The complexes and worries that a teenager experiences about this further aggravate the problem.
Stressful situations. During adolescence, there are a lot of nervous shocks, and they are perceived very acutely. Failures at school, problems with peers, tense family situations and physical punishment can trigger the appearance of nocturnal enuresis.
Hormonal changes in adolescence. The period of sexual maturation causes a disruption in the production of hormones. Among them there are those that regulate the processes of emptying the bladder.

Why does enuresis occur in adults?

There are two types of bedwetting in adults. In the first case, the person was never able to form a reflex that makes him wake up at night to go to the toilet. In another case, urinary disorders appeared in adulthood. What reasons can cause enuresis in adults?

Congenital anomalies of the urinary system. These include: the size of the bladder is too small, its walls are too thick and inelastic.
Hormonal changes in women during menopause. These changes cause a deficiency in the hormones that control the bladder. They cause your kidneys to produce more urine than usual at night, which can cause nocturnal enuresis.
Tumors. The tumors can interfere with the transmission of nerve signals from the bladder to the cerebral cortex.
Weakness of the pelvic muscles and pelvic floor. Muscles can weaken after pregnancy or as you age. This problem is one of the most common causes of enuresis in women.
Aging processes in the cerebral cortex and spinal cord. With age, the connection between nerve cells is disrupted, which, like a chain, transmits nerve impulses from the bladder to the cerebral cortex. This is where the center is located that wakes us up at night and sends us to the toilet.
Weakening of the bladder sphincter. The sphincter is a circular muscle that closes the lumen of the bladder and prevents urine from flowing out. Normally, we consciously relax it when we urinate. But with age, this muscle weakens and therefore, when the bladder fills at night, it is not able to keep it from emptying.

What effective treatments are there for enuresis in children?

If a child has not learned to control his bladder by the age of 6, then this is a reason to examine the baby and begin treatment. It is necessary to take a urine test and do an ultrasound of the bladder and kidneys. The doctor may additionally prescribe an X-ray of the spine or an MRI.

There are more than three hundred different ways to combat enuresis in children. Each of them is quite effective. All of them can be divided into three groups:

Medicinal (various drugs)

Non-drug (physiotherapeutic and psychological techniques)

Regular (night “planting” on the potty)

Medicinal methods of treating enuresis in children

Depending on the cause that causes enuresis, various medications are used. If the child has hyperactivity and is very nervous and fearful, then sedatives (tranquilizers) are prescribed. If an infection is found during the examination, then you must take a course of antibiotics. They kill bacteria that cause inflammation of the kidneys and bladder.

Sometimes enuresis occurs as a result of delayed development of the nervous system. In such cases, nootropic drugs are prescribed. They speed up development processes. Good results are obtained with the use of the hormone desmopressin, which regulates the amount and composition of urine and the functioning of the bladder.

Non-drug methods for treating enuresis in children

This includes the use of urinary alarms, popularly called “urinary alarms.” These devices have a small sensor that is placed in the child's panties. When the first drops of urine fall on it, it transmits a signal to the alarm clock. The child turns off the alarm clock and goes to the toilet.

Physiotherapeutic methods improve the functioning of the bladder and nervous system. For these purposes, electrosleep, electrophoresis, magnetic therapy, acupuncture, music therapy, baths and circular showers, massage and therapeutic exercises are often used.

The help of a psychologist and psychotherapist will help the child cope with an unruly bladder. The specialist will teach him relaxation and self-hypnosis techniques. An effective method would be to keep a special diary. Every dry night is represented by the sun, and wet sheets by a cloud. Five suns in a row is a great reason to receive a small incentive prize from your parents.

To successfully combat enuresis, a child should adhere to a certain diet and not drink after dinner. The most famous diet was developed by N.I. Krasnogorsky. It is aimed at ensuring that water is retained in the body at night. To do this, before going to bed, the baby is given bread with salt, a piece of herring and sweet water. During the day, the child's menu is very varied and rich in vitamins.

Regular methods of treating enuresis in children

Try to have fewer stressful situations in your baby's life. Even strong positive emotions can cause a child to forget to control his bladder while sleeping.

It is important to strictly follow the regime and put a child under 10 years old at exactly 21:00. After 17:00 it is necessary to sharply reduce the amount of liquid that the child drinks. If the norm for a child under 5 years old is 1 liter, then distribute it this way. 700 ml before 15 o'clock, 200 ml before 18 o'clock, 100 ml in the evening.

4 hours before bedtime, the baby’s games should not be too active. Let the child draw, read, watch a non-scary cartoon.

The child's bed should have a slight elevation in the pelvic area and under the knees. To do this, just place a small cushion of rolled up blanket under the mattress. This special crib will help reduce pressure on the walls of the bladder.

Make sure that your baby does not become hypothermic, day or night. Your feet should be especially warm. If they are cold, then the bladder reflexively begins to fill.

Before going to bed, the child must go to the toilet. And during the night it is worth waking him up several times. Put your child on the potty an hour after falling asleep and then every three hours throughout the night. But make sure that he does “his job” not while half asleep. If he naps on the potty, this can only make the situation worse. Turn on a dim light and talk to your baby. Get clear answers from him to make sure that he really woke up.

Ask your child if he needs a night light. Often children are afraid to get out of bed because of the darkness. It is easier for them to sleep on wet sheets than to get out from under the covers. After all, most kids are sure that monsters are hiding in the dark under the bed.

