Enuresis or urinary incontinence is a fairly common phenomenon among children under the age of five, although it sometimes occurs in teenagers.
Enuresis can be a variant of the norm as one of the stages of the formation of the micturition reflex – the so-called monosymptomatic enuresis. And it can be the result of certain congenital pathologies (abnormalities of the urinary tract, colon and spinal cord), emotional shocks or changes in the body. If secondary enuresis is not treated, it can spoil the quality of life, and in the future – even kidney failure can develop.
“UP. Life” spoke with a pediatric urologist, head of the urological department of the St. Nicholas Children’s Hospital in Lviv Dmytro Shevchuk and found out:
- when urinary incontinence is the norm, and when should you consult a doctor;
- causes and symptoms of the disease;
- what should parents do if their child has enuresis;
- how to treat and solve this problem.
What is enuresis and what types exist
Enuresis is urinary incontinence, mainly at night. Its types should be distinguished: primary and secondary.
Primary or monosymptomatic enuresis occurs before the age of five and is a variant of the norm.
“If there are no other causes of the disease (for example, infections), then such a condition does not require treatment. Then we give the child time, because the urination reflex can be formed up to five to seven years.”says the pediatrician.
On the other hand, secondary enuresis is urinary incontinence that occurs as a result of changes in the body, pathologies or anatomical abnormalities. This condition requires intervention and cannot go away on its own.
Incontinence during the day
Incontinence during the day cannot be called enuresis, it is a different problem. Dmytro Shevchuk says that such a pathology is often caused by a neurogenic bladder or neuromuscular dysfunction of the bladder, in which the bladder does not empty properly due to disorders or diseases of the nervous system.
This happens because the bladder cannot collect the required amount of urine and it is not held by the sphincters (then a small volume of the bladder), or when it is overstretched and the bladder cannot be completely emptied (there is chronic urinary retention).
In addition, urine can flow due to diseases or injuries of the spinal cord and brain, spine or nervous system. A neurourologist deals with solving such problems.
The main symptoms are leakage or retention of urine during the day. It can leak due to the fact that the muscles that hold urine do not receive a signal from the brain and it is released uncontrollably. Instead, urinary retention occurs because the bladder does not receive the impulse that it is time to release it.
Living with such a pathology is not an option, because it can cause psychological problems in the child (embarrassment, shame, low self-esteem and problems with socialization). A psychologist can help solve this. But in any case, you need to go to a pediatric urologist.
There is a myth circulating on the Internet that neurogenic bladder dysfunction in children cannot be treated. However, this is not the case. A pediatric urologist says that the pathology can be cured, the specialist selects the tactics after the examination. In general, medicine uses various medications, catheterization (a special tube is inserted into the urinary canal, with the help of which urine is removed), and in some cases, surgical interventions are required.
Neurogenic bladder can lead to inflammation of the urinary organs. Doctor Dmytro Shevchuk urges not to delay and seek help. The most important thing in this situation is to prevent kidney damage: in this case, you can lose an organ and need hemodialysis and/or transplantation (transplantation) of this organ.
Symptoms of enuresis
The main symptom of secondary enuresis is urinary incontinence during night sleep in children who are more than five years old and/or symptoms from the urinary tract (inflammation, anatomical disorders).
The doctor explains that there may also be:
- changes in psychoemotional state;
- increased body temperature (if enuresis is caused by an infection);
- changes in urine;
- violation of urination during the day;
- pain in the area of the bladder or genitals.
Causes of the disease
Primary enuresis occurs due to:
- delay in the formation of the micturition reflex;
- genetic predisposition.
“If one of the child’s parents had bedwetting, then the children more prone his mother”Dmytro Shevchuk emphasized.
The occurrence of secondary enuresis can be provoked by:
- negative emotions and stress, which have a detrimental effect on the child’s psyche;
- chronic urinary tract infection;
- injuries of the brain and spinal cord caused during childbirth, as well as congenital anomalies of the spinal cord;
- pathologies of the large intestine that lead to permanent constipation;
- disorders in the development of the urinary tract (urethra) – posterior urethral valves.
