Nocturnal enuresis in a 5-year-old child. Nocturnal enuresis in children: causes and treatment

Childhood enuresis is a problem that affects 10-15% of children age group from 5 to 12 years. If at 3 years old a child has not yet learned to control and restrain nighttime urges, this is not yet an indicator of the presence or predisposition to enuresis. Only two-thirds of children by the age of three can restrain the desire to “pee” at night or wake up to go to the potty, 75% of children can do this by the age of four, more than 80% by the age of 5, and only by 8 and a half years - almost 90%. children know how to go to the toilet, interrupting their sleep. Therefore it is generally accepted that clinical significance Pathology develops from the age of 5 years.

Enuresis in a child makes it difficult for him to adapt to the children's team. According to medical statistics from various sources, at the age of 5–15 years, the prevalence of the disease reaches 30%. Up to 10% of children, along with bedwetting, continue to have urinary disorders during the day until adolescence and even then adulthood. Enuresis in adolescents can gradually lead to the development of psychopathological disorders, decreased quality of life, depression and even suicidal tendencies.

What is enuresis? This is involuntary urination in a sleeping child over 5 years old. Primary and secondary types are diagnosed:

1. Primary enuresis is a type of disease in which the child has never previously controlled the condition. Bladder at night. This type of disease occurs 5 times more often.
2. Secondary may occur unexpectedly, after quite long period self-control (at least six months) under the influence of any factors (neurological, urological). Secondary enuresis can occur not only at night, but also during the day.

Enuresis is 4 times more common in boys than in girls. Daytime enuresis in children is much less common than nocturnal enuresis in children - only 2% of all cases. Moreover, the daytime uniform is more typical for girls.

Causes

For appointment effective treatment enuresis in children it is very important to establish the cause of enuresis in children. The causes of enuresis in boys and girls are basically the same:

• delayed maturation and immaturity of the central nervous system. The connection between bladder and the part of the brain responsible for issuing the command to empty it. Predisposing factors for this purpose are: organic brain damage (hypoxia or birth trauma) caused by pathologies of pregnancy and childbirth;
• delayed maturation of the nervous system and late formation of the skill of urinary control;
• the effect of constant stress: mother’s departure, moving, shift kindergarten, frequent quarrels between parents, death pet etc.
• heredity plays a role in 44% of cases;
• disturbances in the secretion of the antidiuretic hormone vasopressin, which controls urine excretion by the kidneys. IN normal body Its level increases at night, so urine production slows down at this time. With enuresis, its level decreases at night and excessive fluid production occurs;
• diseases genitourinary system;
• urinary tract infections;
• adenoids.

Bedwetting can also be a symptom of diabetes, hypothyroidism or epilepsy. Some medications can cause this side effect. Some researchers believe that sometimes the cause of childhood enuresis can be too deep sleep.

It should be noted that such traumatic situations in which a secondary type of enuresis can develop in children, such as heavy mental stress, the birth of another child, strict upbringing, frequent punishment, and prolonged use of diapers. Psychotraumatic factors are more common reasons enuresis in girls. Girls are more delicate creatures, more impressionable, on whom stress and experiences have a stronger and more lasting impact. They play a role and specific features character: such as shyness and timidity. What to do if a child has enuresis?

Symptoms of enuresis in children

There is usually only one symptom of enuresis - the child wets himself in the bed at night without waking up. Often with the disease, deep sleep, prolonged falling asleep, and difficult awakening can be noted. Enuresis can be observed together with other sleep disorders: sleepwalking, bruxism, etc. At older ages, due to social reasons the disease may begin to accompany childhood neurosis.

Diagnosis of the disease

When a child and his parents contact a doctor, first of all, necessary research to exclude developmental defects urinary system and spine, diseases of the urinary system, central nervous system, diabetes.

The doctor collects an anamnesis for which he asks the child’s mother about the peculiarities of the pregnancy, whether there was a threat of miscarriage, hypoxia, gestosis, anemia, low and polyhydramnios, intrauterine growth retardation, etc. The features of the growth and development of the baby in the first 3 years of his life are clarified in detail. whether concussions, bruises, neuroinfections, operations. The parent's parenting style, the presence of hygiene and neatness skills, the presence of leukocyturia and constipation are determined. Heredity, frequency of episodes, and type of pathology are determined. The doctor will ask what preceded the onset of the disease: jar of Hearts or stress, hypothermia and a cold or infectious disease, as well as sleep patterns, the presence of insomnia, sleep talking, sleepwalking, bruxism, etc.

