Children's daytime bedwetting causes and treatment. Until what age is nocturnal enuresis in children considered normal? At what age is this the norm

Having been born, the child is not able to control the act of urination. This is natural, since the neuro-regulatory mechanisms are still immature. The skills of voluntary urinary retention in babies are formed by the age of 2.5-4 years. If by this age the child has not learned to control the process and the pants are constantly wet, then parents should worry and go to see a specialist to find the cause of this phenomenon and help the baby. As the child grows, the hygiene problem will bring him more and more discomfort and trouble. It is especially difficult for a teenager - at the age of 12-15, the problem leads to serious psychological disorders and social maladjustment.

What is urinary incontinence in a child?

Urinary incontinence in a child (the medical name is incontinence) is a persistent disorder of controlled urination, that is, the inability to retain urine in the bladder, as a result of which it spontaneously flows out during daytime wakefulness or night sleep. Incontinence is not an independent disease, this disorder accompanies various pathologies and is combined with other manifestations.

About 10% of all children under the age of ten suffer from incontinence, and the most common form of the disorder is enuresis, that is, urine flows out at night, during sleep. Statistics say that the problem of bedwetting is present in about 20% of five-year-old children, and involuntary urination during the day is observed in 8% of babies of the same age.

Now medicine does not classify enuresis before the age of five as pathological conditions, but defines it as a stage in the development of a child, when he is just learning to control his body. Over the years, the issue is resolved by itself. However, about 5% of children by the age of 12 are still suffering from an unpleasant phenomenon.

Incontinence (especially nocturnal) up to the age of five is not classified as a pathological condition.

Boys are more likely to be upset than girls. One tenth of boys under 14 years of age experience enuresis. Little girls learn to control urination faster than boys and learn to walk on the potty - this is due to the functional characteristics of their nervous system.

Teenage incontinence is not very common. It usually appears against a background of severe stress or mechanical injury, while in babies it is often due to organic reasons.

Disorder classification

Pediatric urologists treat urinary incontinence and urinary incontinence separately. In the first case, the child is not able to control the flow of urine, because he simply does not feel any urge to empty, in the second, the baby feels the need to go to the toilet, but cannot interfere with the urination process, is unable to hold urine.

Distinguish between daytime, nocturnal or permanent (mixed) type of incontinence. If uncontrolled urination occurs in a baby older than 3.5-4 years old in a dream (at night or during the day) at least 2 times a month, while no mental abnormalities and urogenital diseases have been identified, then we are talking about enuresis.

Enuresis is a form of urinary incontinence where uncontrolled urination occurs during sleep

The nature of the disorder can be:

• Primary, or persistent. In this case, there is a delay in the natural process of formation and consolidation of the reflex of voluntary urination. The violation usually accompanies neuropsychic diseases or pathologies of the urinary organs.
• Secondary, or acquired. Such a disorder is said if the skill of voluntary retention of urine disappears after a "dry" period, that is, spontaneous urinary excretion was not previously observed (except for physiological incontinence at an early age) or it was absent for more than six months. The secondary disorder can be traumatic or psychogenic.

Depending on the mechanism of development of the disorder, the following types are distinguished:

• Imperative (urgent), when the child cannot control the bladder at the maximum point of urge. This phenomenon is usually observed in babies with a neurogenic bladder with increased excitability of the detrusor (the muscle that is needed to expel urine).
• The reflex form, arising from the uncoordination of the centers of the spinal cord and the brain, which regulate the functionality of all internal organs. With such a violation, there is an uncontrolled release of urine in drops or small portions.
• The stress disorder is caused by poor development of the pelvic muscles and urethral sphincter. In this case, the child urinates due to a sudden change in intra-abdominal pressure when lifting heavy objects, laughing, sudden movements, coughing, sneezing.
• Paradoxical ischuria, or full bladder incontinence. This type of pathology occurs when urinary outflow is disturbed due to obstruction (blockage) of the urinary tract under the bladder or is associated with a neurogenic bladder in a hyporeflex or areflex type. The bladder overflows, overstretches, the gallbladder pressure exceeds the intraurethral pressure, and an involuntary drip of urine occurs.

Urinary incontinence can occur for a variety of reasons.

Total incontinence is rare and is a constant drip of urine. This type of pathology occurs against the background of severe insufficiency of the urethral sphincter, with ectopia, that is, improper location of the ureters (urethral or cervical) or with cystic spasms caused by neurogenic disorders.

Urologists distinguish vesical and extravesical incontinence. In the first case, urine is excreted naturally - through the urethra, in the second - through other pathological channels. Such an unnatural flow of urine is observed with malformations of the genitourinary organs:

• non-closure of the urachus (vesico-umbilical fistula);
• exstrophy of the bladder - underdevelopment, in which the mucous membrane of its back wall is turned outward;
• ectopia of the mouth of the ureters, that is, their atypical extravesical or intravesical location;
• epispadias (splitting of the upper wall of the urethra);
• hypospadias, that is, a displacement of the location of the outlet of the urethra.

Video: a doctor about urinary incontinence in children

Causes of the disorder

Childhood incontinence is a problem that can be caused by completely different factors. Very often, the phenomenon is associated with a malfunction of the neuro-reflex regulation of the pelvic organs, urogenital diseases, endocrine disorders, mental disorders, stress. Several interrelated factors usually play a role in the development of the disorder.

Nerve regulatory disorders are often caused by organic brain damage due to:

• spine or head injuries;
• neoplasms;
• neuroinfections with the development of arachnoiditis (inflammation of the arachnoid membrane of the brain), myelitis (inflammation of the spinal cord);
• infantile cerebral palsy.

Certain mental disorders can serve as the cause of the pathology:

• epilepsy;
• autism;
• oligophrenia;
• schizophrenia.

Urinary incontinence, including enuresis, develops due to dysregulation of the bladder

The disorder may occur against the background of:

• endocrine system disorders:
  • or thyrotoxicosis;
  • diabetes;
• taking certain medications, for example, tranquilizers or anticonvulsants;
• helminthic invasions;
• urologic pathologies:
  • inflammation of the urethra, kidneys, bladder;
  • (prolapse of the kidney);
  • vesicoureteral reflux (reverse flow of urine into the ureters);
  • balanoposthitis (inflammation of the head and foreskin) in boys or vulvovaginitis in girls;
• allergic conditions.

Incontinence at night (actually enuresis) can be hereditary: the probability of incontinence in a child is equal to 80% if both parents encountered it in childhood, and if one of them, then the probability is close to 40%. Most often, urine leakage during sleep is due to a delay in the development of the children's nervous system in the prenatal or postpartum period due to the influence of adverse factors:

• gestosis;
• threats of spontaneous abortion;
• anemia of the expectant mother;
• little or polyhydramnios;
• fetal hypoxia;
• asphyxia or birth trauma.

Subsequently, such babies have a hyperexcitable bladder.

Urinary incontinence is often caused by a neurogenic bladder

Enuresis may be associated with a disruption in the synthesis cycle of the hormone vasopressin, which inhibits urine production. As a result, at night, the baby produces a large volume of urine, the bladder overflows, and the child wakes up on wet sheets.

The disorder is especially acute when the functional capacity of the bladder decreases (its normal volume is 10 ml per 1 kg of the child's weight). Various reasons lead to such a decrease, including chronic constipation.

Separately, it should be said about the stressful nature of the violation. This phenomenon is especially common in preschool children. The disorder can arise due to various traumatic events for the child's psyche: parental conflict or divorce, the death of a relative, admission to school or a new kindergarten, quarrels with peers, moving to another city, the appearance of a brother or sister. Moreover, incontinence can develop both in a quiet, very shy and fearful child, and in a toddler with hyperactivity syndrome.

Urinary incontinence may appear in a child against a background of strong experiences

Among the factors contributing to the onset of the disorder, pediatricians cite the widespread use of baby diapers. The invention so beloved by mothers often causes a delay in the fixation of the reflex, with the help of which the baby further controls urination.

How is the diagnosis carried out?

Evaluation of a child with incontinence is primarily aimed at finding the causes that led to the disorder. Various pediatric specialists take part in the diagnosis: pediatrician, urologist or nephrologist, gynecologist, neuropathologist, neuropsychiatrist.

Parents should prepare for a thorough medical interview. When my five-year-old daughter had a similar problem, the pediatrician asked in detail: when did the incontinence appear, at what time of day does it happen, how often, what are the time intervals between uncontrolled urination, the one-time volume of urine excreted, the peculiarities of the child's nighttime sleep (does he fall asleep well, does he sleep soundly , are there night awakenings). In addition, the doctor asked if there were stressful situations or injuries that preceded the onset of the problem, and how I generally react to the situation. You need to be prepared for such questions and think over the answers in advance.

After the interview, the doctor must examine the baby: measure the weight, height, examine the external genitals, feel the bladder, kidneys, and intestines. The neurologist assesses the general muscle tone, tendon reflexes, and limb sensitivity.

The examination of the child begins with interviewing the parents and examining the little patient.

From laboratory tests, the following are usually used:

• clinical analysis of urine to assess the density and acidity of urine, the presence of inflammatory changes;
• bacterial culture of urine to identify bacterial flora;
• Zimnitsky's test to determine daily urine output;
• a blood sugar test to rule out diabetes.

