Enuresis is urinary incontinence, which in 95% of all cases of the disease occurs during a night’s sleep. Why there is enuresis in children: the causes of the disease often lie in the physiological immaturity of the regulation of urination and psycho-traumatic factors.
Incontinence of urine in children is a topic so delicate that many parents prefer to keep silent about it. Meanwhile, statistics show that about 15% of children, including adolescents, suffer from this disease. The question arises: how to treat enuresis in children? And is it worth doing at all? Treatment of a disease is rather a matter of time, rather than a doctor’s competence or the effectiveness of medicines. Also important is the mental attitude and faith in a successful recovery. First of all it concerns the child himself, his personal motivation. However, the support of mom, dad and all the numerous relatives in this case gives no less therapeutic effect.
Types and forms of enuresis
For medical reasons, a child under 4 years of age must learn to control the process of day urination, and up to 6 years old, night urination control should be developed. If this does not happen within the specified time, we can talk about the problem of incontinence. There are two types of enuresis: primary and secondary.
- Primary. It is installed since birth. As a rule, is hereditary. The conditioned urination reflex, which usually forms by the age of 3-4 years, has not been developed. A long period of “dry nights” was not observed at all. Most cases of childhood enuresis are the primary species.
- Secondary. Urination control was established for at least six months, but then night incontinence resumed. The causes of secondary enuresis most often lie in the area of the psyche, so it is also called psychogenic, neurotic. Also, the cause may be transferred infectious diseases, complications, intoxication.
According to the degree there are three forms of enuresis:
- mild: 1 or 2 cases of involuntary urination per week are noted;
- average: there are about 5 cases of bed-wetting during the week;
- severe: the child is written several times a night, there are no dry breaks at all.
By type of enuresis is:
Only in 5% of cases, daytime enuresis occurs. If we are talking about enuresis, it is usually implied bed wetting.
Causes of childhood enuresis
The most common cause of childhood enuresis is heredity. If both parents had enuresis in childhood, the probability of illness in a child is about 80%. What else can provoke incontinence?
- Immaturity of urination regulation mechanisms. These are physiological disorders that occur in 15% of children. They are associated with the immaturity of the bladder, urinary tract and nervous system. The “connecting link” that tells the brain that the bladder is full does not function fully.
- Neuropsychiatric disorders. If the child had a birth trauma, impaired intrauterine development, there are epileptic seizures, brain dysfunction, mental abnormalities, enuresis occurs much more often. In hyperactive children, there are also frequent cases of bed-wetting.
- Anatomical features of urination. A small bladder, too narrow urethra can cause enuresis.
- Diseases of the genitourinary system. These include various pathologies and infections, as well as complications after illness.
- Reducing antidiuretic hormone. In children prone to enuresis, the production of antidiuretic hormone is impaired. If there is a lot of it in the blood, the volume of urine decreases. If it is not enough, then urine, on the contrary, becomes larger. With nocturnal enuresis, the level of the hormone decreases, which leads to an active production of urine.
- Psychological causes of enuresis in children. Psychotraumatic factors include various stresses and depressive states. They can provoke fear, fear, moving to another city, moving to a new school, problems in the children’s team, traumatic atmosphere in the family, separation, frequent conflicts between parents, etc. In the first place are the tragic cases – the loss of a loved one.
It used to be that the cause of nocturnal incontinence may be the phase of sound deep sleep: the child does not feel how the brain sends signals. It has been proven that children who are fast asleep will still wake up if the bladder is full. The problem is not in sound sleep, but in the immaturity of the very mechanism for regulating urination. You can also find the mythical version that diapers are a provoking factor for urinary incontinence.
There are a huge number of treatments for enuresis. Some parents choose the traditional medical solution to the problem. Others trust psychologists and psychotherapists more. Still others acquire special devices to control urination. The fourth believe in the miracle of conspiracies and prayers attendants. All of these methods work if you truly believe in them. Also, you should always take into account the time factor. People say: “it will outgrow it – and will take everything off like a hand”.