“If there is a congenital abnormality or damage to the brain and spinal cord, it disrupts the maturation process of the voiding reflex. First, the bladder must fill. Next, nerve impulses send signals through the spinal cord to the brain. Then the brain sends a signal to the bladder to contract and the sphincters to relax. If there is a violation at some stage, then one of the consequences may be urinary incontinence,” – the doctor explains.
Diagnosis of secondary enuresis
In order to eliminate the problem, you need to understand its cause. Therefore, first of all, it is worth contacting a family doctor, who should collect an anamnesis, examine the child, give recommendations and, if necessary, refer to a specialist.
To detect enuresis and the cause of its occurrence, they can prescribe:
- general analysis of urine and blood;
- examination of the external genitalia and sacrococcygeal area;
- Ultrasound of the kidneys and bladder (before and after urination);
- complex urodynamic examination (the bladder is filled with physiological solution through a catheter and the volume and pressure in it are measured. This is done in order to find out how the muscles of the bladder work);
- if necessary, patients undergo other types of diagnostics to detect possible neurological disorders.
How to cure enuresis without the use of drugs
Urologist Dmytro Shevchuk says that the method of treatment depends on the cause of the disease:
“If enuresis occurred due to stress or negative emotions, then the first thing to do is to work with a psychologist. It is also important to motivate the child to wake up dry. Parents should take an active part in this.”
The doctor advises parents to start by eliminating psychological problems. In particular, it is important:
- talk with the child about the problem; ask what she thinks and feels;
- encourage her, you can promise a gift or a surprise if she wakes up dry, praise her for every achievement;
- in no case should you shout or punish the child for wet bed; remember – it’s not her fault.
- do not wake the child in the middle of the night – this inhibits the development of the urination reflex.
For the treatment of urinary incontinence, so-called “enuresis alarms” are used around the world.
The Mayo Clinic says that these are small devices with a sensor that gives a signal when urine gets on it and wakes the child up at night. They are placed in the child’s underwear or under the bed. The signal about moisture should sound exactly when the urination process begins. This should help the child wake up, stop the stream of urine and reach the toilet.
If you try to apply this method of treatment, you should be patient and persistent, because the result will not be visible immediately. It usually takes one to three months to see a positive trend.
England’s National Health Service (NHS) states that bedwetting alarms can start working within two weeks of using them. The device can be removed when the child wakes up dry for 14 nights in a row.
Such alarm clocks can be bought in pharmacies without a prescription. They solve the problem in a more long-term perspective, helping to form the urinary system.
Also, the doctor does not recommend children who have enuresis to be in diapers all the time. This is harmful, because then there are violations of the temperature regime of the genitals, which in the future can negatively affect the reproductive system, especially in boys.
Medical treatment of urinary incontinence
Medicines can also be used for treatment.
“Treatment of enuresis is carried out in accordance with current European protocols. We usually prescribe safe hormonal drugs that can be used by children. They come in the form of tablets or in the form of a nasal spray. Its contents are absorbed into the mucous membranes of the nose.”– says Dmytro Shevchuk.
Antispasmodics that act on the muscles of the bladder are widely used in Ukraine. They relax it and thus increase the bladder so that it does not shrink, having a smaller volume.
If enuresis persists in older age, it may be the result of congenital abnormalities, such as a posterior urethral valve or spina bifida. They can be removed only by surgical intervention. The earlier the child is operated on, the better the results will be in the future.
In general, the treatment of enuresis can last from several months to a year. Each case is individual, and there is no universal method.
Urologist Dmytro Shevchuk emphasizes that you should not ignore enuresis and hope that it will go away without treatment.
“Ignoring primary enuresis can lead to psychological trauma and affect the quality of life in the future. Secondary enuresis is more dangerous. It is caused by anatomical reasons that must be identified and eliminated. If enuresis is not treated, there is a risk of damage to the urinary bladder and kidneys, resulting in the development of renal failure. failure, which may require hemodialysis and even a kidney transplant.” – explained the doctor.
How to prevent the development of enuresis?
- help the child develop the urination reflex. To do this, you can start a diary, where the child will note trips to the toilet and how many times he woke up dry;
- follow the bladder;
- improve nutrition, it is important that there is no constipation. Constipation can affect the functioning of the bladder, and enuresis can be a consequence of this;
- minimize stress and strain. For example, if a child is afraid of monsters, arrange lighting in the room and near the toilet. And also take away objects that can cause fear.
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