To diagnose pathology, first of all, urine is taken for analysis.

Instrumental studies, as a rule, are carried out in the following sequence:

1. Ultrasound echography of the bladder and kidneys. Used to detect pathological changes in organs.
2. Urofluometry is a method of studying urodynamics by assessing the speed of the urinary stream during urination. The study helps to assess the patency of the urethra and the tone of the muscles involved in emptying the bladder.
3. Plain urography is an X-ray examination method. On the X-ray of the pelvic organs, the doctor can conclude about the existing pathological changes in them.

Ultrasound is performed to identify pathological changes in the genitourinary organs

If the information obtained during the examination of the child is not enough, then the specialist may resort to additional procedures:

• cystoscopy - examination of the bladder cavity from the inside through an endoscope;
• profilometry of intraurethral pressure to assess the functional capacity of the canal sphincter;
• electromyography of the vesicular muscles - a method for assessing neuromuscular transmission to identify lesions of the peripheral nervous system.

Children with a burdened perinatal history (with pathology of pregnancy and complications in childbirth) are assessed for their neurological status. For this, electroencephalography (study of the activity of cerebral centers), rheoencephalography (assessment of cerebral blood flow and the state of cerebral veins), craniography (X-ray of the skull) are performed. If a problem with the spinal cord is suspected, an MRI scan of the spinal column is done.

Video: tests to diagnose the causes of the disorder

Since urinary incontinence is not an independently existing pathology, differential diagnosis consists primarily in determining the underlying disease, allows you to find out if the child has malformations of the urinary tract, infectious processes in them, diseases of the endocrine or nervous system.

Treatment of infantile urinary incontinence

Therapy is always aimed at the cause that caused the violation: with organic lesions of the genitourinary or nervous system, first of all, the underlying pathology is corrected.

Comprehensive treatment of incontinence includes:

• drug therapy;
• behavioral regulation;
• psychotherapy;
• physiotherapy;
• folk remedies.

Behavioral (regimen) methods involve training for bladder control. To do this, the diet is adjusted, a signaling system is introduced to develop a reflex to go to the toilet or pot when you feel the urge. With enuresis, they limit drinking in the evening, put the child on a potty, or remind him to empty himself before bedtime. A small child in the first half of the night can be woken up to the potty, for older children it is recommended to use urine detectors - special alarm clocks that give a signal when the first drops appear and force the child to wake up. The medical name for these devices is urinary alarms.

Urinary alarm is designed to combat enuresis

It is advisable to introduce a system of rewarding the child (motivational therapy) for voluntary emptying and clean pants during the day and dry bed after a night's sleep. It is impossible to scold, reproach a child for another wet sheet, since this can only make the problem worse. A friendly atmosphere needs to be created in the house, stressful and conflict situations need to be reduced to naught.

For children over ten years of age, psychotherapy can be used. The problem of incontinence caused by stress can be effectively dealt with with the help of an experienced psychologist or psychotherapist.

Urinary incontinence against a background of stress is eliminated in the process of training with a psychologist

Parents of children with severe mental disorders that cannot be corrected can be greatly helped by specially designed products, for example, panties with urological pads for absorbing urine or diapers.

Medication

The choice of drugs depends on the form of the disorder.

Inflammatory processes in the urinary organs require the appointment of antibacterial agents or uroantiseptics. Of antibiotics, protected penicillins (Amoxiclav, Augmentin) or cephalosporins (Cefixim) are usually prescribed, from the group of uroantiseptics - Nitroxoline, Furazidin.

To eliminate incontinence against the background of a hyperexcitable bladder, the following are highly effective:

• anticholinergics:
  • Oxybutynin, Riabal, Driptan;
• alpha blockers:
  • Dalfaz, Doxazosin.

The funds reduce detrusor spasms, increase the capacity of the bladder and at the same time tone the urethral sphincter.

To eliminate enuresis for a long time, appoint:

• antidepressants:
  • Imipramine, Melipramine;
• analogs of vasopressin:
  • Minirin, Desmopressin.

These drugs reduce urine production and inhibit bladder activity during nighttime sleep.

The disorder against the background of psychoemotional disorders and immaturity of the central nervous system is eliminated by prescribing nootropic and sedative drugs:

• Piracetam;
• Phenibuta.

Children with hyperexcitability are prescribed tranquilizers and antidepressants - Amitriptyline, Ritalin, for neurotic conditions with lethargy - psychostimulants, for example, Sydnocarb. In case of disorders of the nervous system, it is advisable to combine drug treatment with psychotherapy.

Photo gallery: drugs for the treatment of childhood urinary incontinence

Desmopressin decreases nighttime urine volume and increases bladder capacity Driptan - a drug that relieves bladder spasms Melipramine, an antidepressant used to treat bedwetting Glycine has a sedative and relaxing effect Pantogam is a nootropic agent prescribed for children with an immature nervous system Amoxiclav is an antibiotic used to treat urinary tract infections

Physiotherapy treatment

All physiotherapy methods used to correct the disorder are aimed at improving the functions of the bladder and nervous system.

Method	Action
Magnetotherapy	Impact on tissue with a pulsed or constant magnetic field. The result is: normalization of blood flow due to vasodilation; improvement of metabolic processes: elimination of spasms - the walls of the bladder relax. The therapy is especially effective for incontinence associated with chronic inflammation and increased irritability of the bladder.
Laser therapy	Treatment with immunostimulating, vasodilating, anti-inflammatory, analgesic effect. The method improves the susceptibility to drug therapy.
Electrophoresis	The introduction of drugs through the skin by means of electric current. Various types of electrophoresis are aimed at improving the functions of the nervous system and relaxing the detrusor.
Inductothermy	Therapy with a high-frequency magnetic field, which leads to local heating of tissues. The procedure improves: microcirculation; metabolism; conduction of nerve impulses.
Bladder electrical stimulation	It is used for gallbladder dysfunction associated with its inflammation or impaired nerve conduction due to pathologies of the brain or spinal cord. The procedures are carried out directly through the anterior abdominal wall or by indirectly affecting certain spinal centers.
Electrosleep	Often used to treat bedwetting. The procedures are effective for urinary disorders associated with neuroses or other nervous disorders. The method consists in inhibition of the subcortical brain centers using a pulsed current. Children are assigned sessions from 30 minutes to 1.5 hours.
Transcranial electrostimulation	The method of exposure to electric current on the brain stem in order to normalize the functions of the nervous and humoral mechanisms. The treatment has the following effect: calming; pain relievers; antidepressant; improves the transmission of nerve impulses.
Thermal treatments	Aimed at local temperature rise for: improving microcirculation and tissue nutrition; elimination of spasms and inflammation. In addition, the procedures improve neuromuscular transmission. For thermotherapy, applications of paraffin, therapeutic mud, ozokerite are used on the lumbar region and the lower abdomen.
Acupuncture	It is aimed at activating the neurohumoral regulation of the bladder, which leads to the restoration of its normal functioning and the development of a persistent "sentry" reflex in the baby. The method of treatment consists in the introduction of special thin needles into reflex points.
Darsonvalization	Exposure to body tissues with alternating electric current of high voltage and low force. Vacuum electrode treatment of the bladder area improves microcirculation and strengthens the internal urethral sphincter.

Art therapy or music therapy can be used as part of a comprehensive treatment with a psychotherapist. Exposure to music is especially effective for children with nervous system disorders.

Exercise therapy for urinary incontinence aims to strengthen the muscles of the pelvic floor and the sphincter of the bladder. Physiotherapy exercises in children should be carried out under the guidance of a physiotherapist. Older children can study on their own. It is recommended to exercise during urination: arbitrarily stop the process, hold urine for a short time, then relax and continue urinating. In this case, you need to remember which muscles are involved in the process of emptying the bladder and regularly repeat the workout - alternately tensing and relaxing them.

Exercise therapy should be carried out under the supervision of an instructor, the load should be selected individually

Surgical intervention

Operations used to treat urinary incontinence in adults (using implants to fix the urethra, sling operations, etc.) are not performed in childhood. Surgical correction is indicated in case of anomalies in the development of the child's urinary tract. This could be:

• plastic urethra with hypospadias or epispadias;
• sphincteroplasty of the bladder in case of complete sphincter splitting or exstrophy of the bladder;
• suturing of the vesicovaginal or vesicousto-intestinal fistula.

Alternative treatments for urinary incontinence

Traditional medicine offers many effective treatments for urinary incontinence in children. They can be used alongside conventional treatments after consulting your doctor.

Agrimony tea has soothing, antispasmodic, astringent and anti-inflammatory properties. Prepare it like this:

1. Chopped grass (2 teaspoons) is poured with a glass of boiling water.
2. Wrap and insist for 1 hour.
3. Strain through cheesecloth and give the child to drink before meals (from 1 tablespoon to a third of a glass, depending on age).
4. The course of taking the funds should be 14 days. After a week break, the course is repeated.

Blueberry-cherry infusion to strengthen the bladder:

1. A small bunch of dry stems of blueberries and young cherry branches are poured over with boiling water (500 ml).
2. Insist 20 minutes.
3. They give the child a drink in a warm form with the addition of honey (if there is no allergy) an hour before meals.
4. You need to drink 2-3 glasses of infusion per day.
5. The course of treatment should be at least a month.