If in the morning you still notice that the bed is wet, then do not scold your child. Mom’s screams and despair in her eyes demonstrate to the baby that the problem is big and scary. This means that he, so small and weak, is unable to cope with it. Make the bed together and explain to your child that this happens to many children, but every child can lock urine in their tummy until the morning. And he will definitely cope with this task. After all, he is your best!

Any of the methods will give good results only if the child himself is interested in solving the problem. He will also really need the support of all family members. Believe in your child and instill in him confidence in his abilities.

How to treat enuresis in adults?

Treatment of enuresis in adults must be comprehensive. This means that treatment with pills must be combined with psychotherapy and traditional medicine. And all this must be complemented by the correct organization of the daily routine. In practice, everything is not so difficult. Follow our recommendations and you are guaranteed many dry nights.

Regular events

Sometimes it is enough to change your habits and the problem itself will leave you. For example, try drinking less in the afternoon, but increase the amount of fluid you drink before lunch.

Avoid drinks and foods that have a diuretic effect. These are beer, coffee, strong tea, cola, cranberry juice, herbal infusions (corn silk, birch buds), watermelon, strawberries.

Follow the diet developed by N.I. Krasnogorsky. After lunch, eat meals with little water. Reduce the volume of drinks after 15.00 by 2-3 times. Do not drink 4 hours before bedtime. And before you go to bed, eat a sandwich with salted fish or just bread and salt. Wash it down with half a glass of water. Salt retains water in the body, preventing it from collecting in the bladder.

Placing a pillow under the mattress at your feet will help relieve pressure on the sphincter that closes the bladder. This way you will strengthen the protection against leakage.

Your bed should be quite hard. Firstly, it will provide good support to the spine. Nerve signals from the bladder will be better transmitted to the brain. And secondly, on a hard bed your sleep will be more sensitive and it will be easier for you to wake up at the right moment.

Set an alarm clock and let it wake you up 2-3 hours after you fall asleep. Change your wake-up time every few days so you don't get used to waking up at the same time at night.

Try to avoid stressful situations and not get nervous. When you are calm, it is much easier for you to control your body.

Psychotherapy

Traditionally, hypnotic techniques are used. The essence of the method is to use hypnosis to suggest to the patient that in a dream he will feel the urge that a full bladder sends. And these sensations will make him wake up. Thus, a “guard” reflex is formed in the cerebral cortex, which allows you to completely get rid of enuresis.

Behavioral techniques often work well when rewards can be given for successful nights. Of course, adults make it for themselves. But these little gifts also boost motivation.

Some methods of self-hypnosis can be learned independently. Try to keep the evening calm. Relax completely before falling asleep. Feel how every muscle in your body is at rest. Then, for several minutes, say to yourself, or better yet out loud, the key phrase: “I have complete control over my body and my bladder. When it’s full, I’ll get a signal and wake up.” Be confident in your abilities, and everything will definitely work out. After all, the human body is capable of coping with more complex tasks.

If you have a logical mind and do not give in to suggestion, then rational psychotherapy will help in this case. The specialist will introduce you to new information about your problem and the capabilities of your body. He will use logic to convince you that enuresis is not a complex and dangerous disease, and that you are able to cope with it.

Physical therapy techniques (physical therapy)

Exercise therapy for enuresis is aimed at strengthening the bladder sphincter and pelvic floor muscles, which control urination. In order to train them, there are even special simulators (for women). But you can do this therapeutic exercise without any equipment.

Try to stop while urinating. Use your muscles to block the flow of urine from the bladder. Listen to your sensations, which muscles tensed? Now relax and continue emptying your bladder. Repeat the exercises every time you go to the toilet. Then you can do the same exercises just while lying in bed. This is a very effective method.

Physiotherapy for the treatment of enuresis in adults

There are many physical therapy machines that can help you get rid of bedwetting. Their action is based on weak discharges of electric current that pass through the body and improve its functioning. The therapeutic effect is explained by the fact that they all improve the transmission of nerve impulses (signals) from the bladder through the nerves and spinal cord to the cerebral cortex. There the decision is already made to wake up the sleeping person and make him feel that it is time to empty his bladder. Physiotherapy procedures are absolutely painless, and sometimes even very pleasant. They have minimal side effects.

Electroson– normalizes sleep patterns and calms the nervous system. Excellent help for those who have problems with urination associated with neurosis and other nervous disorders.

Darsonval on the bladder area– strengthens the sphincter that closes the bladder.

Electrophoresis. Various types of this procedure improve the functioning of the nervous system.

Magnetotherapy relaxes the walls of the bladder. Reduces the desire to urinate.

There are also non-electrical techniques that also help prepare the nerves for signal transmission. Thanks to this, a persistent “guard” reflex is developed. Therefore, these techniques are called reflexology.

Therapeutic mud, warm paraffin and ozokerite are applied to the lumbar area and above the pubis. The procedure helps increase blood flow to this area, relieve inflammation and muscle spasms near the spine. This improves the condition of the nerves running from the bladder to the spinal cord.

Hydrotherapy: shower (rain and circular) baths (nitrogen, pearl, salt-pine). The latter type can be done at home.

Acupuncture. Special thin needles are inserted into reflex points on the body. This improves not only the functioning of the nervous system, but also the emotional state and sleep.

Music therapy, art therapy. Treatment with music and drawing calms and creates a positive mood.