It happens that expectant tactics do not suit parents, and the doctor insists on the use of drugs. Practice shows that the percentage of cure for enuresis with medical drugs is extremely low. If the cure for enuresis in children does not give an effect within a few weeks, it is canceled. When enuresis prescribe such drugs: “Spazmeks”, “Desmopressin”, “Driptan”. They reduce and restrain involuntary urge to urinate, increase the volume of the bladder. Also, with neurological enuresis and increased anxiety of the child, the doctor may prescribe antidepressants: “Amitriptyline”, “Dosulepin”, “Dotiepin”, “Imipramine”.
Highly effective method of treatment, which in 80% of cases gives a complete recovery. It is noteworthy that the child himself becomes the best psychotherapist in this situation. There is a fair opinion: until the child himself wants to get rid of the problem, it will not disappear. This method is used in children older than 5 years, because up to this age there are difficulties with the question of personal motivation. The child is still difficult to formulate goals, to realize and direct volitional efforts. What is the essence of the method? In the notorious “carrot”: if there are dry nights, then there will be a prize, a gift, a reward, praise.
Each child has his own motivation. It is important for someone to be praised. Someone needs a dog, a bicycle, a new toy, a trip to the sea, going to the movies, etc. Rewards can be both tangible and intangible. You can hang a calendar in the baby’s room and mark dry nights on it. It is necessary to concentrate on success, not to focus attention on “wet matters”.
The method is effective only when the child has a desire to get rid of the problem. Usually therapy is conducted with children of primary school age and adolescents.
- It is important that there is confidence in the specialist.
- It is also necessary to take into account that the work involves deep layers of the psyche, and there may be emotional negative outbursts.
- To establish the cause of urinary incontinence, it takes time and effort.
- Often this problem occurs in anxious, vulnerable, touchy children who suppress the true emotions throughout the day, and at night they “relax”.
- It is believed that enuresis reflects the relationship of children with their parents, often mothers and sons.
- Strong control of the child, the desire to make it better than others, excessive guardianship by adults – all these unconscious actions and goals can contribute to persistent incontinence.
- Therefore, without the participation of parents, the meaning of therapy is lost.
Enuresis in boys is observed more often (approximately 60% to 40%). This is explained by the fact that the physiological maturity of the regulation of urination in girls occurs faster than in boys. There is another psychological reason: girls have higher adaptive capacity, their inner motivation is more developed.
Controlled liquid volume
An important point in the treatment of enuresis. After 17 hours, the child should drink 20% of the liquid from the daily requirement. A few hours before sleep, it is desirable to give a minimum amount of fluid. It is important that the air in the room is humid and cool, and the child is not wrapped in a warm blanket during sleep. In this situation, the feeling of thirst will be natural and inevitable. Also, do not allow active games and physical activity before bedtime. The child will sweat hard, ask to drink.
How much time does the child spend in the fresh air? What time does he go to bed? What do you do during the day? It is important to maintain an active lifestyle, observe the daily regimen, and go to bed at about the same time. It is equally important to ask questions: How often does a child play computer games? What movies, cartoons and TV shows does he watch? What peers and adults are you talking to? Everything that children emotionally soak up during the day, is given in full during sleep. Bedwetting in children can be the result of emotional overload in the afternoon. Before going to bed there should be a calm atmosphere in the house.
This method is recommended if there are no problems with urology. This method does not adversely affect the function of the urogenital system. You can tolerate tolerance already from the age of three before every day trip to the toilet “in a small way”. This does not mean that you need to endure half an hour or an hour. 5 minutes is enough for the child to gradually develop urination control.
Unfortunately, in Russia and the countries of the former Soviet Union this device is not so well known. The urinary alarm cures enuresis with almost 100% efficiency. How does it work?
- A wired sensor that reacts to moisture is attached to the child’s underpants.