Infusion of dill or parsley seeds:

1. The dried seeds are poured with boiling water (1 tablespoon per 250 ml of water).
2. Insist 4 hours.
3. Give the child a drink during the day.
4. You need to drink the drink daily for 2 weeks.

Infusion of centaury and St. John's wort (Old Russian decoction):

1. Dry crushed raw materials are taken at the rate of 25 g of each herb.
2. Pour half a liter of boiling water.
3. Insist in a thermos for at least 3 hours.
4. Give the child 3-4 times a day before meals (from 2 tablespoons to 150 ml).
5. The course of treatment should be two-stage and be only 20 days with a week break.

Lingonberry drink:

1. The dried leaves and berries of the plant are crushed.
2. For one serving of the drink, take 2 teaspoons of raw materials and pour 300 ml of hot water.
3. Cover and leave for 20 minutes.
4. They drink 50 ml warm 4 times a day for a month.

Eggshell with honey is an excellent treatment for bedwetting in children. The shell is rich in calcium, which is necessary for the normal conduction of nerve impulses. Prepare the medicine like this:

1. The shell of a boiled egg must be crushed into powder.
2. Mix with the same amount of thick (candied) honey.
3. Roll into small balls (1–2 cm in diameter) from the mixture.
4. You can give your child up to 4 balls daily.

Photo gallery: folk remedies for the treatment of urinary incontinence in children

Dill seeds have an antispasmodic effect, relax the bladder
Agrimony has long been used to treat urinary incontinence. Blueberry stems are used as anti-inflammatory and tonic Lingonberry relieves inflammation, strengthens and normalizes the functions of the bladder Centaury has anti-inflammatory and antispasmodic properties Eggshell with honey is an effective remedy for improving neuromuscular transmission

Treatment prognosis and consequences

Incontinence in children has a relatively favorable prognosis. If all medical recommendations are followed, the problem can be solved within 2 weeks to a year, depending on the form of pathology.

Urinary incontinence can lead to serious psycho-emotional disorders

Preventive actions

• observe the daily routine;
• teach the baby to the pot on time;
• eliminate stressful situations;
• prevent the child from hypothermia;
• to ensure the prevention and treatment of diseases of the urinary organs.

A favorable course of pregnancy plays an important role in the prevention of anomalies in the development of the child's genitourinary system.

Urinary incontinence in children is a problem that needs to be addressed with doctors. Parents need to remember that in no case should they scold and intimidate a child with urinary disorders, as this will only aggravate the situation.

Enuresis is a disease, often of a neuropsychological nature, manifested in urinary incontinence during sleep. Usually nocturnal enuresis is detected in children over five years of age. Sometimes bedwetting occurs in adolescents and adults.

Today, on the website of psychological help site, you will learn what is nocturnal enuresis in children - its causes and treatment.

Enuresis in children

Enuresis in children is quite common before the age of five. Spontaneous urination can be of primary origin (when a small child, due to immaturity, urinates in his pants) and secondary - when children involuntarily pee after they have learned to control urination.

Children's enuresis is nocturnal and daytime: the first refers to secondary, pathological urinary incontinence, and the second (daytime) to primary (non-pathological).

Nocturnal enuresis occurs during sleep, and since young children often have naps (quiet hours), incontinence can also occur during the day.

Parents should know how to behave with children suffering from nocturnal enuresis, and what should be done to help the child get rid of this, more often a nervous, psychological problem, and less often associated with pathology or infection of the bladder and kidneys.

Among children, boys are more likely to suffer from bedwetting than girls. Also, there is enuresis in adults and adolescents, but it is much less common.

Causes of infantile enuresis

The main causes of bedwetting in children are psychological factors: stress, nervous and physical overstrain of the child, disharmonious emotional microclimate in the family.

Any negatively perceived events in the family can serve as stresses for a child to develop enuresis: for example, the birth of a second child, quarrels, scandals in the family, parental divorce, emotional and psychological pressure from parents and the immediate environment ..., even an elementary absence love, affection, praise and attention, sensory deprivation and so on.

Also, the cause of enuresis in children can be an elementary and non-critical delay in the development of some parts of the higher nervous system, those responsible for controlling urination. This, in principle, is not a problem, and in the absence of other stresses and the correct attitude to this childhood ailment from the environment, nocturnal enuresis goes away on its own, due to the development of the necessary part of the brain.

The cause of both childhood and adult enuresis can be an infection of the genitourinary system (bladder, kidneys), and the cause of urinary incontinence can be genetically transmitted and inherited to the child (but this is rare).

Treatment of bedwetting in children

Before starting treatment for urinary incontinence, you need to understand how bedwetting in children is treated. To begin with, you need a diagnosis and correct diagnosis.

If the child is not yet five years old, then you should not worry too much, although it is imperative to comply with the requirements for parents outlined below in relation to a child with enuresis.

If a child urinates in bed at night, during sleep, and he is six years old, then first of all, you need to contact a pediatrician or pediatric urologist in order to be tested and examined for pathology or infections in the urinary system (check the bladder and kidneys). If necessary, the pediatrician will prescribe the necessary treatment.

If there is no pathology in the genitourinary system, then a child psychologist (psychotherapist, psychoanalyst) should treat enuresis. the reason is most likely psychogenic.

The child could develop enuresis on the basis of stress, psychological trauma, strong emotional experiences, fears and anxieties that have arisen and recorded in the head ... And in order to rid his psyche of these stored negatives, the help of a child psychotherapist or psychoanalyst is simply needed.

Also, a psychologist can teach parents how to properly treat a child with enuresis and help him at home to get rid of this disease.

What parents, caregivers and the environment of a child with nocturnal enuresis need to know:

• First of all, parents must create a positive emotional and psychological microclimate in the family. No quarrels and conflicts with a child. No talk about him and his bedwetting in the presence of the baby.
• In no case should you scold, criticize or blame, shame, tease the child if he pees in bed or pants. Don't let others do it ...
• To rid yourself of negative thoughts, emotions and worries about infantile enuresis is to rid yourself of yourself in the shower, and not just to restrain yourself. Otherwise, the child will subconsciously read from your appearance the attitude towards him and his problem, even if outwardly you pretend that you are calm. You need to be calm inwardly, in your soul ...
• Do not wake the child up at night to go to the toilet - do not interrupt sleep
• At night, it is advisable to leave a small light (night light) in the child's room - he may be afraid of the dark, but not talk about it ... You can put a pot near the bed
• To pay more attention to the child, to caress him, to support him morally, to accept him as he is - it is elementary to love him and communicate with him in a positive way. Praise more ... and sincerely
• Exclude all soda from the diet (accordingly, do not drink it yourself with him), various diuretic fruit drinks, drinks, including green tea. Do not give him liquids two hours before bedtime, teach him to empty himself "little" in the evening. Do not give apples and other fruits with a lot of liquid and with a diuretic effect an hour before bedtime. Of course, do not feed your child with foods that make you thirsty (salted herring, for example) - especially before bed.
• Follow the instructions of a doctor, psychotherapist or psychoanalyst given for home care for a child in the treatment of bedwetting
• To accustom the child (along with himself, for example to him) to a healthy lifestyle and the implementation of the daily routine (at least on weekdays), proper nutrition, physical education and psi culture

And remember, you shouldn't worry about nighttime enuresis of children - this disease is curable in 99 cases out of a hundred.

The article reflects modern ideas about nocturnal enuresis, the prevalence of which among 6-year-old children reaches 10%. The existing variants of the classification of this condition are presented, the etiology and probable pathogenetic mechanisms of nocturnal enuresis are described. A separate section is devoted to the problem of controlling the function of the urinary bladder in children, including such multidisciplinary aspects as genetic factors of nocturnal enuresis, circadian rhythm of secretion of some of the most important hormones that regulate the excretion of water and salts (vasopressin, atrial natriyutretic hormone, etc.), and the role of urological disorders and psychopathological / psychosocial factors. For doctors of various specialties, the part of the article devoted to the diagnosis of nocturnal enuresis, as well as differential diagnosis and modern approaches to the treatment of this type of pathology in children (both medication and non-medication) is of interest. This article summarizes the authors' own experience and data from domestic and foreign studies of recent years in the field of studying various aspects of nocturnal enuresis in children.

Key words: enuresis, nocturnal enuresis, desmopressin

Disorders of the act of urination by the type of enuresis have been known since ancient times. The first mentions of this condition are found in ancient Egyptian papyri and date back to 1550 BC. The term "enuresis" (from the Greek "enureo" - to urinate) refers to urinary incontinence. Nocturnal enuresis refers to urinary incontinence after the age at which bladder control is expected to be achieved. Currently, 6 years of age is defined as such a criterion.

Boys suffer from nocturnal enuresis twice as often as girls, according to other sources this ratio is 3: 2.

In general, it is believed that bedwetting is not a disease, but represents a stage in the development of control over physiological functions. Various aspects of the treatment of enuresis are dealt with by doctors of various specialties: pediatric neurologists, pediatricians, psychiatrists, endocrinologists, nephrologists, urologists, homeopaths, physiotherapists, etc. Such an abundance of specialists involved in solving the problem of nocturnal enuresis reflects all the variety of causes leading to urinary incontinence in children.