Animal communication therapy. The best results come from communicating with horses and dolphins. But if dogs and cats improve your mood, then they can also be excellent helpers in treatment. After all, its success depends on your emotions.

Treatment of enuresis in adults with medications.

Different groups of drugs are used to treat enuresis. To maximize their effect, you must strictly adhere to the dose prescribed by your doctor and take them regularly.

If enuresis is caused by inflammation in the genitourinary organs, then antibiotics are necessary: Monural, Norfloxacin.
Nitrofuran drugs are used to treat kidney diseases: Furamag, Furadonin.
Tranquilizers to normalize sleep: Radedorm, Eunoktin. They have a calming effect, help get rid of negative emotions, and tune in to a positive mood.
Nootropic drugs: Glycine, Piracetam, Picamilon. They improve the functioning of the nervous system and help develop a conditioned reflex.
Antidepressant Amitriptyline. Relieves patients from strong experiences that caused psychogenic enuresis.
M-anticholinergics: Sibutin Driptan. Relaxes tense bladder muscles, relieves spasms. This allows you to increase its volume and restrain the urge to urinate. It will be able to hold more urine. Therefore, a person will be able to sleep until the morning without feeling the need to go to the toilet.
Artificial hormone desmopressin. It helps reduce the amount of urine that is released at night. Adiuretin-SD - nasal drops based on this hormone. Very easy to use form. In severe cases, desmopressin is administered intravenously. This increases its efficiency several times.

Traditional methods of treating enuresis

This method is based on improving the transmission of urge from the bladder to the brain. It is necessary to wet a piece of cotton wool in warm water and squeeze lightly. Run wet cotton along the spine from the neck to the tailbone. Repeat 5-7 times. Do not wipe. This procedure is done in bed before going to bed.

Honey perfectly calms the nervous system before bed and helps retain water in the body. A tablespoon of honey should be eaten before bed; you can wash it down with a few sips of water.

“Walking on the buttocks” strengthens the pelvic floor muscles and the bladder wall. You need to sit on the floor, straighten your legs. Alternately move your legs forward, contracting your buttock muscles. You need to walk forward 2 meters, and then go back in the same way.

Good results in the treatment of enuresis in adults are obtained by visiting bioenergetics specialists and traditional healers. They know how to configure the nervous system in a special way and have the gift of suggestion.

What traditional methods of treating nocturnal enuresis exist?

Among the people, nocturnal enuresis has never been considered a complex disease. Traditional medicine very quickly and effectively helps to cope with this defect.

What tablets are used to treat enuresis?

Drug name	Mechanism of action	How to use	Effect of taking
*Drugs to improve the functioning of the nervous system*
Radedorm	Relieves muscle spasms, calms and normalizes sleep	1 tablet in the evening, half an hour before bedtime. Children's dose – half a tablet.	Helps you fall asleep and relaxes the bladder muscles, increasing its volume.
Pantogam	Helps develop a stable “guard” reflex	Adults take 1-2 tablets half an hour after meals, 3 times a day. For children, the dose is reduced by half. The course of treatment is 3 months.	Brain function improves. After 2 months, the bladder becomes full.
Glycine	Has a calming effect and relieves depression. Normalizes sleep.	Dissolve behind the cheek or under the tongue 2-3 times a day. The course of treatment is from 2 weeks to a month.	Improves mood, helps you relax and fall asleep. But sleep remains light and a person may feel that the bladder is full.
Phenibut	Improves the condition of the brain and metabolic processes in its cortex. Promotes restful sleep.	Take 1 tablet at night for 7-10 days. The dose for children is prescribed individually.	Relieves anxiety, which often occurs before bedtime due to enuresis.
Melipramine	Makes sleep less deep, increases the volume of the bladder and blocks the outflow of urine using the sphincter.	Take 1 tablet 3 times a day, regardless of meals. Duration of treatment is at least two weeks.	The bladder relaxes and the flow of urine is tightly blocked. Sleep becomes calm, but sensitive.
*Anticholinergic drugs that relax the bladder*
Spazmex	Reduces the tone of the smooth muscles of the bladder, and at the same time increases the tone of the sphincter.	1 tablet 2-3 times a day before meals. The course of treatment is 3 months.	Prepares the bladder to hold more urine.
Driptan	Increases the capacity of the bladder, reduces the number of contractions, and makes its receptors less sensitive.	1 tablet 2-3 times a day. Take the last dose at night. Children's dose: 0.5 tablets morning and evening.	Helps relax the bladder and reduces the need to go to the toilet at night.
*Synthetic analogues of antidiuretic hormone*
Desmopressin	An analogue of a hormone that is produced in the body at night. Its function is to reduce the amount of urine during sleep.	The dose is prescribed individually, but not more than 10 tablets per day for adults. The course of treatment is 2-3 months.	During night sleep, the bladder does not fill.
Minirin	Regulates kidney function so that less urine is excreted.	Take 1 time before bed for no more than 3 months.	The amount of urine decreases. There is no need to wake up at night to empty your bladder.

How can you treat enuresis at home?

Eneruz in most cases is treated at home. But it is worth remembering that medications alone are not enough to effectively and quickly treat this disease. To combat enuresis, an integrated approach is required.

Nighttime urinary incontinence in children under 5 years of age is considered normal. Unfortunately, there are children who, even at the age of 7-10, sometimes wake up on wet sheets. In addition to the fact that it is uncomfortable for a child to wake up in a wet, cold bed, he is also very ashamed. You can get rid of nighttime troubles only by establishing an accurate diagnosis of the disease that caused nocturnal enuresis.