- The other part of the wire sensor is attached to the alarm.
- As soon as the child begins to write, the sensor is triggered and the alarm sounds.
- The child wakes up, fixes the beginning of urination, turns off the alarm, sits down on the pot or goes to the toilet.
The essence of the method is to fix the control of night urination. There are modern wireless models of the urinary alarm, which facilitates its use.
Is it possible to replace this device with something? Simplified option:
- Mom starts the usual alarm for a certain time, for example, at 0:30;
- wakes up a child at the same time for two weeks, drops it in a pot or leads to the toilet;
- this goes on every night for six months.
After two weeks, the alarm should be set at 1:00 AM, after another two weeks at 1:30, and so on. In this way, urination control is produced. It is important that the child wakes up to the end, and the urination process takes place in a conscious and not half asleep state.
Treatment of enuresis in children folk remedies has a long history, includes many different ways.
- Healing That conspiracies and prayers heal is a fact. Some believe in a miracle. Others believe that there are psychological reasons behind all this. Parents often turn to grandmothers when they recognize that all previous methods are powerless. And some old woman from a deaf village suddenly turns out to be the last instance. The recognition of attendants is also a recognition of the fact that it is impossible to control life and totally, to the point of pain, to control one’s own child. In this there is not only a psychological, but also a philosophical, moral and ethical aspect. This applies not only enuresis, but also other diseases (sometimes severe, incurable).
- Herbal treatments. In folk recipes from enuresis, broths of lingonberry, St. John’s wort, centaury, fragrant violet, sage, plantain seeds, dill are used.
- The inclusion of attention. This advice can be found in the subject of “folk treatment”, although it is used with great success in NLP (neuro-linguistic programming) and is called the anchor method. What is the point? The child puts a ring on the finger. When there is urge to urinate during the day, each time he must take off the ring and put it on another finger. In this case, attention is fixed on the thought: “I pee.” Another similar method: before going to bed, the child must tell himself that he will wake up dry, and knock three times on the wall with his fist. So you need to do for a long time. Most importantly, the child must do this with desire and faith.
- Cold foot bath. In the bathroom you need to dial the cold water ankle-deep. Within 10 minutes the child must wander in the water. When the legs are cold, you need to get out of the bathroom and trample on the floor. You can not wipe your feet, they should dry out.
Difficulties of social adaptation
The older the child becomes, the more often there are problems with social adaptation. This applies to various trips, overnight stays. The help of a psychologist and psychotherapist is often required to work with the correct perception of the disease. The question is not only how to get rid of enuresis, but also how to accept yourself so in this situation. This is an important step towards healing.
Abroad, the problem of nocturnal enuresis in children is easier. There exist specialized products for those who suffer from this disease at different ages. Special sheets are sold, diapers, diapers, etc. In the West, the approach is this: yes, there is a problem, but it should not interfere with a full life. And there is nothing wrong with the fact that the “over-age child” puts a diaper on at night when you have to sleep in a tent, train, hotel, etc. It turns out that a social problem is a matter of mentality.
Of course, this is also a family matter. In ancient times, they tried not to disclose it, so to speak, not to wash dirty linen in public. The point is not that this is a “shameful topic”, but to save energy to resolve this issue: not to be scattered, not to complain, not to be ashamed, but to accept the problem and solve it sensibly.
Perhaps enuresis is given to the child and his family as a test. Someone is aware, takes the disease and passes the obstacle with success. Someone is strengthened in the belief in a higher power, someone believes in himself and his child. Someone rejects, afraid, ashamed, but at the same time persistently treated with medication.
Treatment of enuresis in children includes various methods. More often it is medication and psychotherapeutic. The treatment is carried out by a neurologist, urologist, psychotherapist. However, the most effective way is still the time and patience of the parents. It is important to realize: by pedagogical instructions, enuresis is not treated, but only aggravated. You can not blame children, shame, blame that does not depend on their will, character, behavior.