Prevalence... Nocturnal enuresis is an extremely common occurrence in the pediatric population and is one of the age-related conditions. It is generally accepted that at the age of 5 years, 10% of children suffer from this condition, and by the age of 10, 5%.

Subsequently, as we get older, the prevalence of bedwetting decreases significantly; among 14-year-old adolescents, about 2% suffer from enuresis, and by the age of 18 - only every hundredth individual. Although these figures indicate a high frequency of spontaneous remissions, even among adults, about 0.5% of the general population suffer from nocturnal enuresis. The incidence of bedwetting depends not only on age, but also on the sex of the child.

Classification... It is customary to distinguish primary (persistent) nocturnal enuresis (if the patient has never had control of the bladder) and secondary (acquired if nocturnal urinary incontinence appears after a period of stable urinary control), as well as complicated and uncomplicated (uncomplicated include cases of nocturnal enuresis, in which there are objectively no abnormalities in somatic and neurological status, as well as changes in urine tests). Thus, in patients with primary nocturnal enuresis, the physiological reflex of inhibition of urination ("sentinel") is not initially formed and episodes of "omission" of urine persist as the child grows up, and with secondary enuresis, nocturnal urination occurs after a long "dry" period (over 6 months ). It is noted that primary nocturnal enuresis occurs 3-4 times more often than secondary. In addition, the so-called "functional" and "organic" forms of enuresis were often identified earlier. In the latter case, it was assumed that there are pathological changes in the spinal cord with developmental defects. The functional forms of enuresis included nocturnal (less often daytime) urinary incontinence due to exposure to psychogenic factors, parenting defects, trauma (including mental) and infectious diseases (including urinary tract infections).

Apparently, this classification is somewhat arbitrary. H. Watanabe (1995), after examining a representative group of patients using EEG and cystometrography (1033 children), suggests distinguishing 3 types of nocturnal enuresis: 1) type I (characterized by an EEG response to bladder distension and a stable cystometrogram), 2) type IIa ( characterized by the absence of an EEG response with an overflow of the bladder, a stable cystometrogram), 3) type IIb (characterized by the absence of an EEG response to a distension of the bladder and an unstable cystometrogram only during sleep). This author regards types I and IIa nocturnal enuresis as moderate to severe dysfunction of arousal, respectively, and type IIb nocturnal enuresis as latent neurogenic bladder.

If a child has urinary incontinence not only at night, but also during the daytime, then this may mean that he is experiencing some kind of emotional or neurological problem. As for nocturnal enuresis, it is often noted in children who sleep exceptionally soundly (the so-called "profundosomnia").

Neurotic enuresis is more common among shy, fearful, "downtrodden" children with superficial unstable sleep (such patients are usually very worried about the existing defect). Neurosis-like enuresis (it can be primary and secondary) is characterized by a relatively indifferent attitude towards episodes of enuresis for a long time (until adolescence), and subsequently by intensified feelings about this.

The existing classification of enuresis does not fully correspond to modern ideas about this pathological condition. Therefore, J.Noorgard and co-authors propose to highlight the concept of "monosymptomatic nocturnal enuresis", which occurs in 85% of patients. Among patients with monosymptomatic nocturnal enuresis, there are groups with or without nocturnal polyuria, responding or not responding to desmopressin therapy, and, finally, subgroups with arousal disorders or bladder dysfunctions.

Etiology and pathogenesis... In nocturnal enuresis, the etiology is extremely multifactorial. It cannot be ruled out that this pathological condition includes several subtypes, differing in the following characteristics: 1) the time of onset (from birth or at least after a 6-month period of stable bladder control), 2) symptomatology (only nocturnal enuresis - monosymptomatic or combined nighttime and daytime urinary incontinence), 3) reaction to desmopressin (good or bad response), 4) nocturnal polyuria (presence or absence). It has been suggested that nocturnal enuresis represents a whole group of pathological conditions with different etiology. Nevertheless, it is customary to consider 4 main etiological mechanisms of urinary incontinence: 1) congenital impairment of the mechanisms of formation of the conditioned "sentry" reflex, 2) delay in the formation of urination regulation skills, 3) impairment of the acquired urinary reflex due to adverse factors, 4) hereditary burden.

The main causes of bedwetting. Among the causes of nocturnal enuresis, the following can be listed: 1) infections, 2) malformations and dysfunctions of the kidneys, bladder and urinary tract, 3) lesions of the nervous system, 4) psychological stress, 5) neuroses, 6) mental disorders (less often) ... That is why, first of all, it is necessary to make sure that a child with urinary incontinence does not have signs of inflammation from the bladder (cystitis) or any other disorders of the urinary system (you need to do appropriate urine tests and conduct all the necessary examination as prescribed by a nephrologist or urologist ). If the child's genitourinary system has no pathology, then it can be assumed that the transmission of information about the overcrowding of the bladder to the brain is impaired, that is, there is a partial immaturity of the central nervous system.

The appearance of a second (or next) child in the family, quite expectedly, can lead to "wet nights" in his older brother (or sister). At the same time, the older child seems to be "infantilized" and unlearns to control urination in the form of a conscious or unconscious protest against the apparent lack of attention, love and affection on the part of parents who are completely concerned, first of all, with the "new" child. A similar situation sometimes occurs in such typical situations as moving to another school, transferring to another kindergarten, or even moving to a new apartment.

Quarrels between parents or divorce can also lead to a similar situation, as well as excessive severity in upbringing and physical punishment of children.

Control over the function of the bladder. There are significant individual fluctuations in the timing of the formation of stable independent control of urination. Numerous studies of domestic and foreign authors show that control over the act of urination during night sleep is formed later than a similar function during wakefulness during the daytime: in about 70% of children - by 3 years, in 75% of children - by 4 years, over 80 % of children by the age of 5, 90% of children by the age of 8.5.

There is no doubt that control over the function of the bladder (and nocturnal enuresis) depends on a number of factors: 1) genetic, 2) the circadian rhythm of secretion of a number of hormones (vasopressin, etc.), 3) the presence of urological disorders, 4) delayed maturation of the nervous system and 5) psychosocial stress and some types of psychopathology.

Genetic factors. Among the genetic factors, family history, type of inheritance, and localization of the pathological (defective) gene deserve attention.

Scandinavian researchers found that if both parents had a history of enuresis, the risk of nocturnal enuresis in their children was 77%, and if only one of the parents had enuresis, it was 43%.

The genealogical method of studying twins showed that the levels of concordance for enuresis for monozygotic twins are almost 2 times higher than for dizygotic twins: 68 and 36%, respectively. More recently, appropriate genotyping has been carried out and genetic heterogeneity for enuresis has been established with probable loci of genetic abnormalities on chromosome 13 (13q13 and 13q14.2) - this region is now known as "ENUR1", as well as on chromosome 12q. H. Eiberg (1995) indicates that one autosomal dominant gene with reduced penetrance is involved in the formation of nocturnal enuresis, that is, influenced by environmental factors and / or other genes.

Among boys, 70% of monozygotic twins were characterized by concordance for nocturnal enuresis versus 31% in dizygotic male twins. Among girls, this ratio was 65% and 44%, respectively (no statistically significant differences were found). Apparently, among girls, the genetic influence is not as significant as for boys.

The circadian rhythm of the secretion of certain hormones (regulating the excretion of water and salts). Normally, individuals have marked circadian (circadian) variations in urine production and osmolality, with smaller volumes of (concentrated) urine being produced at night. In childhood, this circadian pattern is partly regulated by vasopressin and partly by atrial natriuretic hormone and the renin-angiotensin-aldosterone system.

Vasopressin. Studies on volunteers have shown that decreased urine production at night (about half of that during the day) is due to increased secretion of vasopressin. More recently, some patients with nocturnal enuresis and polyuria have been found to respond well to desmopressin therapy. But among these children there is a small group of patients with a normal circadian rhythm of vasopressin secretion (they do not respond to this therapy, as do children without nocturnal polyuria). It is possible that these children have impaired renal sensitivity to vasopressin and desmopressin, as in patients without nocturnal polyuria (with normal fluctuations in circadian fluctuations in urine production, urine osmolality and vasopressin secretion).

Other osmoregulatory hormones. Increased secretion of atrial sodium uretic hormone and decreased secretion of renin and aldosterone in obstructive sleep apnea explain the increase in urinary and sodium excretion at night. It has been suggested that a similar mechanism may take place in children with nocturnal enuresis.

However, the available data indicate that in children with nocturnal enuresis, the secretion of atrial natriuretic hormone is characterized by a normal circadian rhythm, and the renin-angiotensin-aldosterone system also does not undergo changes.

Urological disorders... There is no doubt that urinary incontinence (including nocturnal) often accompanies diseases and anomalies in the structure of the organs of the urinary system, acting as the main or concomitant symptom. The nature of these urological disorders can be inflammatory, congenital, traumatic and concomitant.

A trivial urinary tract infection (eg, cystitis) can contribute to bedwetting, especially in girls.