The doctor examines the patient. Then they examine clinical indicators urine, carried out bacteriological examination. If your child has:

• frequent - more than eight times per day urination;
• rare – less than 5 times per day urination;
• sudden, very strong urges;
• day uniform;
• immature urination in a child over 4 years old,

IN the latter case a more in-depth examination is carried out. The child may be prescribed ultrasonography of the kidneys and bladder and ultrasound, uroflowmetry, voiding cystourethrography. If diagnosed secondary form, a urodynamic examination is prescribed. The doctor can refer you for studies such as excretory urography, EEG, cystoscopy, and also give a referral to a consultation with a neurologist and a psychologist. Only after diagnosis can a specialist answer the question of how to treat enuresis.

Sleep hygiene for a child suffering from enuresis

1. Exact adherence to the daily routine is very important. The child should go to bed at the same time every evening.
2. The child should have dinner no later than 3 hours before bedtime. During dinner, you should not eat or drink foods that have a diuretic effect - for example, apples and kefir. You need to drink no more than 100 ml.
3. The last time a child can be given a drink is no later than 2 hours before falling asleep. During the day, you also do not need to drink diuretic drinks, such as cranberry or lingonberry fruit drinks. The diet should include juices, dried fruit compotes, and still water.
4. Avoid active activities before falling asleep. Read a book, play Board games– the baby should not fall asleep without his hind legs.
5. Before falling asleep, he must go to the toilet.
6. At night, place the pot next to your bed and turn on a night light. Some children are simply afraid to get up in the dark to go to the potty.
7. At night, the child either does not need to be woken up at all or he needs to be woken up completely to the point of awakening so that he is aware of his actions. Otherwise, a half-asleep baby will not perceive the fact that he deliberately went small, and the mechanism of enuresis will become psychologically even more entrenched in him.
8. Create a feeling of psychological comfort for your baby. There is no need to scold or punish him; protect him from teasing peers.
9. Praise your child after every dry night.

Treatment of enuresis

Comprehensive treatment of nocturnal enuresis in children should reduce episodes and frequency of urination, increase bladder volume and ensure stable long-term remission. How to treat enuresis in children at home? The duration and number of courses of therapy are selected individually for each patient.

Drug treatment

With proper drug treatment at home, it is possible to overcome enuresis in a third of patients. However, only a doctor can prescribe medications. The causes and treatment of the disease are interrelated. How to cure this unpleasant disease?

1. If the rhythm of vasopressin secretion is disturbed, then its synthetic analogue is used - Minirin or desmopressin. You cannot use this drug on your own, because the cause of the pathology may lie in a different plane. During therapy with Minirin, children experience an increase in the effective volume of the bladder, then a decrease in intravesical pressure and a gradual completion of nocturnal unpleasant episodes.
2. If the cause of the pathology is an infection of the urinary system, antibacterial therapy is prescribed, after which the wet bed will be forgotten within a short time.
3. If a disorder is diagnosed nervous regulation Bladder, increased tone smooth muscle helps to reduce its volume; to cure enuresis, driptan is prescribed. It increases its volume, reduces spasm, making it more rare cuts muscles and, as a result, eliminating episodes of incontinence.
4. Often in children, treatment with minirin is carried out together with driptan.

To activate metabolic processes brain and for neuroses, sedatives and nootropics are prescribed: nootropil, picamilon, novopassit, persen, etc. Pantocalcin calms autonomic pathologies, increases the effective volume of the bladder, and eliminates incontinence. Therapy with vitamins B, A, and E is indicated. Levocarnitine or Elcar is also prescribed to improve energy production.

Non-drug treatment

Much attention is paid to family psychocorrection aimed at solving conflict situations. Physiotherapy for enuresis in children is necessarily included in the treatment complex, in the form of currents on the bladder, ultrasound, and thermal procedures. General strengthening and special massage for enuresis, exercise therapy aimed at strengthening the muscles of the pelvic floor are used. Treatment of enuresis is a long process that can take months. Therefore, a friendly, patient parental attitude is very important so as not to irreversibly damage the child’s psyche.

