Nocturnal enuresis in children
A child cannot harmoniously perceive the world if he suffers from urinary incontinence. This pathology, its causes and features of treatment, are of special importance in modern pediatrics. The International Classification of Diseases defines enuresis of inorganic nature as persistent involuntary daytime and (or) nighttime urination that does not correspond to the psychological age of children. This problem becomes most important when the child turns 5 years old.
A characteristic sign of primary enuresis is that the child does not and did not have control over the process of urination. If the baby has consistently controlled the emptying of the bladder for at least six months in a row, and then lost this ability, enuresis is considered secondary (acquired or recurrent). The development of secondary enuresis is significantly influenced by urological or neurological factors.
In the age group from 4 to 15 years old, according to medical statistics, enuresis is episodically or constantly observed in 20-30% of children. In about 8-10% of cases, daytime urinary incontinence persists during adolescence and adulthood. This circumstance worsens the quality of life, requires long-term treatment, and leads to the development of psychopathologies. Enuresis is acquiring enormous social significance, since in 60% of families, parents consider it a serious problem, about a third of them punish children for urinary incontinence. In most cases, it is very difficult or impossible to identify the cause of the pathology. It is believed that nocturnal enuresis has a polyetiological nature, that is, several factors are involved in its development.
Content:
- Causes of bedwetting in children
- Symptoms of infantile enuresis
- Diagnosis of bedwetting
- Treatment of nocturnal enuresis in children
- Minirin for enuresis in children
- Restricting drinking to treat bedwetting
- Is enuresis treatment effective by reward and motivation?
- Should a child with bedwetting be woken up at night?
- Bladder training
- Treatment of bedwetting in children with folk remedies
- Recommendations for parents
- Which doctor treats enuresis in children?
Causes of bedwetting in children
There are several hypotheses about the causes that contribute to the development of enuresis. The assumptions are confirmed by research by specialists in various fields of medicine (urology, pediatrics, neuropathology, psychology).
The most common causes of bedwetting are:
- Immaturity of the central nervous system. A delay in the maturation of the central nervous system occurs due to pathologies of pregnancy and childbirth, craniocerebral injuries, neuroinfections. Due to immaturity, the regulation of the functions of various body systems, including urination, is disrupted. In support of this hypothesis, studies on enuresis cite the following data: 10-15% of children get rid of urinary incontinence spontaneously, without any treatment.
- Dysfunction of the urinary system. Enuresis may be the only symptom of such pathologies as bladder dysfunction, vesicoureteral reflex, myelodysplasia, overactive bladder.
- Sleep pathological phenomenon. Sleeping too deeply can cause you to urinate involuntarily.
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Violation of vasopressin secretion, nocturnal polyuria. A decrease in the production of antidiuretic hormone leads to the production of large volumes of urine at night, whereas in normal conditions, increased secretion of vasopressin reduces nighttime urine production. About 3/4 of children with bedwetting have nocturnal polyuria.
- Heredity. The genetic predisposition is due to the autosomal dominant mode of inheritance of a similar pathology in 75% of direct relatives of a child with enuresis.
- Stress and socio-psychological prerequisites. A child who has undergone severe stress or a long-term traumatic situation during the first 4-6 years of life subconsciously responds to this with urinary incontinence in protest. This hypothesis is confirmed by the fact that after the cure of enuresis, a positive dynamics of the mental state is observed.
Comments of Dr. Komarovsky about the reasons for the development of children's enuresis:
Symptoms of infantile enuresis
The main and leading symptom is involuntary nocturnal urination. It can be single or repeated more than once a night, it can happen regularly, or it can happen once a week, several times a month. Involuntary urination is usually recorded in the first half of a night's sleep, in its deepest phase. At the same time, children do not wake up, but continue to sleep on a wet bed.
Symptoms of complicated bedwetting:
- Rare (less than 5 times a day) or frequent (more than 8 times a day) urination;
- Irresistible (imperative) urge to pass urine or lack thereof;
- Weak urine stream.
Mental disorders of the child accompanying enuresis:
- Increased anxiety;
- Sleep disturbances (too deep or shallow sleep, falling asleep for a long time, sleeping, sleeping, bruxism (teeth grinding));
- Closure;
- Shyness;
- Vulnerability;
- Tics, stuttering;
- Phobias.
The complex of symptoms unites the concept of "immature bladder". A child with an immature bladder cannot regulate the nighttime emptying of the bladder, or control urination. Normally, the maturity of the bladder occurs by 3-4 years.