Delayed maturation of the nervous system. Numerous epidemiological studies indicate that enuresis is more common among children with a delayed maturation of the nervous system. Often, nocturnal enuresis develops in children against the background of organic brain lesions and the so-called "minimal cerebral dysfunction" due to the influence of adverse factors and pathology during pregnancy and childbirth (antenatal and intrapartum pathological effects). Noteworthy is the fact that, in addition to the delay in the maturation of the nervous system, children with enuresis often have decreased indicators of physical development (body weight, height, etc.), as well as delayed puberty and the inconsistency of bone age with the calendar age (“lagging” of ossification nuclei ).

As for patients in whom enuresis is noted against the background of mental retardation (they are generally characterized by a significant delay or lack of formation of adequate neatness skills), with the subsequent appointment of therapy, greater importance should be given to the psychological age of children (and not calendar).

Psychopathology and psychosocial stress in patients with nocturnal enuresis. Previously, the presence of nocturnal enuresis was directly associated with psychological disorders. Although nocturnal enuresis may in some patients be combined with the presence of psychiatric pathology, this more often occurs with secondary enuresis with episodes of daytime urinary incontinence. The prevalence of nocturnal enuresis is higher among children with mental retardation, autism, attention deficit hyperactivity disorder, and motor and perceptual disorders. It is believed that the risk of developing psychiatric disorders among girls with enuresis is significantly higher than for boys.

There is no doubt that psychosocial factors (belonging to low-income socio-economic groups, large families with poor housing conditions, the stay of children in specialized institutions, etc.) can influence enuresis. Although the exact mechanisms of this influence remain unclear, enuresis is undoubtedly more common in the setting of psychosocial deprivation.

It is of interest to observe that growth hormone production is impaired under these conditions, and it is also suggested that vasopressin production may be inhibited in a similar manner (leading to excess urine production at night). The fact that enuresis is often combined with short stature may support this hypothesis of a combined depression in the production of growth hormone and vasopressin.

Diagnostics... Nocturnal enuresis is a diagnosis that is established primarily on the basis of existing complaints, as well as an individual and family history. It is important to remember that in 75% of cases, relatives of patients with nocturnal enuresis (first degree of relationship) in the past also had this ailment. Previously, it was found that the presence of episodes of enuresis in a father or mother increases the child's risk of developing this condition by at least 3 times.

Anamnesis. When collecting anamnesis, first of all, you should find out the nature of the child's upbringing and the formation of his neatness skills. Find out the frequency of episodes of urinary incontinence, the type of enuresis, the nature of urination (weakness of the stream during miction, frequent or rare urge, pain when urinating), the presence in the anamnesis of indications of the transfer of urinary tract infections, as well as encopresis or constipation. Always specify the hereditary burden of enuresis. Attention is paid to the fact of the presence of airway obstruction, as well as attacks of sleep apnea and epileptic seizures (or non-epileptic seizures). Food and drug allergies, urticaria (urticaria), atopic dermatitis, allergic rhinitis and bronchial asthma in children in some cases can contribute to increased excitability of the bladder. When interviewing parents, it is necessary to find out the presence among relatives of such endocrine diseases as diabetes mellitus or diabetes insipidus, dysfunction of the thyroid gland (and other endocrine glands). Since the vegetative status is closely related to the functions of the endocrine glands, any violations of them can be the cause of enuresis.

In some cases, urinary incontinence can be induced by the side effects of tranquilizers and anticonvulsants (sonopax, valproic acid preparations, phenytoin, etc.).

Therefore, it is necessary to find out which of these drugs and in what dosage the patient is receiving (or received earlier).

Physical examination. When examining a patient (assessment of the somatic status), in addition to identifying the above violations from various organs and systems, attention is paid to the state of the endocrine glands, abdominal organs, and the urogenital system. Assessment of indicators of physical development is mandatory.

Psychoneurological status. When assessing the neuropsychiatric status of a child, congenital anomalies of the spine and spinal cord, motor and sensory disorders are excluded. The sensitivity in the perineal region and the tone of the anal sphincter are necessarily investigated. It is important to clarify the state of the psychoemotional sphere: characterological characteristics (pathological), the presence of bad habits (onychophagia, bruxism, etc.), sleep disorders, various paroxysmal and neurosis-like states. A thorough defectological examination is carried out according to the Veksler method or using test computer systems (Ritmotest, Mnemotest, Binatest) to determine the state of the child's intellectual development and the status of the main cognitive functions.

Laboratory and paraclinical research. Since urological disorders play a significant role in the occurrence of enuresis (congenital or acquired anomalies of the genitourinary system: dyssynergia of the detrusor and sphincter, hyper- and hyporeflex bladder syndromes, low bladder capacity, the presence of obstructive changes in the lower parts of the urinary tract: strictures, contractures, valves; urinary tract infections, household injuries, etc.), first of all, it is necessary to exclude the pathology of the urinary system. From laboratory studies, great importance is attached to the study of urine (including general analysis, bacteriological, determination of the functional capabilities of the bladder, etc.). An ultrasound examination of the kidneys and bladder is mandatory. If necessary, additional studies of the urinary system are carried out (cystoscopy, cystourethrography, excretory urography, etc.).

If you suspect the presence of anomalies in the development of the spine or spinal cord, it is necessary to conduct an X-ray examination (in 2 projections), computed or magnetic resonance imaging (CT or MRI), as well as neuroelectromyography (NEMG).

Differential diagnosis... Nocturnal urinary incontinence should be differentiated from the following pathological conditions: 1) nocturnal epileptic seizures, 2) some allergic diseases (skin, food and medicinal forms of allergies, urticaria, etc.), 3) some endocrine diseases (diabetes mellitus and diabetes insipidus, hypothyroidism , hyperthyroidism, etc.), 4) nocturnal apnea and partial obstruction of the airways, 5) side effects due to taking medications (in particular, thioridazine and valproic acid preparations, etc.).

Treatment of nocturnal enuresis... Although in some children, nocturnal enuresis goes away with age without any treatment, there are no guarantees on this score. Therefore, if episodes or persistent urinary incontinence persist at night, therapy is necessary. Effective therapy for nocturnal enuresis is determined by the etiology of this condition. In this regard, the approaches to the treatment of this pathological condition are extremely variable, therefore, for many years, doctors have been using a variety of therapeutic methods. In the past, bedwetting was often attributed to late potty training; today, disposable diapers are often the “culprit”, although both are wrong.

Although today, unfortunately, none of the known treatment methods provide a 100% guarantee of cure for nocturnal enuresis, some therapeutic methods are considered highly effective. They can be roughly divided into: 1) medication (using various pharmacological drugs), 2) non-medication (psychotherapeutic, physiotherapeutic, etc.), 3) regime. The methods and scope of therapy depend on the specific situational circumstances. In any case, successful treatment of bedwetting is possible only with the active, committed participation of the children themselves and their parents.

Medication methods of treatment... In cases where nocturnal enuresis is a consequence of a urinary tract infection, it is necessary to carry out the full course of treatment with antibacterial drugs under the control of urine tests (taking into account the sensitivity of the isolated microflora to antibiotics and uroseptics).

The "psychiatric" approach to the treatment of nocturnal enuresis includes the appointment of tranquilizers with a hypnotic effect to normalize the depth of sleep (Rakedorm, Eunoktin); in case of resistance to them, it is recommended (usually with neurosis-like forms of enuresis) to take stimulants (Sydnocarb) or thymoleptic drugs (amitriptyline, melepramine, etc.). Amitriptyline (Amizole, Tryptizol, Elivel) is usually prescribed in a dose of 12.5-25 mg 1-3 times a day (available in tablets and pills of 10 mg, 25 mg, 50 mg). When there is evidence that urinary incontinence is not associated with inflammatory diseases of the genitourinary system, preference is given to imipramine (millepramine), available in the form of 10 mg and 25 mg pills. Before 6 years of age, it is not recommended to prescribe the above drug to children for the treatment of bedwetting. If prescribed, it is dosed as follows: up to 7 years of age, gradually increase from 0.01 g to 0.02 g per day, at the age of 8-14 years: 0.03–0.05 g per day. There are treatment regimens in which a child receives 25 mg of the drug 1 hour before bedtime, in the absence of a visible effect after 1 month the dose is doubled. After reaching "dry" nights, the dose of milepramine is gradually reduced until complete cancellation.

In the treatment of neurotic enuresis, they resort to the appointment of tranquilizers: 1) hydroxyzine (Atarax) - tablets of 0.01 and 0.025 g, as well as syrup (5 ml contains 0.01 g): for children over 30 months, 1 mg / kg of body weight / day in 2-3 doses, 2) medazepam (Rudotel) - tablets of 0.01 g and capsules of 0.005 and 0.001 g: daily dose of 2 mg / kg of body weight (in 2 doses), 3) trimethosine (Trioxazine) - 0.3 g tablets: a daily dose of 0.6 g in 2 doses (6-year-old children), 7-12-year-olds - about 1.2 g in 2 doses, 4) meprobamate (0.2 g tablets ) 0.1-0.2 g in 2 divided doses: 1/3 dose in the morning, 2/3 dose in the evening (course lasting about 4 weeks).