What can cause enuresis in children aged 7-10 years

The processes that contribute to nighttime urinary incontinence (enuresis) in children of primary school age are represented by a physiological and psychological component. A wet bed upon waking causes trouble not only for the child, but for all family members. Most often, bedwetting occurs in boys and disappears by the beginning of adolescence.. This does not mean that the situation that has arisen does not need to be dealt with. If a child pees at night, he feels psychological discomfort, is ashamed and withdraws into himself.

The occurrence of nocturnal enuresis is caused by several reasons

Psychological reasons

By the way, the nervous stress that the baby experiences can provoke bedwetting.

Change of environment (change of place of residence or transfer to a new school).
Conflicts in the family.
Loss of a loved one or four-legged pet.
Exams or tests at school.

In most of these cases, enuresis goes away without outside intervention, but sometimes the help of medical professionals may be required.

2. Failure or immaturity of the central nervous system

The body does not receive a signal that the bladder is full and that it is time to empty it. This reason is one of the main ones contributing to the manifestation of enuresis.

3. Hereditary factors

If both mom and dad suffered from the problem of night urination, then the probability of its occurrence in the child is almost 80%, and if one of the parents, then up to 45%.

4. Cold weather

Children are more sensitive to strong drops in temperature.

5. When a child is often taken to the toilet at night

He can sometimes wake up on his own and his conditioned reflex to urinate will quickly work.

6. Malfunctions of the endocrine system

In this case, the child exhibits not only enuresis. His sweating increases noticeably, his face becomes swollen, or he tends to become overweight.

7. Hormonal imbalance

8. Pathological abnormalities in the urinary system

9. Infection in the genitourinary system or vaginal infection (in girls)

10. Weak bladder or kidney function

The problem of enuresis during night sleep at 7-10 years old can be quite prosaic in nature. It’s just that the baby has a healthy, sound sleep or the root cause lies in the large amount of liquid, fruit or cold foods that he consumed before bed. Treatment in these cases will consist of timely monitoring of children.

Which doctor will help children get rid of enuresis?

First of all, parents, faced with nocturnal enuresis, turn to a pediatrician. As a rule, the doctor advises to wait a little, claiming that the problem will disappear over time. At best, he will prescribe a general blood test and an ultrasound examination of the internal organs.

On your doctor's advice, you should not wake your child up more often at night. This can only make the situation worse. Due to frequent getting up at night, the child may later develop symptoms of childhood neurosis.

A good pediatrician should determine what kind of specialist the baby will need and give a referral to a pediatric urologist, psychologist or neurologist. Only a complete examination will help determine what caused urinary incontinence during night sleep.

Don't wait for the problem to resolve itself without medical intervention. Contact your doctor at the first signs of the disease.

Methods to combat enuresis, depending on the causes of its occurrence

After a complete examination and detection of the causes of the disease, the doctor decides which method to use to solve the problem in a particular case.

Treatment with medications

The drug Adiuretin-SD is recognized as one of the effective remedies for childhood enuresis., which contains the substance desmopressin. It is an analogue of vasopressin, a hormonal agent that normalizes the process of excretion or absorption of free fluid by the body. The drug is released in the form of nasal drops and is prescribed to children from the age of eight. For a child who has not reached this age, the doctor reduces the dosage.
For bedwetting, tranquilizers may be prescribed to improve children's sleep. having a hypnotic effect. (Radedorm or Eunoctin).
For neuropathic manifestations of the disease, Rudotel is prescribed, Atarax or Trioxazine (children over 6 years old).
Neuro-like form of bedwetting is treated with Amitriptyline, however, its use before 6 years of age is contraindicated.
To increase the volume of the bladder, Driptan is prescribed in tablets.
To improve brain function, sedatives are prescribed, such as Persen, Nootropil, Novopassit, B vitamins, vitamin A and E. Pantocalcin may be prescribed. With its help, the development of impulses responsible for the acquisition of new skills is stimulated.

These products can only be used as directed and under the supervision of a physician. To avoid harm to the child, strictly adhere to the prescribed dosage.

Non-drug therapy

When the problem of bedwetting is psychological in nature, no medications will help unless irritating factors are eliminated from the student’s life. First of all, you should not scold your child for a wet bed or tease and ridicule him. This will only make the situation worse.

Fear of punishment or ridicule will provoke the development of the disease. You cannot tell strangers about the problems of your son or daughter, especially in their presence.

Creating a favorable microclimate in the family is the first step to success in the fight against childhood enuresis.

