A delicate disease, which is not customary to spread, is a huge problem, both psychologically, socially and hygienically. Urinary incontinence (incontinence) is found among both children and adults.
Urination physiology, normal
This diagnosis is valid to put the patient over 4-5 years. The lower age limit, according to some authors, is somewhat different. But in the medical community, it is assumed that the disease has clinical significance at the age of about 5 years and older.
The ability to retain urine in newborns and babies of the first years of life is absent. This skill begins to form closer to three years, and ends closer to four. At this age, urination is already controlled by the child: he is able to delay the act of urination, if necessary, to regulate the flow of urine.
The following mechanisms help to keep the urine normal:
- Elasticity and normal tone of the organs of the genitourinary system.
- The controlling influence of the CNS and PNS.
- Adequate development and activity of the smooth and striated muscles of the urethra and the adjacent zone.
- Normal anatomical development and position of the bladder and urethra.
However, as a result of some reasons, organic or functional, there is a violation of urination control processes, and enuresis develops in adults or children.
There are several classifications of this pathology.
By reason of appearance:
- Primary. This is an independent nosological disease. Arises from childhood. In this form, there are no manifestations of organic lesions or psycho-emotional nature. Most often it is nocturnal enuresis.
- Secondary. It appears as a symptom in the pathology of the kidneys, against the background of neurological, endocrinological, and urological diseases. Its symptoms occur both during the day and at night.
Primary enuresis of inorganic nature in children occurs in 80-90% of cases, the incidence of secondary pathology that occurs on the background of previous somatic diseases increases with age.
By the time of onset of symptoms:
- Night. Symptoms occur at night. This is the most common form, among all cases of night enuresis up to 85%.
- Day. In 5% of cases, clinical symptoms occur during the day.
- Mixed. In about 10% of patients, incontinence can occur both day and night.
By the presence / absence of complications:
- Uncomplicated. The form in which the patient during the examination does not observe deviations in the laboratory studies of urine analysis, and there are no changes in the somatic, neurological status, psychological disorders are not detected.
- Complicated. If a patient is diagnosed with somatic diseases, anatomical and physiological abnormalities in the structure of the urogenital system or neurological disorders, this form of enuresis is considered to be complicated.
According to the frequency of manifestations:
- Frequent. Urination involuntarily occurs every night or daily.
- Moderate. Night enuresis happens several times a week (2-3).
- Rare. 2-3 times a month incontinence episodes are possible.
It should be noted special forms of enuresis:
- Neurotic enuresis. This pathology is more common in shy, shy children, with superficial sleep and its disorders. Such children are extremely acute and painful experiencing the presence of their disease. Occurs again against the background of a psychotrauma or lability of the nervous system: visiting a kindergarten, doctor, school, parents’ divorce, or other changes affecting the child’s psyche.
- Urgent. It is characterized by the strongest, unbearable urge to urinate, which a person cannot restrain. This form occurs in injuries of the spinal cord, brain, infectious processes of the urinary system.
- Neurosis-like enuresis. May be of primary or secondary origin. If it occurs in childhood, then a feature of this form is that young patients before adolescence, unlike neurotic enuresis in children, are relatively indifferent to incontinence episodes. Later, there is criticism and heightened feelings about this. Often occurs with nervous tics, stuttering, phobias.
- Neurogenic. A form of incontinence that occurs again with a neurogenic bladder.
The causes of enuresis are many-sided. And today this problem continues to be studied and investigated.
There are several theories of the onset of pathology:
- Delayed maturation of the nervous system. It may be due to both organic and functional (psychogenic) disorders.
- Unfavorable heredity. The risk of this disease in children is several times higher if their parents had this disease.
- Violation of the rhythm of vasopressin secretion. The hormone vasopressin helps to reduce diuresis. Normally, it is more produced at night, so a healthy person has less urine at night. If the secretion of vasopressin in the dark of the day pathologically decreases, there is nocturnal enuresis.
- The impact of stress and psychological factors. The causes of bed-wetting in childhood often occur due to the strong impact of stressful situations: nervous situation in the family, severe fright, and constant psycho-emotional stress.
Several theories are sometimes intertwined in one patient. The disease is considered polyetiological.
The provoking factors that can lead to the disease are:
- Elderly age. With age, muscle tone decreases, the walls of the bladder become sluggish and flabby, and changes in the functioning of the brain develop.