Taking into account the fact that the immaturity of the child's nervous system, developmental delay, as well as pronounced manifestations of neurotization play an important role in the pathogenesis of enuresis, nootropic drugs (calcium hopantenate, glycine, piracetam, phenibut, picamilon, Semax, instenon, gliatilin, etc.). Nootropic drugs are prescribed in courses of 4-8 weeks in combination with other types of therapy in an age-specific dosage.

Driptan (oxybutynin hydrochloride) in tablets of 0.005 g (5 mg) can be used in children over 5 years of age in the treatment of nocturnal enuresis resulting from 1) instability of the bladder function, 2) urinary disorders due to neurogenic disorders (detrusor hyperreflexia), 3) idiopathic disorders of detrusor function (motor urinary incontinence). In case of nocturnal enuresis, the drug is usually prescribed 5 mg 2-3 times a day, starting at half the dose to avoid the development of unwanted side effects (the last dose is taken just before bedtime).

Desmopressin (which is an artificial analogue of the hormone vasopressin, which regulates the release and absorption of free water in the body) is one of the most effective medications.

To date, its most common and popular form is called Adiuretin-SD in drops.

One bottle of the drug contains 5 ml of solution (1 drop applied from a pipette contains 5 μg of desmopressin - 1-deamino-8-D-arginine-vasopressin). The drug is injected into the nose (or rather, applied to the nasal septum) according to the following scheme: the initial dose (for children under 8 years old - 2 drops per day, for children over 8 years old - 3 drops per day) - for 7 days, then, when "Dry" nights, the course of treatment continues for 3 months (with subsequent discontinuation of the drug), but if "wet" nights persist, then the dose of Adiuretin-SD is systematically increased by 1 drop per week until a stable effect is obtained (maximum dose for children up to 8 years old is 3 drops per day, and for children over 8 years old - up to 12 drops per day), the course of treatment is 3 months in the selected dose, then the drug is canceled. In case of recurrence of episodes of enuresis, a repeated 3-month course of treatment in an individually selected dose is practiced.

Experience shows that when using Adiuretin-SD, the desired antidiuretic effect occurs within 15–30 minutes after taking the drug, and intranasal administration of 10–20 μg desmopressin provides an antidiuretic effect in most patients for 8–12 hours. Along with the higher therapeutic efficacy of adiuretin compared with melipramine, there is a lower frequency of relapses of nocturnal enuresis after completion of therapy with this drug in the literature.

Non-drug treatments... Urinary alarms (also called "urinary alarms") are designed to interrupt sleep when the first drops of urine appear so that the child can finish urinating in the pot or toilet (thus forming a normal stereotype of physiological functions). It often turns out that these devices wake up not the child himself (if his sleep is too deep), but all other family members.

An alternative to "urinary alarms" is the method of nightly awakening on a schedule. In accordance with it, the child is woken up every hour after midnight for a week. After 7 days, he is woken up repeatedly during the night (strictly at certain hours after falling asleep), selecting them in such a way that the patient does not wet himself during the remaining night time. Gradually, this period of time is systematically reduced from three hours to two and a half, two, one and a half, and finally to 1 hour after falling asleep.

With repeated episodes of nocturnal enuresis twice a week, the entire cycle is repeated again.

Physiotherapy. If we list just a few other less common methods of treating nocturnal enuresis, then among them will be acupuncture (acupuncture), magnetotherapy, laser therapy and even music therapy, as well as a number of other techniques. Their effectiveness depends on the specific situation, age and individual characteristics of the patient. These methods of physiotherapy are usually used in combination with medications.

Psychotherapy... Special psychotherapy is carried out by qualified psychotherapists (psychiatrist or medical psychologist) and is aimed at correcting general neurotic disorders. In this case, hypnosuggestative and behavioral techniques are used. For children who have reached the age of 10, the use of suggestion and self-hypnosis (before going to bed) of the so-called "formulas" of self-awakening with the urge to urinate is applicable. Every evening before going to bed, the child, for several minutes, tries to mentally imagine the feeling of a full bladder and the sequence of his own further actions. Immediately before falling asleep, the patient must, for the purpose of self-hypnosis, repeat several times the "formula" of approximately the following content: "I want to always wake up in a dry bed. While I sleep, the urine is locked tightly in my body. When I want to urinate, I will quickly get up myself. "

The so-called "family" psychotherapy is also important. Parents can successfully use the child's dry nights reward system. To do this, the child himself must systematically keep a special ("urinary") diary, which is filled in every day (for example, "dry" nights are indicated by the "sun", and "wet" - "clouds"). In this case, the child must be explained that if for 5-10 days in a row the nights are "dry", he will receive a prize.

After episodes of urinary incontinence, it is necessary to change bedding and underwear (it will be better if the child does this on his own).

It should be especially noted that it is possible to expect a positive effect from the listed psychotherapeutic measures only in children with intact intellect.

Diet therapy... In general, fluid is significantly limited in the diet (see "Regimen measures" below). Of the special diets for nocturnal enuresis, the diet of N.I. Krasnogorsky is considered the most common, which increases the osmotic pressure of the blood and promotes water retention in the tissues, which reduces urination.

Regime measures. When treating nocturnal enuresis, parents and other family members of children suffering from this condition are advised to adhere to some general rules (be tolerant, balanced, avoid rudeness and punishment of children, etc.). It is necessary to achieve compliance with the daily regimen. It is important to constantly instill in children with enuresis self-confidence and the effectiveness of the treatment.

1). You should limit your child's intake of any liquid after dinner as much as possible. It seems impractical not to give children a drink at all, but the total volume of fluid after the last meal should be at least halved (versus the amount used). They restrict not only drinking, but also meals with a high liquid content (soups, cereals, juicy vegetables and fruits). At the same time, food should remain complete.

2). The bed of a child suffering from nocturnal enuresis should be quite hard, and if the child is deeply asleep, it should be turned over several times during the night during sleep.

3). Avoid stressful reactions, psycho-emotional unrest (both positive and negative), as well as overwork.

4). Avoid hypothermia of the child throughout the day and night.

5). It is advisable to avoid giving your child food and drinks that contain caffeine or have a diuretic effect throughout the day (these include chocolate, coffee, cocoa, all varieties of cola, forfeits, seven-ups, watermelon, etc.). NS.). If you cannot completely avoid their use, it is necessary to recommend refraining from using these types of foods and drinks for at least three to four hours preceding sleep.

6). It is necessary to insist on the visit of the child to the toilet or "landing" on the potty before going to bed.

7). Artificial sleep interruption 2-3 hours after falling asleep is often effective so that the child can empty the bladder. However, if at the same time the child urinates in a sleepy state (without waking up completely), such actions can only lead to a further deterioration of the situation.

eight). It is better to leave a dim light source in the children's room at night. Then the child will not be afraid of the dark and leaving the bed, if he suddenly decides to use the potty.

nine). In cases where there is increased urine pressure on the sphincter, elevating the pelvic region or creating an elevation under the knees (using a roller of an appropriate size) can help.

Prevention... Measures for the prevention of nocturnal enuresis in children are reduced to the following main actions:

• Timely refusal to use any diapers (standard reusable and disposable).
  Usually, diapers are completely stopped using when the child reaches the age of two, teaching children to basic neatness skills.
• Control over the amount of fluid consumed during the day (taking into account the air temperature and season).
• Sanitary and hygienic education of children (including training in observance of the rules of hygienic care of the external genital organs).
• Treatment of urinary tract infections.

When a child suffering from enuresis reaches the age of 6, further "expectant" tactics (with the refusal of any therapeutic measures) cannot be considered justified. 6-year-olds with nocturnal enuresis should receive adequate treatment.

The most important factor determining the development of enuresis is the ratio between the functional capacity of the bladder and nighttime urine production. If the latter exceeds the capacity of the bladder, then nocturnal enuresis appears. It is possible that some of the symptoms regarded as abnormal in children with nocturnal enuresis are not such, since episodes of urinary incontinence are periodically observed in healthy children.

Literature

1. Norgaard J. P., Djurhuus J. C., Watanabe H., Stenberg A. et al.

Experience and current status of research into the pathophysiology of nocturnal enuresis. Br. J. Urology, 1997, vol. 79, p. 825-835.

2. Lebedev B.V., Freidkov V.I., Shanko G.G. et al. Handbook of childhood neurology. Ed. B.V. Lebedev. M., Medicine, 1995, p. 362-364.

3. Perlmutter A.D. Enuresis. In: "Clinical Paediatric Urology" (Kelalis P.P., King L.R., Belman A.B., eds.) Philadelphia, WB Saunders, 1985, vol. I, p. 311-325.

4. Zigelman D. Bed-wetting. In: "The Pocket Pediatrician". New York Auckland, Main Street Books / Doubleday, p. 22-25.

5. Handbook of a pediatrician. Ed. M.Ya.Studenikin. M., Poliform3, Publisher-press, 1997, p. 210-213.

6. Adiuretin in the treatment of nocturnal enuresis in children. Edited by M.Ya.Studenikin. 2000, c. 210.

7. Zavadenko N.N., Petrukhin A.S., Pylaeva O.A. Enuresis in children: classification, pathogenesis, diagnosis, treatment. Bulletin of Practical Neurology, 1998, No. 4, p. 133-137.