It cannot be said that treatment of childhood enuresis with folk remedies is very effective, but when the child began to pee recently and this happens rarely, you can try treatment with folk remedies: herbal infusions. Treatment is mainly carried out with decoctions and infusions of parsley, St. John's wort, violet, dill, sage, yarrow, thyme, wheatgrass and other herbs. Some parents practice this method: feed the child salty food, for example, herring, at night, so that he does not want to go to the toilet at night. But this is too painful for a child who will probably want to drink.

Prevention of enuresis in children

To minimize the likelihood of developing enuresis you should:

• stop using diapers in time. The use of diapers for babies over two years of age is not recommended;
• do not develop the habit of drinking a lot before bedtime;
• develop the habit of going to the toilet before bed;
• teach with childhood genital care;
• promptly recognize and treat possible infections and diseases of the genitourinary system;
• ensure that the child is free from traumatic circumstances.

List of used literature:

• Glazener C. M., Evans J. H., Peto R. E. (2005), “Alarm interventions for nocturnal enuresis in children,” The Cochrane database of systematic reviews (Chichester, UK: John Wiley & Sons, Ltd) (no. 2)
• Hjalmas K., Arnold T., Bower W., Caione P., Chiozza L. M., von Gontard A., Han S. W., Husman D. A., Kawauchi A., LAckgren G., Lottmann H., Mark S., Rittig S., Robson L., Walle J. V., Yeung C. K. (2004). “Nocturnal enuresis: an international evidence based management strategy.” The Journal of urology. 171 (6 Pt 2): 2545-2561
• Glazener C. M., Evans J. H. (2002), “Desmopressin for nocturnal enuresis in children,” The Cochrane database of systematic reviews (Chichester, UK: John Wiley & Sons, Ltd) (no. 3)

Children under 5 years old can still pee in their pants. At the age of 8 years this already becomes a problem. The student is not only uncomfortable, but also ashamed of this situation. How to solve this problem and get rid of it?

To solve the problem, it is necessary to identify the cause of nocturnal enuresis in boys aged 8 years. There are many reasons that differ in their etiology.

First place is taken psychological factors. A student can write at night if there is a change in the situation. For example, a child went to new school, the family changed their place of residence. Conflicts in the family, the loss of a close relative or a pet can lead to stress. In this case, enuresis may go away without treatment, but parents should restore psychological condition your child.

Stop domestic conflicts, try to spend more time with your baby, be sincere and honest with him. If your situation changes, explain the need to move. But it’s better not to dwell on issues of death. Just drop this topic.

Immaturity or dysfunction of the central nervous system can also cause incontinence.

A child may start peeing in bed even if there is a malfunction endocrine system. In this case, in addition to enuresis, there will be heavy sweating and swelling of the face.

Violation hormonal levels, genetic predisposition, weakening of the functionality of the kidneys and bladder, the presence of pathologies in the genitourinary system can also provoke night and even daytime urinary incontinence.

Cold weather is a common cause of childhood enuresis. Children at this age react more strongly to sudden changes in temperature and to cooling the body.

Also, a schoolchild at the age of 8 can pee in bed if he is often woken up at night to go to the toilet.

What is the cause of bedwetting in children aged 8 years? Is it possible to cure childhood enuresis?

The child wakes up at night to go to the toilet, but does not have time to get to the potty, as his conditioned reflexes are triggered.

The reason for periodic nocturnal enuresis can be very commonplace: deep sleep baby, a large number of drinking water and eating fruit before bed.

If a student does not drink water or eat fruits and vegetables several hours before bedtime, and often wets the sheets, then you should contact a specialist rather than wait for the problem to disappear on its own.

Only after full examination and receiving the results of all tests, you can make a diagnosis, determine its causes and, if necessary, begin treatment. Treatment must be carried out strictly according to the doctor’s regimen, in compliance with all special recommendations.

Urinary incontinence in children at night or V daytime – an unpleasant symptom observed both as a manifestation of urinary tract disease and in somatic and neuropsychic diseases.

