Enuresis

Enudeis is a pathology in which a person is not able to control bladder emptying. In the vast majority of cases (over 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 bladder emptying has been lost.

The problem of involuntary urination manifests predominantly at night, when a person sleeps (up to 80% of all cases). Much less this happens during the waking.

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

Disease types

The enuresis is classified according to various parameters. Depending on the root cause of the disease, it distinguishes:

• Primary enuresis. According to statistics, it is responsible for more than 90% of cases among children under 5 years of age. A characteristic of 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 (3 to 6 months) when he wakes up dry. With age, the participation of primary enuresis in the structure of the incidence is reduced. For example, in children 12 years or older, about 50%is responsible for this.
• Secondary enuresis. This type of pathology is also called a recurrent, as 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 for the first time after the child reaches control over urination (however, not before 6 months after that).

Depending on the time of the 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 nocturnal urine incontinence may 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 keeps moisture in the body. The disease can also be associated with a very strong sleep in a child and difficulties in awakening.
• Daily enuresis. This form of disease is much less common. It is characterized by the fact that patients have problems with control over daytime urination.

Depending on the diseases and complications that accompany you from enuresis, this happens:

• Not complicated. In this case, the patient has no pathological changes caused by urinary incontinence.
• Complicated. This form of the disease is discussed when it occurs against the background of other disorders. For example, these are infections or anomalies in the development of the urinary, nervous system and other pathologies.

Prevention of enorez

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

1. Timely treatment of urinary tract infections;
2. Control on 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. Implies the teaching of hygienic care for the genitals;
4. Oportus rejection of diapers. Often diapers cease to use completely when the child reaches the age of two;
5. If episodes of urinary incontinence are persisted at night by the child to reach six years of age, it is necessary to take action 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 sense, experts present various theories, each with various indirect evidence and, as a rule, is taken into consideration in treatment. Consider these theories in more detail:

• Violation of maturity. 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 of an organic and psychogenic nature. In the first case, we are talking about a direct injury to some brain structures, spinal cord or peripheral nerves (eg, due to the infection). Psychogenic factors can be emotional shocks, traumatic experience and others.
• Heredity. According to some observations, the likelihood of developing the disease is greater if the child's parents also suffered from this disease at the same time. Due to the delicacy of this problem, it is quite difficult to identify this pattern.
• Hormonal theory. A possible cause of night enuresis is a violation of vasopressin secretion. This hormone maintains water in the body and its production increases at night. For this reason, a healthy person during sleep is rarely concerned with urination. If the child reduces hormonal production at night, this contributes to the development of enuresis. It should be said that this hormonal imbalance is observed with some pathologies, for example, non -analysis diabetes.
• Stress. It is not yet clear where the chicken is and where the egg is. According to observations, many children with urinary incontinence have stressful mental factors and others. 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 usually improves. Therefore, it is possible to incontinently and serve as a factor in an unstable mental state of a person.

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

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

This problem can also be caused by taking some drugs, for example, contraceptive.

Symptoms of the disease

The main symptom of enorez is involuntary urination. Most of the time, this happens at night, but it also happens during the day (during the waking). In the context of urinary incontinence, the following symptoms are also possible:

• shyness;
• Closing;
• Cuck complexity;
• Emotional instability;
• Aggressive behavior (in rare cases).

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

Complications

There are two main groups of complications with an enuresis:

• Psyche and nervous system complications. Especially this applies to children. The child feels inferior, closed. Some aspects of children's lives become inaccessible, for example, travel to camps. Adult enuresis can also cause these problems. All of this is a serious factor in the development of anxiety and depression.
• Complications of the organs of the urinary system. The risk of infectious and inflammatory diseases of the urinary tract increases. They are cystitis, urethritis, prostatitis and other pathologies, which are manifested by painful urination, atypical discharge of the urethra, as well as pain in the virile and 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 examination and initial research, the doctor can direct the patient to strengthen specialists - urologist, nephrologist, psychiatrist or neurologist.

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

• research and neurological examination;
• Kidney and bladder ultrasound;
• General urine analysis, as well as Nechiporenko analysis;
• X -ray of the lower back.

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

Enorez treatment

Enoorez treatment is comprehensive. Consider the main components of this therapy:

• Drug treatment. Medicines that reduce the volume of urine produced are prescribed. They are analogs of the hormone vasopressin. The dosage and reception mode is selected so that moisture remains mainly at night (if we are talking about a nightly enuresis).
• The way of taking fluid and nutrition. The doctor will provide recommendations on the use of fluid and energy system. In this case, it is necessary to consider the diet of a child or adult, the level of their physical activity, the presence of concomitant diseases and various other factors. In particular, it is recommended to abandon the use of caffeine -containing beverages as they improve diuresis and help to take additional fluid. If the patient is playing sports (which means he is actively sweating), we will accept the ingestion of increased fluid volume.
• Amburant alarm. At the beginning of the last century, a special Enureremary alarm clock was developed for the treatment of enorez. The first alarms of this type functioned with the principle of closing the electrical circuit when the first drop of urine appeared. At the same time, the patient was annoyed with a small electric discharge because of which a person was awakened. Modern lounted alarm clocks are acoustic and equipped with a sensitive moisture sensor. The most common option is a clip attached to the panties. 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 reflection "the desire to urinate - awakening". There are also special leaves with sensors, however, unlike an alarm clip, in which case the signal is then triggered, when the urine flow already reaches the sheet. The efficacy of the treatment of nightly monosymphomatic enuresis using an enreular alarm clock is about 70-80%.

Depending on the disturbances that accompany you, the treatment of enuresis can also be assumed by the correction of mental or neurotic disorders. Complex treatment of this problem also provides sessions with a psychologist. At the same time, it would not badly consult the child's expert and parents. The psychologist will tell you how to properly motivate children to meet 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 occurs 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 necessary after treatment. In some cases, the child needs classes with a psychologist or psychotherapist who will help him socialize if the patient had already experienced certain difficulties of a psychological nature.

Prevention

There are no specific measures to prevent enuresis. It is important for parents to come together to solve the problem in the early stages, without waiting for the disease to go through their own. As for adults, it can be preventive measures in this case:

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