In addition, other factors have a beneficial effect on solving the problem

Daily regime. It is necessary to properly organize the teenager’s rest and study time. He should avoid heavy loads that lead to fatigue and increase the duration of sleep. The last meal should be 2.5-3 hours before bedtime. In the evening, you need to limit your intake of liquids, especially juices, dairy and fermented milk products.
Bladder training. The procedure begins at the age of seven. The child is taught to delay the process of urination. Watch when your baby goes to the toilet, ask him to be patient a little longer. Increase the delay time little by little. This will help develop bladder control.
Motivational therapy. The method is highly effective, allowing to solve the problem of nocturnal enuresis in 80% of children. The best doctor in this case is the child himself. The essence of the method is very simple - rewarding children for every dry night. One child needs simple praise, another needs a new toy, bicycle or skates. Hang a calendar above your son or daughter's bed, marking all the dry nights. Agree with your child that with a certain number of dry nights per week or month, the baby will receive a long-awaited gift. If he fulfills his part of the agreement, you, without any excuses, must fulfill yours.
Physiotherapy. The procedures promote improved functioning of the nervous system, brain and bladder. As therapeutic procedures, to ensure that the baby has a dry bed, electrophoresis, acupuncture, magnetotherapy are used, electrosleep, circular showers and therapeutic exercises are used.
Psychotherapy. The specialist teaches the child self-hypnosis and relaxation techniques. During the exercises, the reflex connection between the bladder and the nervous system, weakened for various reasons, is restored. In cases of severe neurotic enuresis, therapy for depressive mood shifts - tearfulness, fear, irritability or anxiety - is used. Family psychotherapy plays a big role in this, that is, creating a favorable climate in the family and comprehensive support for the child.

Traditional methods of combating bedwetting

Traditional medicine with its recipes can also become an assistant in the fight against illness.

A tablespoon of dill seeds Brew a glass of boiling water and leave for 1 hour. Children up to 10 years of age are given half a glass to drink in the morning on an empty stomach.
A decoction of St. John's wort leaves is added to the lingonberry compote. and give the child something to drink several times a day. The product helps well with incontinence, which is caused by psychological factors.
Pour 2 tablespoons of rose hips into one liter of boiling water. and let it brew. You need to drink the infusion several times a day, replacing tea or compote with it. Rosehip not only helps to cope with enuresis, but also has a general strengthening effect on the entire body.

Traditional medicine offers a huge number of recipes for enuresis. But before using them, do not forget to consult your doctor.

For treatment to be effective, family members must become a moral support for the child. Praise him for every dry night, don’t scold him if the bed suddenly turns out to be wet again.

You need to reassure your loved one, inspire him that you can get rid of all this and that he is able to cope with the problem that has arisen. Feeling the full support of loved ones, the baby will quickly cope with such an unpleasant phenomenon as nocturnal enuresis.

All parents are faced with the problem of bedwetting in children, but not everyone knows that you really need to start worrying when it happens after 5 years. The disease means the bladder is unable to hold its contents. When a person sleeps, the muscles relax, so involuntary urination occurs.

If “trouble” happened to a small child, then there is nothing to worry about. Parents of children who have crossed the five-year mark and continue to wet the bed should sound the alarm. Factors contributing to the onset of the disease.

Until a certain age, urination in babies is not regulated due to the fact that from the moment of birth they adapt to new conditions, form all life processes and skills to meet their physiological needs. If by the age of 4 these processes have not returned to normal, then parents need to ask themselves the question of the causes of the pathology.

According to the famous pediatrician Komarovsky E.O., enuresis does not mean the presence of serious pathologies in the body, so its treatment can quickly help get rid of involuntary urination during sleep, if it is properly organized. The main thing is that parents must remember the need for a gentle attitude towards the child, even if the treatment is delayed. The activity of all organs in the body is carried out through the brain, which is connected to them by nerves through the central nervous system, so the problem of urinary incontinence at night is not only physiological and medical in nature, but also psychological.

Anything can become an irritating factor: quarrels, parental divorce, the appearance of a small child in the family who receives more attention, fear, relationships in the classroom. Along with sessions with a psychologist, parents need to create a favorable environment in the family that minimizes stress: no punishment, ridicule, or publicizing the problem.

About the causes of the disease

In newborn children, the nervous system is not yet sufficiently developed, so urination occurs uncontrollably - up to 20 times a day. As the baby grows, nerve endings develop, children begin to control urges and learn to go to the toilet.

Full formation of the reflex should occur on average by 4 years, but depending on the individual characteristics of the body, it can happen a year earlier or upon reaching 5 years. The alarm should be sounded if, at the age of 6, 7, 8, 10, 11 years, involuntary urination in a child occurs during daytime and night sleep. Causes of enuresis:

complications during pregnancy or childbirth, as a result of which the child was found to have perinatal hypoxic damage to the nervous system;
hereditary predisposition - this means that a gene is passed from the parents to the child, which helps to increase the level of substances that reduce the response of bladder cells to antidiuretic hormone in the blood;
presence of infection in the urinary tract or urological disease;
stressful situations, unfavorable environment, psychological trauma;
insufficient bladder capacity - this symptom must be taken into account if the child has previously had pyelonephritis;
congenital or acquired diseases of the brain or spinal cord;
diabetes;
allergic reaction.

The cause of urinary incontinence can be psychological trauma received by the child. The nervous system of children is unstable, so even a quarrel in the family sometimes turns into health problems.

Enuresis in children can occur as a result of the action of several factors simultaneously; one cause can give rise to another. A very simple reason for involuntary urination at night can be, in the absence of pathologies, a sound sleep or an excessive amount of liquid, fruit, cold foods taken immediately before bed, or hypothermia of the body. Do not discount the psychological factors that contribute to the development of urinary incontinence: quarrels, night terrors, jealousy, etc.

Which specialist should I contact?

The doctor who deals with the primary diagnosis and treatment of all childhood diseases is a pediatrician. Despite the fact that the disease is associated with the urinary organs, it is worth starting with a visit to this particular specialist. A qualified doctor must identify the specialist who will be needed for a more accurate diagnosis and refer the parents and child for a full examination.