- The weakening of the muscles of the perineum, pelvic floor (typical for women after childbirth).
- Nutrition and diet. Acceptance of citrus, coffee, chocolate, alcohol can affect the increased urge to empty the bladder.
- Increased physical activity. Excessive physical activity leads to an increase in pressure on the walls of the urinary tract.
- Various diseases. Strokes, spinal cord injuries, neurogenic disorders, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, urinary tract infections, kidney diseases, diabetes mellitus are pathologies that are risk factors for developing enuresis.
Symptoms of enuresis can occur in patients of any age: in children over 4-5 years old, in adolescence, in young people or in elderly people. The main symptom of the disease is urinary incontinence. Wet bed during sleep, urine leakage during the day – patients (their parents) can contact a doctor with such complaints.
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Involuntary urination may occur unnoticed by the patient: if the process is typical for night time, the awakening during the emptying of the bladder may not occur, and in the morning wet sheets become an unpleasant “surprise.” Sometimes awakening occurs from the first drops of urine, before emptying at night, patients behave restlessly, characterized by superficial sleep.
Some people have complaints of frequent urgency to urinate, sometimes they are painful (more characteristic of the infectious nature of the urinary organs).
Inability to retain urine adversely affects the psychological state of patients: they become notorious, closed, or, conversely, overly aggressive, emotionally unbalanced.
This pathological condition requires the intervention of specialists and the provision of medical care.
Treatment of enuresis primarily requires the elucidation of the root cause of the disease to eliminate it. Currently, they use an integrated approach in therapy: they use medications, psychological correction of behavior, physiotherapy, and compliance with the regimen.
Comprehensive treatment of the underlying disease
If enuresis is of secondary origin and is a symptom of the underlying disease, chances of success in the treatment of incontinence are high: with adequate treatment of the root cause and elimination of the disease, the patient will forget about the delicate problem:
- If enuresis occurs on the background of infectious processes in the urinary tract, it is necessary to conduct courses of antibacterial or antiviral therapy, depending on the pathogen that caused the infection.
- Normalize hormones should endocrine pathologies, which can also provoke involuntary urination.
- Neurological correction with nootropic drugs, agents that improve metabolic processes in cells, is required if neurotic enuresis occurs.
With timely identification of the causes that led to the occurrence of pathology, and its elimination there are great chances for success. More difficult is the situation with the primary forms of the disease.
Correction of behavior and mode
It is very important, especially in childhood, to approach the treatment of enuresis, especially if it was provoked by nervous disorders and psychotrauma. A trusting, warm relationship should be established between the child and the parents. In no case should not be punished, ridiculed or humiliated the little patient for wet sheets. It should explain in an accessible form the essence of the problem, talk about how to deal with it.
It is useful to keep a diary at home, noting in it “dry nights”, to praise and encourage the child for them. Wake up the baby for urination several times a night.
At any age, this problem is important psychological comfort, minimizing stress, a positive attitude towards success in therapy. One of the components of treatment, especially for neurosis-like forms, is training with a psychotherapist.
It is necessary to correct the diet, excluding from the use of coffee, alcohol, do not use liquid before bedtime and in the evening, limit the use of salt, chocolate, tea.
The following drugs are used for enuresis:
- Drugs that reduce urine formation: Desmopressin (adiuretin).
- Bladder capacity enhancement agents: Oxybutynin.
- Tricyclic antidepressants: Imipramine.
There is no universal cure for enuresis in children or adults. The selection of medicines, their dose and the scheme is prescribed by the doctor in each case individually.
It has a positive effect as one of the methods of complex therapy in combination with other methods.
According to the recommendations of the doctor may use:
- Darsonvalization on the projection of the bladder.
- Electrophoresis with substances that reduce the tone of smooth muscles: atropine, euphylline.
- Therapeutic mud on the lumbar region and lower abdomen.
- Paraffin therapy.
- Ionogalvanization with atropine sulfate solution.
- Nitrogen, hydrogen sulfide baths, circular showers.
Physiotherapy procedures are usually prescribed for 10-14 days, after a break and good tolerance, it is possible to repeat the course of treatment.
Urinary incontinence or enuresis is quite widespread among the population. This pathology suffers from 5 to 30% of children aged 5 to 15 years (and boys are affected 2-3 times more often than girls), enuresis in adults occurs with a frequency of 1.5-2%. The treatment of pathology is complex, long-lasting, requires an individual approach to the patient.