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

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

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

Bedwetting can occur in overly excitable, impressionable children due to lack of sleep or overwork. It is necessary to avoid provoking factors in the lives of such children. In addition, you should limit your consumption of water, tea, and milk before bedtime.

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

Enuresis and associated symptoms

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

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

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

There are functional forms of enuresis (due to psychogenic factors, defects in education, mental trauma suffered infectious diseases; sometimes reflex factors arising from diseases of the genitourinary system) and organic (changes spinal cord with developmental defects).

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

Marked neurotic disorders– hot temper, secrecy, depression, shyness. In the organic form, changes in muscle tone, tendon reflexes, mild pyramidal signs, and impaired sensitivity are detected.

Treatment of bedwetting in children: drugs, medications, procedures

Treatment consists of excluding mental trauma, and prescribing a correct water-hygienic regimen with fluid restriction in the afternoon.

Sedatives, restoratives and tonics are used (glutamic acid for 2–3 months, glycerophosphate, calcium gluconate, phytin, lecithin-cerebro, arsenic, strychnine, bromine, vitamins, elenium, melipramine, securenin, adiurecrine, dibazole, ephedrine). Physiotherapeutic procedures are prescribed: darsonvalization, quartz, galvanic collar according to Shcherbak, pine baths, rubdowns. Sanitation of lesions is of great importance chronic infection(adenoids, tonsillitis).

Treatment with folk remedies for urinary incontinence in children at home

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

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

Yarrow. 10 g of herb with flowers per 1 glass of water. Boil for 10 minutes over low heat. Leave for 1 hour, strain. Take 1/2 cup 3 times a day.

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

Common lingonberry:

1) 2 tbsp. l. Brew a mixture of leaves and berries with 2 cups of boiling water and boil for 10 minutes over low heat, cool, strain. Drink half during the day in several doses, and drink the other half before bed.

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

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

Blueberry, eat fresh berries.

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

The most reliable means A mixture of 2 herbs was considered for urinary incontinence: St. John's wort And centaury. They should be taken in equal quantities (1:1), brewed and drunk like tea, 1 tsp. appointment.

At frequent urges before urination, celery, watermelon, very ripe grapes and asparagus should be excluded from the diet until complications with the bladder have completely resolved.

Video on the topic

What not to do if a child has enuresis: Dr. Komarovsky

Dr. Komarovsky will tell you what parents should not do if their child has enuresis.

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

Dr. Komarovsky will tell you when and how to treat enuresis, and will emphasize that parents need to be patient and develop a desire to get rid of the unpleasant feature in the child himself.

Elena Malysheva: bedwetting in children

In this episode of the TV show “Live Healthy!” with Elena Malysheva you will learn how to get rid of bedwetting in children.

You cannot scold or punish children for having a wet bed. The child feels unhappy because he cannot control himself, but he cannot cope with this alone.

Causes of bedwetting in children

1. Functional immaturity of the mechanisms regulating urination. In adults, when the bladder is full, its muscular lining stretches and the nerve endings embedded in it send signals to the brain, which gives the command to urinate. In children, the relationship between the bladder and the brain is not fully formed. The brain cannot give the command to urinate, so the bladder spontaneously performs its function.
2. Urinary system infections.
3. Epilepsy.
4. Tumors.
5. Spinal injuries.

What to do

1. If a child over 3 years of age has bedwetting, you should consult a doctor to rule out diseases that cause incontinence as a symptom.
2. Get a urine test and an ultrasound to rule out urinary tract infections.
3. Monitor the amount of fluid your child drinks and excretes. To do this, it is necessary that the child excretes urine not into the toilet, but into some container with a known volume. If it turns out that you drank a lot and excreted little, then the problem is most likely related to kidney disease.
4. Bedwetting in a child may be the only manifestation of epilepsy. To exclude this disease, it is necessary to undergo a special overnight examination, as a result of which doctors will be able to accurately say whether bedwetting is a symptom of epilepsy.

How parents should behave

The child feels unhappy because he cannot control himself, but he cannot cope with this alone.

1. Don't scold your child, don't put him in a corner.
2. Take your child to the toilet before bedtime, and try to wake him up during the night.
3. Reward your child for dry nights. Keep a calendar in which “dry” nights are indicated, for example, with asterisks. Bad nights are ignored. Praise your child for increasing the number of dry nights.