Considering that enuresis is a disease that can be caused by a number of different factors, it is appropriate to undergo examination by several specialists:

the neurologist prescribes electroencephalography, which should reveal the state of the nervous system;
the psychologist finds out whether there have been stressful situations, how the child is developing, uses special techniques to identify the emotional background in the family, and gives recommendations to parents;
The urologist prescribes an ultrasound of the kidneys and bladder, a urine test, and then drug treatment.

Each specialist works in turn, looking for the causes of the disease in their area.

If there is any doubt about determining the cause, the council may refer the child for examination to other specialists - a nephrologist, an endocrinologist. A core range of specialists is usually enough to confidently make a diagnosis and prescribe treatment that will help relieve the child of involuntary urination at night.

How to treat enuresis?

There is no single prescription for the treatment of bedwetting in children, since the prescription depends on the causes of its occurrence. Each specific case requires an individual approach. Methods of drug treatment are prescribed based on the results of diagnosing the condition of the bladder muscles, the content of the hormone vasopressin, which regulates fluid levels, as well as the condition of its receptors:

Minirin - produced on the basis of vasopressin in the form of nasal drops, instilled before bedtime;
Driptan – with increased bladder tone;
Minirin in combination with Proserin - for hypotension of the bladder in the form of injections;
Nootropil, Persen in tablet form, B vitamins - treat nocturnal enuresis of neurotic origin.

All medications are used only after examination, identification of the causes and prescription by a specialist with strict adherence to the rules of administration and dosage. Alternatively, patients may be referred to a homeopathic physician who will prescribe alternative remedies:

Pulsatilla – in the presence of infectious diseases of the urinary tract, also for emotionally excitable children;
Gelsemium – for symptoms of relaxation of the bladder muscles as a result of stressful situations;
preparations containing Phosphorus are prescribed to children who drink a lot of cold water;
Sepia – for urinary incontinence when coughing, laughing at any time, also in the first 3 hours after falling asleep.

Modern homeopathic medicines can guarantee a cure for enuresis, provided that the diagnosis is correct. Alternative methods may be prescribed if medications do not have the desired effect and bedwetting in children cannot be cured.

Diseases of nervous origin are often treated using traditional medicine. Persen is considered one of the safest sedatives. About non-drug methods

Medications will not have the necessary effect on curing enuresis if the cause of its occurrence is psychological. Other factors that help normalize the urination process:

Organization of the daily routine. Correct regulation of all processes during the day will accustom the body to internal discipline (eating at strictly defined hours, walks, daytime rest, sleep, entertainment) and will gradually eliminate enuresis in children. It is necessary to teach your child to stop eating 3 hours before bedtime. To fulfill this difficult condition, the best example should be the parents themselves.
Bladder training exercises. It is necessary to teach how to control the process of urination. To do this, you need to learn to briefly delay the desire to go to the toilet.
Creating a motive. Motivational therapy is a powerful psychotherapeutic tool that is used for children suffering from enuresis. It is used exclusively in cases where the cause of the disease is psychological factors. The motive should be to reward the child for “dry” nights. What will be the subject of reward and for how many successful nights is an individual decision, but the technique works in 70% of cases.
Physiotherapeutic treatment. Physiotherapy in the form of electrophoresis, acupuncture, magnetic therapy, electrosleep, circular shower, and therapeutic exercises is designed to improve the functioning of the brain and nerve endings.
Psychotherapeutic assistance. Using special techniques, the specialist teaches the child methods of self-hypnosis. As a result, the reflex connection between the central nervous system and the bladder muscles should be restored. If the neurotic nature of bedwetting is pronounced, then psychologists use their tools to shift depressive states. The main role in psychotherapy should be played by creating a favorable positive atmosphere in the family.

In some cases, the child can be helped by therapeutic exercises, which stimulate nerve endings and strengthen the nervous system. Traditional medicine in the fight against the disease

Traditional medicine is a storehouse of healing methods for all kinds of diseases, so you should not neglect effective home recipes that came from time immemorial. They have been tested in practice by many generations of people and contain only natural ingredients:

For children under 10 years old, brew a tablespoon of dill in a glass of boiling water and leave for an hour. Drink half a glass in the morning on an empty stomach.
Cook lingonberry compote with the addition of 2 tablespoons of rosehip, let it sit. The infusion can be drunk several times a day; it has a calming effect on the nervous system.
Pour 2 tablespoons of rose hips into one liter of boiling water and leave. Instead of tea, drink throughout the day. Rosehip strengthens nerve cells well.
Bring lingonberry berries and leaves, St. John's wort in an arbitrary small amount to a boil in ½ liter of water. Leave for 30 minutes, strain, cool and take throughout the day.
Brew 30 g of crushed plantain leaf in 350 ml of hot water, let it brew, take 10 g 4 times a day.
Chop the herbs of mint, St. John's wort, birch leaves, chamomile flowers in equal parts and mix. Pour 50g of the mixture into 1 liter of hot water in a thermos and leave for 8 hours. Take 100 g half an hour before meals. To ensure that your child drinks the infusion with pleasure, you can add honey to it. After 3 months you need to take a break for 2 weeks, then continue taking the drug.
A collection of knotweed, yarrow, St. John's wort, and blackberry leaves will relieve the symptoms of enuresis. All ingredients must be crushed and mixed in equal parts. Pour 300 ml of boiling water over the finished 10g mixture and leave in a thermos for 2 hours. The infusion should be taken 5 times a day before meals.

