Enuresis

Enuresis is a pathology in which a person is not able to control the emptying of the bladder. In the vast majority of cases (more than 95%), we are talking about a children's enuree, when control over urination has not yet been fully formed. However, the disease is also found in adults (especially the elderly) when the ability to control the emptying of the bladder has already been lost.

The problem of involuntary urination is predominantly manifested at night, when a person sleeps (up to 80% of all cases). Much less often this happens during wakefulness.

There is no exact information about the prevalence of this disease, since far from always parents turn to the doctor about this. According to reports, among children of 5 years of age, enuresis occurs in 5-10% of cases; among 10-year-olds-in 3-5%; Among 15-year-olds and older (enuresis of adults and adolescents)-1%.

Types of the disease

Enuresis is classified according to various parameters. Depending on the root cause of the disease, distinguish:

• Primary enuresis. According to statistics, it accounts for more than 90% of cases among children under 5 years of age. A feature of the primary enuresis is the absence of any neurological or urological pathologies, against which a person could develop urinary incontinence. With this form of disease, the child has no long periods (from 3 to 6 months), when he wakes up dry. With age, the share of primary enuresis in the structure of incidence is reduced. For example, in children 12 years old and older, about 50%accounts for it.
• Secondary enuresis. This type of pathology is also called recurrent, since it occurs again after a long period of remission. In this case, there is a connection with some urological, endocrine or neurological diseases that can contribute to involuntary urination. It should be noted that this variety of the problem may first appear after the child reaches control over urination (however, not earlier than 6 months after that).

Depending on the time of manifestation, the disease can be the following types:

• Night enuresis. This is the most common version of the disease that manifests itself at night. It is assumed that a night incontinence of urine can be associated with the late ripening of the bladder in a child or a small volume. Hormonal causes are also possible - for example, a low level of vasopressin. This is a hormone that holds moisture in the body. The disease can also be associated with a very strong sleep in a child and difficulties with awakening.
• Daily enuresis. This form of disease is much less common. It is characterized by the fact that patients have problems with control over urination in the daytime.

Depending on the accompanying diseases and complications of enuresis, it happens:

• Uncomplicated. In this case, the patient has no pathological changes provoked by urinary incontinence.
• Complicated. This form of the disease is discussed when it proceeds against the background of other disorders. For example, these are infections or anomalies in the development of the urinary system, nervous and other pathologies.

Enorez prevention

Parents can recommend some preventive measures that help prevent the onset of the disease. Such events include:

1. Timely treatment of urinary tract infections;
2. Control over the volume of fluid consumed by the child during the day, but in this case it is worth considering the season and air temperature;
3. Sanitary and hygienic education of the baby. It implies teaching hygienic care for the genitals;
4. Timely rejection of diapers. Often, diapers completely cease to use when the child reaches the age of two;
5. If the episodes of urinary incontinence are persisted at night by the child to reach six years of age, it is necessary to take measures for a comprehensive examination of the baby, establishing the cause of the disease and its treatment.

The reasons for the development of the disease

The reason for the development of enuresis is unknown. In this regard, experts put forward various theories, each of which has a number of indirect evidence and, as a rule, is taken into account in treatment. Consider these theories in more detail:

• Violation of ripening. It is assumed that involuntary urination in night or daytime is associated with a delay in the development of the human nervous system. Moreover, these violations can have both organic and psychogenic in nature. In the first case, we are talking about a direct lesion of some structures of the brain, spinal cord or peripheral nerves (for example, due to infection). Psychogenic factors can be emotional shocks, traumatic experience and others.
• Heredity. According to some observations, the probability of developing the disease is higher if the child’s parents also suffered from this disease at one time. Due to the delicacy of this problem, it is quite difficult to identify such a pattern.
• Hormonal theory. A possible cause of night enuresis is a violation of the secretion of vasopressin. This hormone holds water in the body, and its production increases at night. For this reason, a healthy person during sleep is quite rarely worried about urination. If the child has reduced hormone production at night, then this contributes to the development of enuresis. It must be said that such a hormonal imbalance is observed with some pathologies, for example, non -naichar diabetes.
• Stress. It is still not clear where the chicken is and where is the egg. According to observations, many children with urinary incontinence have stressful and other mental factors. For example, inexplicable fears, low self -esteem and others. At the same time, when the problem of enuresis is resolved, the patient’s mental state often improves. Therefore, it is possible to incontinate and served as a factor in an unstable mental state of a person.