8. Watanabe H. Sleep patterns in children with nocturnal enuresis.

Scand. J. Urol. Nephrol., 1995, vol. 173, p. 55-57.

9. Hallgren B. Enuresis. A clinical and genetic study. Psychiatr. Neurol.

Scand., 1957, vol. 144, (suppl.), P. 27-44.

10. Butler R.J. Nocturnal Enuresis: The Child's Experience. Oxford: Butterworth Heinemann, 1994, 342 p.

11. Buyanov M.I. Systemic neuropsychiatric disorders in children and adolescents. M., 1995, p. 168-180.

12. Rushton H.G. Nocturnal enuresis: epidemiology, evaluation and currently available treatment options. J Pediatrics, 1989, vol. 114, suppl., P. 691-696.

13. Bakwin H. Enuresis in twins. Am. J Dis Child, 1971, vol. 121, p. 222-225.

14. Jarvelin M.R., Vikevainen-Tervonen L., Moilanen I., Huttenen N.P.

Enuresis in seven year old children. Acta Paediatr. Scand., 1988, vol. 77, p. 148-153.

15. Eiberg H. Nocturnal enuresis is linked to a specific gene. Scand. J.

Urol. Nephrol., 1995, suppl., Vol. 173, p. 15-18.

16. Rittig S., Matthiesen T.B., Hunsdale J.M., Pedersen E.B. et al. Agerelated changes in the circadian control of urine output. Scand. J.

Urol. Nephrol., 1995, suppl., Vol. 173, p. 71–76.

17. George P. L. C., Messerli F. H., Genest J. Diurnal variation of plasma vasopressin in man. J. Clin. Endocrinol. Metab, 1975, vol 41, p.

18. Hunsballe J.M., Hansen T.K., Rittig S., Norgaard J.P. et al.

Polyuric and non-polyuric bedwetting - pathogenic differences in nocturnal enuresis. Scand. J. Urol. Nephrol, 1995, vol. 173, suppl., P. 77-79.

19. Norgaard J.P., Jonler M., Rittig S., Djurhuus J.C. A pharmacodynamic study of desmopressin in patients with nocturanal enuresis. J. Urol., 1995, vol. 153, p. 1984-1986.

20. Krieger J. Hormonal control of sodium and water excretion in vasopressin and oxytocin-immunoreactive neurons in the paraventricular and supraoptic nucleus of the hypothalamus following urinary retention.

J. Kyoto Pref. Univ. Med., 1995, vol. 104, p. 393-403.

21. Rittig S., Knudsen U.B., Norgaard J.P. et al. The diurnal rhythm of plasma atrial natriuretic peptide in children with nocturnal enuresis.

Scand. J. Clin. Lab. Invest., 1991, vol. 51, p. 209.

22. Essen J., Peckham C. Nocturnal enuresis in childhood. Dev. Child.

Neurol., 1976, vol. 18, p. 577-589.

23. Gillberg C. Enuresis: psychological and psychiatric aspects. Scand.

J. Urol. Nephrol., 1995, suppl., Vol. 173, p. 113-118.

24. Schaffer D. Enuresis. In: "Child and adolescent psychiatry: modern approaches" (Rutter M., Hershov L., Taylor E., eds.). 1994, Oxford: Blackwell Science, 1994, p. 465-481.

25. Devlin J.B. Prevalence and risk factors for childhood nocturnal enuresis.

Irish Med. J., 1991, vol. 84, p. 118-120.

26. Korovina N.A., Gavryushova A.P., Zakharova I.N. Protocol for the diagnosis and treatment of bedwetting in children. M., 2000, 24 p.

27. Badalyan L.O., Zavadenko N.N. Enuresis in children. Review of Psychiatry and Medical Psychology. VM Bekhtereva, 1991, No. 3, p. 51-60.

28. Tsirkin S.Yu. (ed.). Handbook of psychology and psychiatry of children and adolescents. SPb .: Peter, 1999.

29. Studenikin M.Ya., Peterkova V.A., Fofanova O.V. et al. The effectiveness of desmopressin in the treatment of children with primary nocturnal enuresis. Pediatrics, 1997, No. 4, p. 140-143.

30. Modern approaches to the treatment of nocturnal enuresis with the drug "Adiuretin". Ed. M.Ya.Studenikin. M., 2000, 16 p.

31. Register of medicines of Russia "Encyclopedia of medicines" (Chief ed. Yu.F. Krylov) - Publishing house 8, revised. and add. M., RLS-2001, 2000, 1504 p.

32. Directory Vidal. Medicines in Russia: A Handbook. M., AstraFarmService, 2001, 1536 p.

Urinary incontinence is a common problem in children. At the age of 5, about 15% of children do not always retain 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 the form of enuresis in which the child did not have a history of dry nights. Children with a history of dry nights lasting more than 6 months have a form called secondary enuresis.

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

Secondary nocturnal enuresis is often thought to be caused by a high level of stress (parental divorce, 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 bedwetting remains unknown.

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

Controlling fluid intake

This method involves parents monitoring their fluid intake throughout the day. For those patients who are found to consume a disproportionate amount of fluid in the evening hours, different regimens may be restricted. Some authors recommend that patients consume 40% of the daily volume in the morning (from 7 to 12 hours), 40% in the afternoon (from 12 to 17) and only 20% in the evening (after 17 hours), 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 afternoon 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 during the day. Getting enough fluid in the morning and afternoon reduces the baby's need for fluid in the evening. In addition, it increases daily urine volume and may help exercise your bladder.

Treatment of bedwetting with "urinary signaling"

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

The method works by creating a conditioned reflex: the patient learns either to wake up to empty the bladder at night, or to retain 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 the child up when the signal sounds.

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

NB! Only the child should turn off the device.

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

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

Approximately 30% of patients discontinue urinary signaling therapy for various reasons, such as skin irritation, anxiety among other family members, and / or parental refusal to get up with their baby at night.

Children who, due to the increased frequency of episodes of bedwetting after the end of the signaling therapy, are forced to use the device again, have much higher rates of effectiveness of the second course of such therapy, due to the creation of an initial effect with the first course.

Alarm clocks

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

Medical treatment of bedwetting in children

Self-medication and errors in the dosage of drugs are unacceptable and can cause serious harm to the child, up to a threat to life.

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

1. Preparations of desmopressin (minirin, etc.). It is a synthetic analogue of the antidiuretic hormone, it, through a number of mechanisms, reduces the production of urine for several hours after administration. Injected only inside

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

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

Desmopressin drugs are expensive and many families simply cannot afford it.

In addition, sufficient bladder volume is required for their effectiveness (i.e. exercises aimed at increasing bladder capacity should be used before the drug is prescribed). The drug must be carefully "titrated", that is, the dose must be increased individually, starting with small ones and choosing the dose that is optimal for a particular child. The dose is changed by the doctor about once every 10 days, the full selection of the dose 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 order for the right dose to be correctly selected and have the maximum effect.

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

Side effects of correct desmopressin therapy are rare. The most serious side effect is dilutional 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 in the evening and not take liquid at night. If the child is forgotten, or, for objective reasons, took a large volume of water in the evening (ARVI, intestinal infection ...), then desmopressin treatment must be interrupted.

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

The mechanism of action of these drugs is:

• decreased sleep time
• stimulating the secretion of vasopressin (antidiuretic hormone)
• relaxation of the detrusor (the muscles of the bladder, which somewhat increases the "working" volume of the bladder)

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

What is the effectiveness of TAD therapy?

Varies across studies. Approximately 20% of children show complete clinical improvement (estimated as 14 or more dry nights in a row), the rest of children have a decrease in the frequency of episodes by an average of 1 "wet" night per week. After discontinuation of the course of therapy with TAD, symptoms return to their initial level in 75% of patients.

Side effects of this therapy?

• Approximately 5% of children treated for ADT have neurological side effects: irritability, personality changes, and sleep disturbances.
• These drugs are under FDA scrutiny for their potential to increase the risk of suicide, especially in adolescents with depressed moods.
• 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 in its relatively inexpensive cost.

Much less effective and have less evidence

other methods of drug therapy:

3. Indomethacin in candles.

One small randomized controlled trial showed that indomethacin in the form of suppositories increased dry nights in children over six years of age with primary nocturnal enuresis after three weeks of treatment. There were no side effects in the study. The proposed mechanism of action: the drug removes the physiological inhibitory effect of prostaglandins on the production of vasopressin and improves the function of the bladder.

often very difficult for the family from the material point of view

has a number of side effects

requires the child to receive regularity and be especially attentive to the dosage, as well as dietary measures

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

in no case is it a substitute for the rest, non-drug approaches, on the contrary - a full-fledged effect can be achieved only when used together with several methods of non-drug treatment 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 treatment.

Complementary and alternative treatments for bedwetting

Studies of complementary and alternative 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 spontaneous cure rate. Most cases do not require initiation of therapy before the age of 7 years.

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

Simple behavioral methods (such as motivational therapy, bladder training) are usually used first, but more serious methods need to be applied when the child is under social pressure and self-esteem.

