Enuresis

Enuresis is a pathology in which a person cannot control the emptying of the bladder. In the vast majority of cases (more than 95%), we are talking about a child enuree, when control over urination has not yet been completely 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 manifests itself predominantly at night, when a person sleeps (up to 80% of all cases). Much less often this happens during the vigil.

There is no exact information about the prevalence of this disease, since parents always resort to the doctor about this. According to reports, among 5-year-old children, enuresis occurs in 5-10% of cases; among 10-year-old children in 3-5%; Among 15 -year -old and older young people (adult and adolescents enuresis) -1%.

Types of disease

ENURESIS is classified according to several parameters. Depending on the root cause of the disease, it distinguishes:

• Primary enuresis. According to statistics, it represents more than 90% of cases among children under 5 years. A characteristic of primary enuresis is the absence of neurological or urological pathologies, against which a person could develop urinary incontinence. With this form of illness, the child has no long periods (from 3 to 6 months), when he wakes out dry. With age, the proportion of primary enuresis in the structure of the incidence is reduced. For example, in children of 12 years and older, around 50%represents 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 appear first after the child reaches control over urination (however, not before 6 months after that).

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

• Night enuresis. This is the most common version of the disease that manifests at night. It is assumed that a night incontinence of urine can be associated with the late maturation 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 contains moisture in the body. The disease can also be associated with a very strong dream 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 during the day.

Depending on the accompanying diseases and complications, it happens:

• Without complications. In this case, the patient has no pathological changes caused by urinary incontinence.
• Complicated. This form of disease is discussed when proceeds in the context of other disorders. For example, these are infections or anomalies in the development of the urinary, nervous system and other pathologies.

Bewind prevention

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

1. Timely treatment of urinary tract infections;
2. Control over the volume of liquid consumed by the child during the day, but in this case it is worth considering the season and the temperature of the air;
3. Health and hygienic education of the baby. It implies teaching hygienic attention to the genitals;
4. Timely rejection of diapers. Often, diapers stop using it completely when the child reaches the age of two years;
5. If the child persists at night the episodes of urinary incontinence to reach six years of age, it is necessary to take measures for an integral exam 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 sense, experts present several theories, each of which has a series of indirect evidence and, as a rule, takes into account in treatment. Consider these theories in more detail:

• Maturation violation. It is assumed that involuntary urination at night or day is associated with a delay in the development of the human nervous system. In addition, these violations may have an organic and psychogenic 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.
• Inheritance. According to some observations, the probability of developing the disease is greater if the child's parents also suffered this disease at the same time. Due to the delicacy of this problem, it is quite difficult to identify such a pattern.
• Hormonal theoryA possible cause of nocturnal enuresis is a violation of the secretion of vasopressin. This hormone contains water in the body and its production increases at night. For this reason, a healthy person during the dream is rarely worried about urination. If the child has reduced the production of hormones at night, then this contributes to the development of enuresis. It should be said that such hormonal imbalance is observed with some pathologies, for example, diabetes that are not anhnaichar.
• Stress. It is still not clear where the chicken is and where the egg is. According to observations, many children with urinary incontinence have stressful and other factors. For example, inexplicable fears, low self -esteem and others. At the same time, when the problem of enuresis is solved, the patient's mental state often improves. Therefore, it is possible to incontine and serve as a factor in an unstable state of a person.

Previous theories refer mainly to children. As for adult enuresis, the following violations and circumstances act here adverse factors:

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

This problem can also be caused by taking some medications, for example, contraceptives.

Symptoms of the disease

The main symptom of Enoraz is involuntary urination. Very often, this happens at night, but also happens during the day (during the vigil). In the context of urinary incontinence, the following symptoms are also possible:

• shyness;
• Closing;
• Complexity of twist;
• emotional instability;
• Aggressive behavior (in rare cases).

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

Complications

There are two main groups of complications with an enuresis:

• Complications of the psyche and the nervous system. Mainly this applies to children. The child feels lower, closed. Some aspects of children's life become inaccessible, for example, travel to camps. Adult enuresis can also cause such problems. All this is a serious factor in the development of anxiety and depression.
• Complications of 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, the atypical discharge of the urethra, as well as pain in the crotch and the lumbar region.

Diagnosis

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

The diagnosis, as a rule, includes the following events:

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

In rare cases, the patient addresses other studies, for example, TC or MRI.

WWTING TREATMENT

The worse treatment is integral. Consider the main components of said therapy:

• Pharmacological treatmentMedications that reduce the volume of urine produced are prescribed. These are analogs of the vasopressin hormone. The dose and the reception mode are selected to make humidity mainly persistent at night (if we are talking about a night enuresis).
• The way of taking liquid and nutrition. The doctor will give recommendations on the use of fluid and the energy system. In this case, it is necessary to take into account the diet of a child or adult, the level of their physical activity, the presence of concomitant diseases and a series of other factors. In particular, it is recommended to abandon the use of drinks that contain caffeines, since they improve diuresis and help to have additional fluid. If the patient is practicing sports (which means he is actively sweating), let's accept the intake of the increase in the volume of the fluid.
• Enurant alarm. At the beginning of the last century, a special enuremar alarm was developed for the treatment of prior. The first alarms of this type worked in the beginning of closing the electrical circuit when the first drop of urine appeared. At the same time, the patient was upset by a small electric shock, due to which a person was awakened. Modern Enuremados are acoustic are equipped and equipped with a sensitive humidity sensor. The most common option is a clip attached to underwear. As soon as the first drop of urine enters the sensor, the alarm works. The task of this treatment is the formation of the reflection "The impulse to urination: Awakening". There are also special leaves with sensors, however, unlike a clip and an alarm clip, in which case the signal is activated later, when the urine current already reaches the sheet. The effectiveness of the treatment of night monosyntomatic enuresis with the use of an enureular alarm is approximately 70-80%.

Depending on the accompanying disorders, the treatment of enuresis can also be assumed by the correction of mental or neurotic disorders. The complex treatment of this problem also provides sessions with a psychologist. At the same time, it would not be to consult with the specialist and the child's parents. The psychologist will tell you how to correctly motivate children to comply with all the doctor's instructions to achieve control over urination. The child's punishment 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 general rule, in children, this pathology takes place after treatment or independently, which cannot be said about adult enuresis (since it occurs in the context 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 experienced certain difficulties in a psychological nature.

Prevention

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

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