The above theories mainly concern children. As for adult enuresis, the following violations and circumstances act here adverse factors:

• pathology of the nervous system, for example, stroke, damage to the spinal cord, neurogenic bladder and others;
• diseases of the urinary system, including renal failure, pathology of the prostate gland, a decrease in the tone of the muscles of the pelvic floor, frequent urinary tract infections and other diseases;
• Pregnancy, because in this state, strong pressure from the uterus (especially with large size of the fetus and/or its active movement) is on the bladder.

This problem can also be provoked by taking some medicines, for example, contraceptives.

Symptoms of the disease

The main symptom of Enorez is involuntary urination. Most often, this happens at night, but also happens during the day (during wakefulness). Against the background of urinary incontinence, the following symptoms are also possible:

• shyness;
• Closure;
• Cruck complexity;
• emotional instability;
• Aggressive behavior (in rare cases).

Adult enuresis can be accompanied by frequent urination (often against the background of some diseases). Due to the weakness of the muscles of the pelvic floor (which develops with age), urine leakage during sudden movements, coughing, and even at rest, is possible.

Complications

There are two main groups of complications with an enuresis:

• Complications from the psyche and nervous system. Mostly this applies to children. The child feels inferior, closed. Some aspects of children's life become inaccessible, for example, trips to camps. Adult enuresis can also cause such problems. All this is a serious factor in the development of anxiety and depression.
• Complications from the urinary system organs. The risk of infectious and inflammatory diseases of the urinary tract increases. These are cystitis, urethritis, prostatitis and other pathologies, which are manifested by painful urination, atypical discharge from the urethra, as well as pain in the crotch and lumbar region.

Diagnostics

With an enuresis, it is initially recommended to contact a pediatrician (if we are talking about a child) or a therapist. After the initial examination and survey, the doctor can direct the patient to narrow specialists - urologist, nephrologist, psychiatrist or neurologist.

Diagnosis, as a rule, includes the following events:

• survey and neurological examination;
• Ultrasound of the kidneys and bladder;
• general urine analysis, as well as analysis of Nechiporenko;
• X -ray of the lumbar region.

In rare cases, the patient is directed to other studies, for example, CT or MRI.

Enorez treatment

Enorez treatment is comprehensive. Consider the main components of such therapy:

• Drug treatment. Drugs that reduce the volume of urine produced are prescribed. This is analogues of the hormone vasopressin. The dosage and reception mode is selected so that moisture mainly lingers at night (if we are talking about a night enuresis).
• The mode of taking fluid and nutrition. The doctor will give recommendations regarding the use of fluid and the power system. In this case, it is necessary to take into account the food diet of a child or adult, the level of his physical activity, the presence of concomitant diseases and a number of other factors. In particular, it is recommended to abandon the use of caffein -containing drinks, as they enhance diuresis and help to take additional fluid. If the patient is playing sports (which means it is actively sweating), then let's accept the intake of the increased volume of the fluid.
• Enurant alarm clock. At the beginning of the last century, a special enuremary alarm clock was developed for the treatment of Enorez. The first such alarms worked on the principle of closing the electric circuit when the first drop of urine appeared. At the same time, the patient was annoyed by a small electric discharge, because of which a person was awakened. Modern enuremated alarm clocks are acoustic and equipped with a sensitive moisture sensor. The most common option is a clip that is attached to underwear. As soon as the first drop of urine enters the sensor, the alarm clock works. The task of this treatment is the formation of the reflex "The urge to urination - awakening. "There are also special sheets with sensors, however, unlike a clip an alarm clip, in which case the signal is triggered later, when the urine stream already reaches the sheet. The effectiveness of the treatment of night monosymptomatic enuresis with the use of an enureular alarm clock is about 70-80%.

Depending on the accompanying disorders, the treatment of enuresis may also be assumed by the correction of mental or neurotic disorders. The complex treatment of this problem also provides for sessions with a psychologist. At the same time, it would not hurt to consult with the specialist and parents of the child. The psychologist will tell you how to correctly motivate children so that they fulfill all the doctor’s instructions to achieve control over urination. The punishment of the child or the formation of an unfavorable emotional environment in the family (due to urinary incontinence) is unacceptable and will only aggravate the situation.

Rehabilitation

As a rule, in children, this pathology takes place after treatment or independently, which can not be said about adult enuresis (since it occurs against the background of certain chronic diseases). As such, rehabilitation is not required after treatment. In some cases, the child needs classes with a psychologist or psychotherapist who will help him socialize if the patient had previously experienced certain difficulties in a psychological nature.

Prevention

There are no specific measures to prevent enuresis. It is important for parents to join the solution of the problem in the early stages, without waiting for the disease to pass on their own. As for adults, it may be preventive measures in this case:

• timely treatment of diseases of the bladder and other urological pathologies;
• active lifestyle;
• Preventive examinations at the doctor, especially after 45 years.