Daytime urinary incontinence is much more dangerous than nighttime incontinence and indicates some serious illness! During the day, when the child is awake, the connection between the brain and the bladder should not be disrupted.

How to solve the problem of urinary incontinence in children

In children, the excretory or excretory system matures much later than other organs and systems in the body. Final maturation is observed only around the age of four.

And if your child wets the bed within this age range, there is no need to be alarmed.

Sometimes the bladder matures to normal with a delay. But if this happens already in more late age, then this may already be a problem of development or consequences of the disease or complications after them. This video contains some tips on how to solve the problem of urinary incontinence in children using folk remedies and in a cheaper way.

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 level 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 in the evening, fluid restrictions may be recommended. various schemes. 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. By doing this method sometimes the child is unable to wake up from sound signal or vibration of the device, in this case, parents should 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 urinary alarm therapy due to various reasons, for example: skin irritation, disturbance of other family members and/or refusal of parents 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 more high performance the effectiveness of 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 this drug when administered in 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 proper therapy desmopressin 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 forgot, or for objective reasons took 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 various 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 may occur from of cardio-vascular 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.

Complementary and alternative treatments for enuresis

Research on additional and alternative methods Treatments for primary nocturnal enuresis such as hypnosis, psychotherapy and acupuncture show that beneficial effects are 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.

Available various methods therapy, but none of them, used separately, is effective (which reflects 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 should 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 for short-term relief, allowing the child to plan social contacts with peers, such as visiting children's camp or a 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 some responsibility for enuresis treatment, it is recommended that simple methods treatment. These include keeping a record of dry nights, bladder training and monitoring your fluid intake (see above).

"Urine alarm" or drug therapy should be used in children who have no effect within 3 to 6 months 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 alarms 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.

Urinary incontinence in children is defined as frequently repeated spontaneous urination at night or during the day, regardless of desire. According to pediatric statistics, a similar pathology is diagnosed in approximately 9% of children; it is also called enuresis.

It is important to understand that until 18-24 months the baby’s nervous system is not yet mature, therefore, until this age, uncontrolled urination is considered a natural phenomenon, that is, the norm.

The ability to delay the act of urination when wanting to empty the bladder in a child is fully formed only by the age of 3, but if the baby has already crossed this age limit, and urinary incontinence continues, then parents, of course, should look for the reason.

Causes of urinary incontinence in children

Experts identify a number of factors that can lead to urinary incontinence in children during the day or at night, these include:

• Lesions of the central nervous system or spinal cord - traumatic brain injuries, spinal hernia, as a result of which the roots of the spinal cord are compressed, inflammation of the arachnoid membrane of the brain, myelitis, cerebral palsy;
• Mental illnesses – schizophrenia, epilepsy and others;
• Anatomical congenital pathologies organs of the genitourinary system – ectopia of the ureteric orifice, obstruction urethra or ureters, hypospadias;
• Diseases of the endocrine system - diabetes or hyper or hypofunction of the thyroid gland;
• Treatment by some medicines, for example, tranquilizers;
• Delayed development of the central nervous system caused by birth trauma in the child, fetal hypoxia during pregnancy, asphyxia during childbirth, severe gestosis suffered by the mother during pregnancy, oligohydramnios or polyhydramnios;
• Violation of the production of the hormone vasopressin (antidiuretic hormone) - nocturnal enuresis in children is most often caused by this disorder;
• Infectious and inflammatory diseases of the genitourinary system - cystitis, urethritis, pyelonephritis, vulvovaginitis, balanitis or balanoposthitis in boys;
• Allergic diseases - dermatitis,...

Often doctors have to deal with stress urinary incontinence in children, which is caused by scandals in the family, separation of parents, loss of a beloved animal, fear, ridicule of peers, change of place of residence.

According to doctors, the reasons for bedwetting in children aged 3 years are also the long-term use of disposable diapers, as a result of which the child does not feel his body and does not feel the urge to urinate.

First of all, it is important to understand that urinary incontinence in young patients is not an independent problem, but a combination of disorders in the body of a neurogenic, hormonal or infectious nature. Enuresis can be constant or episodic in nature, prevailing during the day or night.