Diagnostics
When the parents together with the child come to the pediatric urologist's appointment, the specialist begins the diagnosis by taking a detailed anamnesis.
It includes the following parameters:
- The presence of pathologies of pregnancy and childbirth in the patient's mother;
- The presence during the first 3 years of a child's life of spinal cord and brain injuries, neuroinfections, operations on the organs of the central nervous system;
- Family parenting style;
- Parents' requirements for the child's neatness skills;
- Genetic predisposition;
- The frequency of urinary incontinence, the nature of enuresis;
- The presence or absence of sleep disorders;
- An event that gave impetus to the development of enuresis (stress, psychotrauma, illness with hyperthermia, hypothermia).
The more detailed the anamnesis is collected, the less unnecessary examinations will need to be carried out. To facilitate the collection of data, the parents of the child can fill out a kind of diary within 3-4 days before visiting the doctor, in which day and night incidents of urination are recorded, their exact time. In addition, the doctor may be interested in how the child and his parents relate to the problem, what they are doing to treat urinary incontinence.
After collecting the analysis, the specialist conducts a visual examination of the patient.
First of all, the doctor is interested in:
- The condition of the abdominal organs and the genitourinary system;
- The presence of a site of hair growth and retraction of the epithelium in the sacrum, which indicates possible congenital anomalies of the spinal cord;
- Anal sphincter tone;
- Perineal tenderness.
If necessary, the child is sent to the laboratory for the study of urine analysis, bacterial culture.
If there are signs of "immature bladder", an in-depth study is carried out by instrumental methods:
- Ultrasonography of the bladder and kidneys;
- X-ray of the spine;
- Uroflowmetry;
- Cystourethrography;
- Cystoscopy;
- Electroencephalography;
- Measurement of the level of residual urine.
If necessary, the urologist will refer the child and his parents for psychological counseling.
Treatment of nocturnal enuresis in children
Therapy for urinary incontinence is primarily aimed at eliminating the cause of the disease. The selection of drugs depends on what factors provoke enuresis.
Medicines to stimulate the immature nervous system:
- Cortexin is a drug for the development of brain structures, containing vitamins, minerals, biological additives. Release form - ampoules for intramuscular injections. The course of treatment is 10 days with a single injection of 10 ml
- Pantocalcin is a nootropic drug that promotes the transmission of nerve impulses, helping to consolidate new skills. The frequency of use is 25-50 mg three times a day for 2 months.
Drugs prescribed for increased activity and irritability of the bladder:
- Driptan (Oxybutynin) - used to block excessive activity of the bladder muscles in children over 5 years old. The course of treatment is 1 month, the dosage is individual.
- Detrusitol (Tolterodine) - has a similar effect, but is better tolerated by children.
Drugs for the treatment of polyuria (large volume of urine):
- Minirin (Desmopressin) tablets:
- Spray Presmainex.
Antibiotics for urinary tract infections:
- Augmentin;
- Furamag;
- Kanephron N;
- Suprax.
In addition to drug treatment, physiotherapeutic methods are used - heating with paraffin applications of the suprapubic region. A pronounced effect is possessed by psychotherapeutic treatment aimed at eliminating complexes and consolidating useful neatness skills.
Videos about the various forms and treatment of bedwetting:
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Read More: Popular Bedwetting Medicines
Minirin for enuresis in children
The drug is a synthetic analogue of the antidiuretic hormone produced by the pituitary gland. Minirin acts quickly and effectively, after application there are no complications. The effect after taking the medication is visible after 15 minutes and lasts for 10 hours.
The dosage and frequency of use of the drug are determined by the attending physician in accordance with the age and individual characteristics of the child. Minirin tablet, which has a neutral taste, is placed under the tongue and remains there until completely absorbed.
Contraindications:
- Overweight;
- Congenital polydipsia (pathological thirst);
- Psychogenic polydipsia;
- Disorders of the cardiovascular system;
- Intolerance to the components of the drug.
Despite the tangible cost of Minirin, it is very often used in pediatric practice due to its high efficiency.
Restricting drinking to treat bedwetting
Reducing fluid intake is one way to reduce the likelihood of bedwetting.
The drinking regimen of a child suffering from enuresis should be based on the following scheme:
- Liquid drunk before 12.00 - 40%;
- Liquid drunk before 17.00 - 40%;
- Liquid drunk after 17.00 - 20% of the total.