The urinary signaling therapy is the most effective and long-lasting method. Controlling fluid intake and exercising your bladder can be helpful complementary methods. Medication can be effective for short-term effects by allowing the child to plan social interactions with peers, such as going to a children's camp or spending the night 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, according to the results of the examination, are recognized by the doctor as incapable of taking responsibility for the treatment, should be assured of the very likely spontaneous cure of enuresis. Once the child is able to take on some of the responsibility for bedwetting therapy, it is recommended that simple treatments begin. These include keeping a record of dry nights, exercising your bladder, and monitoring your fluid intake (see above).

"Urinary alarm" or drug therapy should be used in children who have no effect within 3 to 6 months of behavioral therapy. "Urinary signaling" is preferable to pharmacotherapy, since the effect persists for a long time after the cancellation of the course of treatment 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 adjunct to "signaling" 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 within 8 hours after taking desmopressin.

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

- disorder of voluntary urination, inability of the child to control the act of urination. Urinary incontinence in children is characterized by the inability to store and retain urine, which is accompanied by involuntary urination during sleep or wakefulness. To find out the reasons, children undergo urological (ultrasound of the urinary system, cystoscopy, radiography of the kidneys and bladder, electromyography, uroflowmetry) and neurological (EEG, EchoEG, REG) examination. Treatment of urinary incontinence is based on the cause and may include drug therapy, physical therapy, psychotherapy, etc.

General information

Urinary incontinence in children is persistently repeated involuntary (unconscious) urination during the day or night. Urinary incontinence affects 8 to 12% of children, with enuresis being the most common form of pathology in childhood. The polyethiological nature of urinary incontinence in children makes this problem relevant for a number of pediatric disciplines: pediatric neurology, pediatric urology, and child psychiatry.

In children under the age of 1.5-2 years, urinary incontinence is considered a physiological phenomenon associated with the immaturity of somatovegetative regulatory mechanisms. Normally, the skills of urinary retention during filling of the bladder are formed in a child by 3-4 years of age. However, if by this period the skills to control urination have not been established, one should look for the causes of urinary incontinence in the child. Urinary incontinence in children is a social and hygienic problem, often leading to the development of psychopathological disorders that require long-term treatment.

Causes of urinary incontinence in a child

Urinary incontinence in children can be caused by a violation of the nervous regulation of the function of the pelvic organs due to organic lesions of the brain and spinal cord: injuries (craniocerebral, spinal cord), tumors, infections (arachnoiditis, myelitis, etc.), cerebral palsy. Children with various mental illnesses (oligophrenia, autism, schizophrenia, epilepsy) often suffer from urinary incontinence.

Urinary incontinence can be caused by anatomical abnormalities in the development of the child's genitourinary system. So, the organic basis of urinary incontinence can be urachus non-closure, ectopia of the ureteral orifice, bladder exstrophy, hypospadias, epispadias, infravesicular obstruction, etc.

In some cases, urinary incontinence in children occurs against the background of sleep apnea syndrome, endocrine diseases (diabetes mellitus, diabetes insipidus, hypothyroidism, hyperthyroidism), medication (anticonvulsants and tranquilizers).

In some cases, nocturnal urinary incontinence is explained by a violation of the rhythm of the secretion of antidiuretic hormone (vasopressin). Due to the insufficient concentration of vasopressin in plasma at night, the kidneys secrete a large volume of urine, which overflows the bladder and leads to involuntary urination.

Urinary incontinence can accompany urogenital diseases (pyelonephritis, cystitis, urethritis, vulvovaginitis in girls, balanoposthitis in boys, vesicoureteral reflux, nephroptosis, pyelectasis), helminthic invasion. Allergic diseases, such as urticaria, atopic dermatitis, bronchial asthma, and allergic rhinitis, can contribute to increased excitability of the bladder and urinary incontinence in children.

In children, especially preschoolers, urinary incontinence can be stressful in nature. Quite often, a divorce of parents, the death of a loved one, conflicts in the family, ridicule of peers, transfer to another school or kindergarten, change of place of residence, the birth of another child in the family is a psycho-traumatic situation. Recently, among the reasons that contribute to urinary incontinence, pediatricians have called the widespread use of disposable diapers, which delay the formation of a conditioned reflex to urinate in a child.

In most cases, urinary incontinence in children is triggered by a combination of these factors.

Classification

In the event that an involuntary flow of urine occurs through the urethra, they speak of vesical incontinence; if urine is excreted through other unnatural channels (for example, urogenital and urointestinal fistulas), this condition is regarded as extravesical urinary incontinence. In the future, only the forms of vesical urinary incontinence in children will be considered.

In pediatric urology, it is customary to distinguish between incontinence and urinary incontinence: in the first case, the child feels the urge to urinate, but cannot keep urine; in the second, the child does not control urination, because he does not feel the urge. In the event that urinary incontinence occurs during sleep (in children over 3.5-4 years of age at least 2 times a month) in the absence of mental illness and anatomical and physiological defects of the urogenital sphere, they speak of enuresis (nocturnal or daytime).

Urinary incontinence in children can be primary or secondary. Primary (persistent) means a delay in the formation of a physiological reflex of formation and control of urination. This usually occurs against the background of neuropsychiatric disorders or organic disorders of the urinary system. Secondary (acquired) urinary incontinence refers to situations where the skill of inhibition of urination is lost after a period of urinary control over 6 months. Secondary urinary incontinence in children can be of psychogenic, traumatic and other origins.

According to the mechanisms of development, urinary incontinence can be imperative, reflex, stressful, from overflow of the bladder, combined.

With imperative (imperative) urinary incontinence, the child is unable to control urination at the height of the urge. This variant usually occurs in children with a hyperreflex form of a neurogenic bladder.

Stress urinary incontinence in children develops due to efforts accompanied by a sharp increase in intra-abdominal pressure (coughing, laughing, sneezing, lifting weights, etc.). This type is most often due to functional weakness of the pelvic floor muscles and urethral sphincter.

Dissociation of the cortical and spinal centers that regulate the function of the pelvic organs, including voluntary urination, leads to reflex urinary incontinence in children. In these cases, there is an involuntary flow of urine in drops or in small portions.

Paradoxical ischuria, or urinary incontinence associated with an overflow of the bladder, can be small - up to 150 ml; medium -150-300 ml and large volume - more than 300 ml. This disorder is characterized by the involuntary discharge of urine due to overflow and hyperextension of the bladder in children with hyporeflex neurogenic bladder, bladder outlet obstruction.

Symptoms of urinary incontinence

Urinary incontinence is not an independent disease, but a disorder that occurs in various nosological forms. Urinary incontinence in a child can be persistent or intermittent; be noted only in a dream or also in a waking state (usually while laughing, running); have the character of slight urine leakage or complete spontaneous emptying of the bladder.

Children with urinary incontinence often have comorbidities such as recurrent urinary tract infections, constipation, or encopresis. Due to the constant contact of the skin with urine, dermatitis and pustular lesions often occur.

Children with enuresis are characterized by emotional lability, isolation, vulnerability or hot temper, irritability, and behavioral deviations. Such children may suffer from stuttering, bruxism, sleep disturbances, sleepwalking, sleepy speech. Autonomic symptoms are typical: tachycardia or bradycardia, sweating, cyanosis and cold extremities.

Diagnostics

Specialized examination of children with urinary incontinence is aimed primarily at finding out the causes of this condition. Therefore, a team of pediatric specialists, including a pediatrician, pediatric urologist or pediatric nephrologist, and child psychiatrist, can participate in the diagnostic search. The study of the somatic status involves the collection of a detailed history, assessment of the general condition, examination of the lumbar region, perineum, external genitalia.

At the stage of urinephrological examination, the circadian rhythm of urination is assessed, laboratory tests are carried out (general urine analysis, bacteriological urine culture, Zimnitsky's, Nechiporenko's test, etc.), uroflowmetry, electroneuromyography.

Treatment of urinary incontinence in children

Depending on the identified etiological factors, treatment is carried out differentially. In case of congenital malformations of the urinary tract, their surgical correction is performed (plastic urethra, sphincteroplasty, suturing of the bladder fistula, etc.). In case of detection of inflammatory diseases, courses of conservative treatment of urethritis, cystitis, pyelonephritis are prescribed. Treatment of children with mental disorders and psychogenic urinary incontinence is carried out by child psychiatrists and psychologists with the help of drug therapy, psychotherapy. If the cause of urinary incontinence in a child is insufficient maturity of the nervous system, courses of nootropic drugs are indicated.

An important role in the treatment of all types of incontinence is played by regime moments: elimination of stressful situations, creation of a benevolent atmosphere, limitation of fluid intake at night, forced awakening of the child and putting on a pot at night, etc.

In the treatment of various forms of urinary incontinence in children, physiotherapeutic methods are effective: darsonvalization, diathermy, electrophoresis, electrosleep, magnetotherapy, IRT, electrical stimulation of the bladder, transcranial electrical stimulation.

Prevention

The variety of preventive measures aimed at preventing urinary incontinence in children is due to the polyetiological nature of the violation. General recommendations include adherence to sleep and wakefulness, timely potty training, sanitary and hygienic education of children, and normalization of the psychological climate. Timely treatment of urinary tract infections, anomalies of the genitourinary system and other concomitant diseases is necessary. The favorable course of pregnancy plays an important role.

Children should never be scolded for urinary incontinence, as this can increase the child's feelings of shame and inferiority.