Clinically, the pathology manifests itself as follows:

• Complete emptying of the bladder, which occurs spontaneously;
• Urine leakage while laughing physical activity, straining, sleep;
• Enuresis of an infectious nature is often accompanied by pain and cramping when urinating, discharge of blood or pus in the urine, periodic increases in body temperature and fever;
• Associated symptoms of enuresis in children are isolation, irritability, psycho-emotional instability, stuttering, vulnerability, and sleep disturbances.

Bedwetting in children

Prevalence of childhood nocturnal enuresis, graph

Most often, doctors have to deal with nocturnal enuresis, and the pathology can be observed not only in children, but also in adolescents up to 12-16 years of age.

If there is no urinary incontinence in children during the day, and involuntary urination occurs only during night sleep, in most cases the pathology is due to a hereditary predisposition and the maturation of the nervous system.

The correct approach to the problem, the organization of a calm environment in the family and timely diagnosis and treatment of possible infectious and inflammatory diseases as the causes of enuresis, allows you to get rid of involuntary urination.

Diagnosis of childhood enuresis

Examination of a child with involuntary urination is aimed primarily at identifying the cause of enuresis, therefore not only a urologist, but other specialized specialists can take part in diagnostic procedures.

Diagnosis of urinary incontinence includes:

• Collecting an anamnesis of the child’s life - the course of pregnancy in the mother, past illnesses organs of the genitourinary system, family situation;
• Visual assessment general condition– conversation with the child, assessment of the adequacy of his behavior;
• Examination of the external genitalia and palpation of the lumbar area;
• Laboratory tests - urine tests: bacterial culture, according to Nechiporenko and others;
• Ultrasound of the retroperitoneum and bladder;
• Urography with the introduction of a contrast agent;
• If necessary, invasive procedures are performed - cystoscopy, urecystoscopy, cystometry, electromyography of the bladder muscles;
• To assess neurological status, how possible reason enuresis in a child - EEG, EchoEG, craniography, or computed tomography;
• Consultation with specialized specialists – psychiatrist, psychologist, neurologist.

Treatment of urinary incontinence in children (enuresis)

A specific cure for enuresis in children has not yet been found; treatment of the pathology is aimed at eliminating the causes that contribute to urinary incontinence:

1. Congenital anomalies of the development of the genitourinary system - carrying out surgical interventions aimed at eliminating the defect (plastic sphincters, urethra, suturing fistulas);
2. Inflammatory and infectious diseases - antibiotics and antibacterial drugs;
3. Psychotrauma – therapy sessions with a psychologist or psychiatrist, appointment sedatives, tranquilizers if necessary;
4. Immaturity of the nervous system due to heredity or birth trauma - nootropic drugs.

Regardless of the type and cause of enuresis in a child, to successfully cure the problem, parents must provide him with the necessary conditions:

1. Favorable psychological environment in the family;
2. Waking up and forcing the child to sit on the potty at night;
3. Limiting fluids before bed, especially with stimulants nervous system effect - carbonated drinks, coffee, black tea, cocoa;
   Elimination of stress.

In addition, very in effective ways Physiotherapeutic methods for treating incontinence in children include:

• D'arsonval;
• Electrosleep;
• Electrophoresis;
• Acupuncture and others.

Treatment of enuresis in children with folk remedies

There are several effective folk remedies for the treatment of urinary incontinence:

Honey– give the child 1 teaspoon of honey at night (of course, if the baby is not allergic). This healing product has a calming effect on the central nervous system, reduces the load on the kidneys, and retains fluid in the body. The course of therapy is at least 10 days.

Dill seeds– Pour 1 tablespoon of seeds into 0.5 liters of boiling water and leave until completely cool. Strain, drink the resulting infusion ½ cup 3 times a day.

Cowberry– take 1 tablespoon of lingonberry leaves and berries, pour two glasses of boiling water and cook in a water bath for 5 minutes, then cool, strain and drink the infusion of 1 tablespoon 3 times a day.

Traditional methods of treating enuresis in children can be a good addition to those prescribed by a doctor drug treatment, but do not replace it.

An integrated approach to the problem will help to quickly get rid of urinary incontinence and significantly improve the patient’s quality of life.