An important note - the liquid drunk in the evening should not contain caffeine (tea, coffee).
Comments of Dr. Komarovsky on restricting drinking:
Is enuresis treatment effective by reward and motivation?
Motivational therapy is about rewarding your child with effective rewards for not wetting the bed. This can be any incentive for several "dry nights": a trip to the circus, buying the desired toy, things, books. The degree of encouragement can be discussed at the family council with the child and not deviate from the promise.
The effectiveness of the method can be judged by the following data: in 70% of children suffering from enuresis, the number of episodes of bedwetting decreased by 80%. In about 25% of cases, the application of the method provided 14 or more "dry nights" in a row, which is equivalent to a cure for pathology. The reward method works best for young patients with primary bedwetting.
Comments by Dr. Komarovsky on incentives and rewards in the treatment of bedwetting:
Should a child with bedwetting be woken up at night?
Knowing what time the child usually urinates at night, parents can raise him a little earlier so that he did it out of bed. The awakening time needs to be slightly shifted forward. Then, after a few months, it may be possible to bring it to the desired time of morning awakening.
Comments of Dr. Komarovsky on whether to wake the child at night:
Read more: Effective treatment of bedwetting with an alarm clock
Bladder training
Most children with bedwetting have a decreased bladder capacity. The age-appropriate volume required can be calculated using the formula: Add 2 to the child's age. The result is measured in ounces (1 ounce = 30 ml). If the amount of urine excreted at one time is less than the norm expected at this age, you need to interest the child in conducting a bladder training.
This method cannot be considered a panacea in the treatment of enuresis, it is an additional way to normalize the child's condition. Training consists in consistently holding urine for longer and longer periods of time. Retention should be practiced after the first urge to urinate. To track the effectiveness of the method, the volume of excreted urine is recorded in a special diary weekly. The goal will be achieved when the bladder maintains its age-appropriate volume. Compared to drug therapy, the method has no side effects.
Read more: special exercises for enuresis
Treatment of bedwetting in children with folk remedies
In the piggy bank of traditional medicine, there are several effective recipes for the treatment of bedwetting. Before using them, you need to make sure that the child is not allergic to the components used.
Effective recipes:
- Plowed clover. The aerial part of the plant is brewed and drunk with sugar instead of tea; a tablespoon of clover herb is taken for 200 ml of boiling water.
- Honey water. To retain moisture before going to bed, you need to give your child a teaspoon of honey diluted in 1/2 cup of warm water. You need to drink honey water for at least 3 days, or 30 ml of such water 3 times a day. Another recipe for using honey for the treatment of enuresis is to dilute it in a strained infusion of 15 g of herbal collection (mint, knotweed, birch leaf, chamomile, St. John's wort, centaury), steamed with boiling water and infused for 10 hours. The course of treatment is long - up to 3 months, drink 1/2 cup 4 times a day.
- Dill seeds. Insist one tablespoon of seeds for an hour in a glass of boiling water, covered with a saucer or lid, strain, give the child a drink on an empty stomach. Therapeutic dose: up to 10 years - 1/2 glass, after 10 years - a whole glass.
Recommendations for parents
Since bedwetting is a delicate problem, it should be approached carefully. The main burden of accompanying the therapy of enuresis prescribed by the doctor falls on the shoulders of the parents. In order not to aggravate the situation, they have to choose a special approach to their child.
Recommendations for parents:
- There is no need to force children to wash wet sheets - this is humiliating, and besides, the washing machine will do the washing better
- Do not change your child's usual diet;
- If night awakenings are difficult, and the baby then cannot sleep for a long time, you should not forcefully wake him up at night;
- There is no need to punish a child for bed-wetting; it is much more effective to reward for dry sheets;
- Restricting drinking during the day is a brutal method of dealing with enuresis, fraught with dehydration, especially in the warm season;
- You should not consider a child sick and subject him to traumatic and unpleasant examinations if he does not have pronounced symptoms of urinary tract pathology (a pungent smell and abnormal color of urine, the presence of pathological inclusions in it, a complete lack of control over the urination process).
The best behavior strategy for parents is to calmly regret episodes of bedwetting, provide moral support to the child, and prohibit discussion of this topic with strangers.
Which doctor treats enuresis in children?
If bedwetting is accompanied by pathological signs indicating a probable disease of the genitourinary system, you should contact your pediatrician. Ideally, pediatric urologists in specialized medical centers are involved in the treatment of bedwetting.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.