Folk remedies will have the desired effect if taken under the supervision of a physician. Herbal remedies are an addition to the main treatment and should not be a complete replacement for it. In addition, herbal remedies can have a good effect in preventing enuresis.

Reading time: 5 min.

Enuresis is persistent nocturnal urinary incontinence, involuntary urination at night that does not correspond to the psychological age of the child. Enuresis in children may be associated with organic causes, or it may be psychogenic.

The disease is considered primary if involuntary urination at night is observed regularly, and secondary when the child has already had a “dry period” - the disappearance of incontinence symptoms for 6 months or more.

1. Prevalence

In general, boys suffer from the disease 1.5-2 times more often than girls. Among those children whose parents were also diagnosed with enuresis, the likelihood of its occurrence increases to 70%. The frequency of involuntary urination at night is higher in dysfunctional families.

Cystectomy, transurethral resection and other types of bladder surgery

2. Causes of bedwetting

Proven causes of enuresis in children are:

1Hereditary predisposition. If one of the parents suffered from the disease, then the probability of it occurring in the child is about 40%, if both parents, then the risk of the disease increases to 70%. Currently, experts distinguish several types of pathology caused at the gene level: type 1 (*600631, 13q13–q14.3, ENUR1 gene, Â) and type 2 (*600808, 12q13–q21, ENUR2 gene, Â).
2 Urinary tract infection. According to research, the incidence of asymptomatic urinary tract infections in five-year-old girls is 1%, and with enuresis - 5%.
3Stress. If a child experiences severe emotional shock at the age of 3-4 years, then the likelihood of pathology doubles. Typical stressful conditions for children are separation from their mother for more than 1 month, parental divorce, moving, the birth of a second child, accidents, hospitalization, sexual abuse, etc.
4Social disadvantage. This means living in orphanages, cramped apartments, and being raised in socially disadvantaged families.
5Delayed neuropsychic development. Enuresis in the group of children with delayed speech development and motor skills is observed 2 times more often.
6Late potty training.
7Insensitivity of the kidneys to antidiuretic hormone (ADH) at night.

Unlikely causes of enuresis include structural abnormalities of the urinary tract, decreased functional ability of the bladder, heavy sleep, and epilepsy.

Secondary enuresis can be one of the symptoms of the following diseases:

1Developmental anomalies, injuries and tumors of the spinal cord - spina bifida, myelomeningocele, etc.
2Epilepsy - against the background of ongoing antiepileptic therapy or during minor seizures.
3Attention deficit hyperactivity disorder.
4Neurosis and neurosis-like conditions.
5Intellectual disability, mental retardation.
6Taking medications used in neurology - phenytoin, valproate, diazepam, baclofen, botulinum toxin, thioridazine, etc.
7Food allergies.
8 Malabsorption syndrome, intolerance to certain foods - gluten, lactose.

Urinary incontinence in women - causes, diagnosis, treatment methods

3. Diagnosis criteria

According to the International Classification of Diseases, X Revision (ICD), there are 5 main criteria for diagnosis.

Table 1 - Diagnostic criteria for enuresis

Causes, symptoms, treatment tactics and main groups of antibiotics prescribed for cystitis in children

4. Features of pathogenesis

The physiological development of urinary control in a child occurs in several stages:

1Infantile bladder. It is observed in the first months of life after birth. The bladder fills and then empties under the influence of the parasympathetic nervous system. This process is not controlled by consciousness.
2Immature bladder. At the age of 1-2 years, impulses from the bladder, when it is filled, are sent to the cerebral cortex, so the child already partially controls urination independently. First, involuntary urination disappears during the day, and then at night.
3The bladder usually becomes mature by 3-4 years, less often by 5-6 years. By this time, its volume increases, the baby is able to actively contract the pelvic floor muscles and the urethral sphincter, as well as suppress detrusor hyperactivity.

With enuresis, bladder maturity is not observed. In some children, the maturation process is completed by 6-7 years, less often by adolescence, after which spontaneous healing occurs.

5. Pathogenetic mechanisms

Whatever the causes of enuresis, the mechanisms of development of the disease can be reduced to 3 main ones:

1Violation of the correspondence between the volume of the bladder and the amount of urine.
2Increased detrusor activity at night.
3Disturbance of awakening processes.

Violation of the correspondence between the volume of the bubble and the amount of contents can be caused by:

1Anomalies in the structure of the genitourinary system, initially accompanied by a decrease in the volume of the bladder, etc.
2Impaired production of hormones that reduce urine formation at night - vasopressin (ADH), etc.
3 Habit of drinking at night.
4Insensitivity of the kidneys to the action of antidiuretic hormone.
5 Diabetes mellitus or diabetes insipidus.
6Snoring, episodes of apnea.
7Pathologies of the nervous system, leading to increased detrusor tone and sphincter weakness.

5.1. Increased detrusor activity at night

The detrusor is the main muscle of the bladder, responsible for contracting it and expelling urine.

With its increased activity, uncontrolled urgent urination is observed at any time of the day, including at night, so overactive bladder syndrome is often accompanied by enuresis.

5.2. Disruption of awakening processes

It is now believed that deep sleep alone does not contribute to bedwetting. Most often, the awakening processes are disrupted: the child does not wake up, despite the fact that the bladder is full.

This is partly due to insufficient interaction between the brain stem structures - the locus coeruleus, which is responsible for awakening, and the urinary center. Now research in this direction is actively continuing.

6. Classification and types of enuresis

We present the classification of the disease in the form of Table 2.

