Enuresis in children - causes, symptoms, diagnosis and treatment
Enuresis in children - Violation of the controlled emptying of the bladder, accompanied by involuntary urination during sleep. Enuresis in children manifests leak urine during sleep that can occur intermittently or repeated up to several times per night. Diagnosis of enuresis in children requires the establishment of the causes of violations and includes voiding diary, laboratory tests of blood and urine tests, ultrasound of the bladder, urodynamic studies, neurological examination, and so forth. In the treatment of enuresis in children applied psychotherapy, physiotherapy, drug therapy.
Enuresis in children
urinary incontinence in children, accompanied by repeated episodes of urinary incontinence, which usually occur during sleep. The problem of enuresis in children requires an integrative approach; its decision must be conducted with the participation of experts in the field of pediatrics, pediatric urology and nephrology, pediatric neurology, child psychology, etc. The prevalence of enuresis in children ranging from 4 to 20%: urinary incontinence occurs in 18-20% 5-year-old children. 12-14% - 7-year-olds and about 4% - of adolescents 12-14 years old. Statistically more likely (approximately 2-fold) enuresis in boys.
diabetes, obesity, etc .; epileptic form indicated in epilepsy in children. The development of neurosis enuresis in children is associated with organic lesions of the central nervous system due to toxemia of pregnancy, hemolytic disease of the fetus, intrauterine hypoxia, birth traumas, infections (meningitis, encephalitis, influenza, etc.), Intoxication, traumatic brain injury.
In addition, bedwetting is common in children with a history of urinary tract infection (cystitis), congenital malformations of the urogenital region (epispadias, hypospadias, ectopia of the bladder or the mouth of the ureter), obstruction of the urinary tract (stricture of the urethra or ureter, hydronephrosis), neurogenic bladder bubble, helminth infections, abnormalities of the spine and spinal cord. In the clinic, psychiatric diseases enuresis may be accompanied by current mental retardation and schizophrenia.
When considering the pathogenesis monosemeiotic enuresis in children, most authors are inclined to believe that the basis of violations is delayed the timely formation of reflex control of urination. It is believed that the rate of this control is formed by 3-4 years, when the child increases bladder capacity, the number of urination is reduced to 7-9 per day, children can begin to consciously or hinder urination, feel the need to comply with hygiene rules, awakening during the filling bladder and so on. However, when the functional maturation of the CNS delay informed formation control urination is delayed, leading to the development of children enuresis. Spontaneous disappearance of enuresis in children indicates the completion of the process control over urination. In support of this hypothesis is supported by the fact that enuresis in children is often accompanied by other symptoms delay development of the child: violation of voluntary control of defecation, delayed motor and speech development.
In addition, the researchers point out that in children with enuresis is often disturbed hormonal regulation of water metabolism - namely, the normal circadian rhythm of secretion of antidiuretic hormone (vasopressin). This results in a sufficiently large volume of urine during the night, in the absence of control over urination accompanied by involuntary urine expiration.
constipation or faecal incontinence, emotional instability, increased anxiety and vulnerability, isolation, shyness, various sleep disorders (long falling asleep, restless surface or overly deep sleep, waking disorders). Neurosis enuresis in children is often associated with stuttering, tics, ADHD, fears.
pediatrician, neurologist of children, children's endocrinologist, a child psychiatrist, and others. However, the leading role in the initial stages, of course, belongs to a pediatric urologist.
When collecting history specified perinatal and family burdened, past illnesses, especially the flow of enuresis in children, triggers, and so on. N. A physical child examination involves palpation of the abdomen, examination of the external genitalia, perineum and lumbosacral area, conducting rectal examination to identify developmental abnormalities. Parents of children with enuresis are encouraged to keep a diary in which to record the number of urinary incontinence episodes and a child per day, involuntary urination while, comorbid disorders.
To exclude a urinary infection is carried out a general analysis of urine and blood biochemical analysis of blood and urine, urine culture on the flora. In order to identify anatomical urinary tract changes performed ultrasound of the kidneys and bladder. With urodynamic studies (uroflowmetry, electromyography, cystometry, sphincterometry, profilometry) revealed bladder outlet obstruction and detrusor instability features.
According to the testimony of the children with enuresis can be carried out endoscopic (ureteroscopy, cystoscopy), radiographic (urethrography, cystography, radiography sella, radiography of the lumbosacral spine, etc.), Electrophysiological studies (electroencephalography).
The entire range of diagnostic search allows you to exclude or confirm the presence of enuresis in children with developmental abnormalities of the urinary tract and the spine, urinary tract infections, endocrinopathies, central nervous system diseases.
child psychologists. For younger children, may be used autogenous training, motivational therapy (encouragement for each "dry" night). Among the methods of physical therapy in children with enuresis have proven themselves magnetic therapy, laser therapy, electrophoresis, inductothermy, electrostimulation, galvanization, heat treatments, acupuncture, exercise therapy.
The choice of pharmacotherapy depends on the type of enuresis in children. High efficiency shows the assignment of anticholinergics (oxybutynin), tricyclic antidepressants (imipramine) and analogues of antidiuretic hormone (desmopressin). These funds increase the functional capacity of the bladder, reduce the amount of urine the night, reduce the activity of the bladder at night.
Prediction and prevention of enuresis in children
Enuresis has a relatively benign course: every year 15% of children achieved spontaneous remission, and to the 15-18 age enuresis appears only in 1-2% of individuals. In other cases, with the help of therapy fails to achieve cessation of enuresis in children of 9 out of 10. A complete cure is necessary to speak in the absence of episodes of incontinence for 2 years.
Prevention of enuresis in children is the earliest possible elimination of the causes of urinary incontinence; creating a favorable emotional environment surrounding the child; timely accustom child to the pot and the refusal (no later than 2 years), the use of disposable diapers. Treatment of enuresis in children requires persistence and patience on the part of doctors, parents and teachers, friendly and at the same time demanding attitude towards the child. Lack of attention to the problem of enuresis in children is fraught with the development of their future secondary mental accretions and an inferiority complex.