Pediatrics – Enuresis: By Chris Cooper M.D.
Enuresis in children: pathology or physical condition?
Enuresis in a child is a problem that many children aged 5-12, as well as their parents, face. Urinary incontinence at night, during sleep (day and night), complicates the psychological and social adaptation of children, especially in children's institutions, and involuntary nighttime urination in adolescents often leads to severe medical and social conflicts.
At the age of three, it may not be about enuresis as a diagnosis. The kid just did not learn to control urges, especially during sleep.
Studies have shown that only 70% of children by the age of three are able to control their urges. The rest learn it at different ages up to 8.5 years.
The child's age at which one can talk about the presence of enuresis is at least five years.
Causes of the disease
Distinguish between primary and secondary enuresis. The primary is manifested by urinary incontinence at night, during sleep (the child does not wake up to the urge to empty the bladder). Secondary enuresis occurs with various congenital and acquired pathologies, it can manifest itself not only in sleep, during the daytime and at night.
To cure enuresis, it is important to find out the true cause of its occurrence. Only a doctor can determine this reason during a comprehensive examination.
The most common causes of bedwetting in children are:
- Immaturity of some structures of the brain and bladder. The child does not have a signal to wake up to empty the bladder;
- Delayed maturation of the nervous system - often associated with the presence of neuropsychiatric disorders such as hyperactivity and lack of attention syndrome;
- Stressful and psychogenic factors (change of scenery, new people, parting with mom, scandals and fights in the family);
- Hereditary factors. If the father or mother suffered from enuresis in childhood, then the child with a high degree of probability will also get acquainted with this pathology. If both parents suffered, then the child's illness is simply guaranteed;
- Disruption of the production of antidiuretic hormone, which regulates the volume of urine produced. Normally, its level rises at night, which entails a decrease in the produced urine. Enuresis entails the opposite process - an increase in the volume of urine and a decrease in the level of the hormone;
- Anatomical pathologies of the genitourinary system (narrowing in girls or narrowing of the foreskin in boys, insufficient bladder capacity);
- Infectious percentesses of the urinary tract.
In rare cases, nocturnal enuresis can be triggered:
- Sleep apnea and upper airway obstruction;
- Some endocrinological pathologies.
- Certain medications.
- Consultation with a specialist is necessary in cases where the child urinates more often than once every three weeks and is over four years old. You will have to visit a pediatrician, urologist, gynecologist and neurologist.
- Children over 10 years of age with bedwetting must undergo urological examination.
Treatment of the disease
In modern medicine, there are more than 300 methods of treating bedwetting: physiotherapy, nutritional, acupuncture, auto-training, medication, and even hypnosis.
How and by what means to cure enuresis, only a specialist decides, and only after a comprehensive examination and discovery of the true causes of enuresis.
General guidelines for parents to help manage bedwetting:
- Support the child morally, explain that he is not alone with similar problems;
- Do not scold or punish in any way if the bed is wet again - this is not his fault;
- Don't put diapers on your baby. From about 18 months, the baby should wean from them, and the parents should teach him to potty. Most of modern children suffering from bedwetting, at one time got used to diapers, did not feel moisture and discomfort, so they simply do not know that it is necessary to use the toilet or wake up to urinate;
- Limit drinking 3-4 hours before bedtime, compensate for it in the morning;
- Teach your child to go to the toilet before going to bed;
- Observe the daily routine without watching movies, cartoons, computer games and surfing the Internet at night. If the child's biorhythms are normal, then it will be much easier for him to develop a reflex;
- Avoid overexcitation before bedtime (active games, scary movies, etc.);
- Do not forcefully wake the child up to urinate - this is not his own reaction, and if you use this method, then wake up until you fully regain consciousness;
- Make a night light if your baby is afraid of the dark;
- Praise dry nights, such praise also builds a reflex to wake up on time.
Medication is prescribed only by a doctor.
Used in such cases:
- Hormones (prescribed for hormonal etiology of the disease), which are used in the form of nose drops or capsules;
- Psychostimulants affecting the general tone of smooth muscle organs, incl. bladder.
- Drug-induced caffeine;
- Antidepressants. Precise Mechanismm of impact has not been studied, and the effectiveness of their use has been established empirically, but confirmed by practice;
- Adrenomimetics, the action of which is associated with a psychostimulating effect;
Psychotherapy quite effectively helps to get rid of the manifestation of enuresis. With this pathology, various methods are used, up to dolphin therapy (communication with dolphins), hippotherapy (communication with horses).
Although these are expensive and not always available methods, sometimes their effectiveness exceeds all traditional methods.
In addition to such exotic variations, you can talk to a psychologist who will prepare the child and help him overcome the disease.
Various methods of hypnotherapy are also used, in particular, classical and Ericksonian hypnosis, suggestions in sleep, which, according to the exact instructions of a specialist, are performed by parents at home.
In some cases, herbal medicine is used - medicinal herbs that have a sedative effect can be used in the form of decoctions, baths, and pillows with dried herbs in bed.
A good effect is achieved by normalizing relations within the family, eliminating scandals or assault in front of children, and eliminating school and other social problems.
The treatment of bedwetting in children selected by a specialist and careful adherence to all recommendations eliminates the disease quite quickly, or significantly reduces its manifestations.
Remember that your care, support and psychological comfort for the child at home is more important and necessary than any medication.