Primary		80-90% of all cases of the disease among young children, the child wets the bed regularly
Secondary		50% of all cases among children 12 years of age and older have a period of “dry” nights lasting at least 6 months, there is a connection with neuropsychiatric, urological or endocrine diseases
Uncomplicated		Absence of objectively confirmed abnormalities in the neurological and somatic status of the child
Complicated		There are deviations in the neurological and somatic status
Organic		With changes at the anatomical and physiological level
Inorganic		With changes at the psychoneurological level
Primary	Monosymptomatic	Bedwetting only
	Combined	Night and daytime urinary incontinence

Table 2 - Classification and types of enuresis

Table 3 - Forms of enuresis based on EEG and clinical observations

6.1. Neurotic form

The neurotic form of enuresis differs from others in that children are absolutely not indifferent to the fact that they have episodes of bedwetting.

Children can experience a variety of emotions, ranging from simple interest in what is happening to painful experiences. As a rule, psychotrauma plays a large role in the occurrence of the neurotic form of enuresis.

Types of neurotic form:

1Asthenoneurotic. It develops after psychological trauma in weakened, emotionally vulnerable, quiet and shy children only during certain age periods associated with critical age (3, 5, 7 years). They are very sensitive about their defect, which leads to a feeling of inferiority. Restless sleep, you may dream about a traumatic situation. No changes are observed on the EEG.
2 Hysterical. It is more common in artistic, active, sociable girls with a lively temperament and rich facial expressions. No changes are observed on the EEG.
3Jet. In this form, enuresis itself serves as a psychological trauma and causes a severe emotional state (up to and including suicide attempts). If symptoms persist, there is a risk of permanent personality changes even after the disease disappears in older age.

7. Treatment

Treatment of bedwetting in children is complex, including the use of psychotherapeutic techniques, drug therapy, and lifestyle changes.

7.1. Mode optimization

It should be aimed at strengthening the conditioned urination reflex or its development. Includes:

1Psychologically comfortable mode – eliminating stress, prolonged viewing of TV shows, overwork, etc.
2Maintaining optimal body and surrounding temperature (avoid hypothermia, warm bed).
3Wake the child until he is fully awake at the same time to consciously go to the toilet.

7.2. Diet correction

Have dinner no later than 3 hours before bedtime. In the evening meal, exclude foods that increase urination: strong tea, coffee, cucumbers, apples, watermelons, milk, kefir.

For dinner you can give dry crumbly porridge, cheese, egg, a sandwich with jam, butter.

7.3. Attitude of family members

It is necessary to create a warm and cozy atmosphere in the family. The attitude towards the child should be even and calm. He should not be punished for involuntary urination, so as not to increase feelings of guilt and anxiety. After each case, it is necessary to change bed linen and wet clothes; the baby should not be left in a wet bed until the morning.

7.4. Self-control training

Regular performance of special exercises contributes to the development and consolidation of mechanisms for independent control of urination. Important aspects are strengthening self-confidence, elements of role-playing games, behavioral psychotherapy, alarm therapy (urinary “alarm clocks”).

7.5. Physiotherapy

Exercises are prescribed to strengthen the abdominal and pelvic floor muscles. Skating, skiing, cycling, and swimming are quite effective.

7.6. Drug therapy

As a rule, treatment of primary enuresis begins with the appointment of an analogue of the antidiuretic hormone - desmopressin, minirin. According to the recommendations of WHO and the European Society for the Study of Enuresis, these are the drugs of choice No. 1, which have proven their effectiveness.

The dose of desmopressin is selected individually, starting from 0.2 mg. The course of treatment is 3 months. Then they take a week's break, and if the episodes recur, then a repeat three-month course is carried out with an adequate dosage of the drug (up to 0.4 mg).

The effectiveness of desmopressin reaches 80-90%, so in foreign clinics treatment begins with it. Desmopressin can be combined with many antibacterial agents.

If desmopressin is intolerant, drugs of other groups are prescribed. The choice of a specific remedy depends on the clinical picture and the expected nature of urinary incontinence.

Nocturnal enuresis in children is considered a fairly common problem in preschool and school age. This is the uncontrolled separation of urine in a small or large volume at night. This problem needs an urgent solution, since over time, in the absence of proper treatment, it can develop into a permanent condition. Why does enuresis occur and how to treat bedwetting in children?

“Wet bed” does not happen rarely in growing children, but this phenomenon should not be treated as temporary and left to chance.

Types of enuresis

There are two main types of bedwetting:

Primary enuresis - occurs for the first time in a child and is manifested by uncontrolled urination at night. This type of enuresis has a mild form and there is no need to apply a specific treatment method to it.
Secondary - occurs under the influence of certain factors (it may appear and then disappear again).

Types of enuresis depending on the form of occurrence:

uncomplicated - symptoms appear related only to uncontrolled urination, otherwise everything is fine with health;
complicated - the malaise is expressed not only by characteristic symptoms, but also affects internal organs, provoking an inflammatory process and some deviations in the development of the child.

Minor types of incontinence in children:

Neurotic enuresis - appears in children who are ashamed and to some extent afraid of their condition. Such children have disturbed sleep, as they fear that they may wake up “wet.”
Neurosis-like enuresis - incontinence appears in overly nervous and hysterical children. Until adolescence, they do not worry about their condition, and then, beginning to understand that it is bad, they withdraw into themselves and alienate society.