Enuresis in children and adults - Causes, symptoms and treatment. MF.

Enuresis, like Ariadne's thread in the search for a disease, he is not a disease, it's just one of the manifestations of a disease. Enuresis is involuntary urinary incontinence. In medical practice, it has been developed that this term is most commonly understood as involuntary night incontinence in children. It is necessary to understand that the word "involuntary" implies complete lack of control from the cerebral cortex, i.e.consciousness. Thus, if a person feels a urge to urinate, but can not hold urine - this is a fundamentally different pathological process, which is commonly called incontinence( urinary incontinence).

And what about newborn babies? It turns out that they are born with an "enuresis"?Yes. But for them this is the norm, since control of urination is formed before the age of 5 years. Therefore, it is legal to talk about pathology if the child is more than 5 years old.

Causes of enuresis

The realization of involuntary urination occurs through the nervous system, regardless of the cause that caused such disorders. The fact is that the regulation of the act of urination occurs on two levels: the first is the spinal cord( outside our consciousness, due to it, involuntary urination occurs in infants up to about 1.5-5 years), the second - the brain( the variolium bridge, the cortex).The latter, as is known, ensures the presence of our consciousness, through which we are able to control our behavior, actions, including urination.

Now you yourself understand that the cause of enuresis is disabling the effect of the cerebral cortex. For clarity, the scheme:

Diseases, the symptom of which may be enuresis

The first place in the frequency of occurrence belongs to the violation of the formation of the reflex itself, or its insufficient stability and vulnerability. It is, undoubtedly, a question of young children. Due to the extreme emotionality of children, any conflict situation produces psychological trauma , and the newly formed neural pathways responsible for control of urination are exposed to intense nerve impulses from neighboring brain centers. And at night, when the cerebral cortex is turned off, this influence leads to a complete disabling of the control, and when the bladder is filled, the nerve impulses from the latter close the reflex arc at the level of the spinal cord, involuntary urination occurs.

A strong sleep, in which the urge to urinate does not awaken the child, can also lead to enuresis.

More rarely the cause of enuresis may be the following diseases:

- urinary tract infections - inflammation of the bladder, urethra, foreskin in vulva boys in girls. In this case, the number of pulses sent from the bladder increases dramatically, and reaching a certain limit, they can initiate a reflex at the level of the spinal cord;
- spinal cord injuries , accompanied by abnormalities of the pelvic organs.

Adults plus psychological problems, injuries and infections:
- diabetes insipidus is a violation of the production of an antidiuretic hormone( ADH), the main effect of which is the retention of water in the body at night;
- Multiple Sclerosis ;
- bladder stones ;
- chronic renal failure .

It should be noted one rather rare form - enuresis in young men on the background of complete physical well-being. This occurs most often at the age of 15-18, during the period of greatest sexual activity. The point is that the center of regulation of sexual behavior and cortical representation of the bladder are located quite close. Thus, with hyperexcitation of the first, nerve impulses are transferred to the center of urination, and a team is sent to the bladder. There is an involuntary urination. In the future, such conditions pass on their own in the presence of regular sexual life. In this case, the excitation of the sexual center is reduced, and the processes in the brain are proceeding correctly.

To which doctor should I apply for signs of enuresis

If it is a sick child, first of all it is necessary to visit the pediatrician. He will appoint all the necessary examinations, and after finding out the reasons, he will direct you directly to the specialist in charge. The last can be a psychologist, psychotherapist, psychiatrist, children's urologist, andrologist, neurologist, endocrinologist.

Adults with enuresis should initially seek treatment from a urologist, unless there is a back injury or head injury. In this case, a consultation of a neurologist is required.

A number of examinations are possible to diagnose the disease that caused enuresis:

1) General urine analysis, general blood test, biochemical blood test( urea, creatinine, blood sugar. ..) to exclude infections and chronic pathology.
2) ultrasound of the kidneys, bladder, internal organs.
3) Overview and intravenous urography with cystography.
4) Cystoscopy.
5) The level of antidiuretic hormone( ADH).
6) Consultation of a neurologist, psychiatrist or psychotherapist.

Treatment of enuresis in children and adults

At the current level of medical development, there are many methods for treating enuresis. With the correct diagnosis and treatment of the effect can be achieved almost always. The main principle is a comprehensive approach to the impact on the causal pathological process. The following mechanisms of influence are possible:

• decrease in urine production at night;
• decrease in the number of pulses emanating from the bladder;
• influence on emotions;
• removal of inflammation.

First of all it is necessary to observe special drinking regime , at which it is not recommended to take liquid two hours before bedtime. Observance of sleep and wakefulness according to age is also important, as the regime is able to normalize sleep. Important and psychological peace , including the need to exclude cartoons and computer games before bed. Sometimes, only compliance with regimes can quickly rid the child of enuresis.

When neurotic factor is revealed, psychocorrection is shown together with vitamin therapy and with the appointment of sedatives. I want to pay a little attention to a specific situation, which occurs very often - it is a conflict between parents. This is what causes the strongest experiences in the child. Externally, you can not even notice the changes in the behavior of the child, and during surveys, he may not admit. If the parents do not treat this problem with due attention, the inferiority complex is aggravated by the small person, and the consequences can be much more serious than enuresis. Therefore, I will allow myself a little farewell to all young parents to be considerate and respectful of their children, since this is a separate planet, a separate world in which concepts and rules are very different from reality.

In the case of , the child with enuresis urinary tract infection shows the appointment of antibiotics, uroseptics and phytopreparations( manual 3.0 once, fumagag 50 mg 3 times daily, 7-10 days, Brovniki broth 1/2 cup 1 time per day,10 days).

When is detected, the use of m-cholinergic blockers( for example, tolterodine 1 tablet( 2 mg) 2 times a day, 2-3 months) is recommended, which relax the muscle layer of the bladder, and as a result, the latter is able to accumulate moreurine, without causing a feeling of urge to urinate.

With proven violation of the rhythm of the release of ADG ( antidiuretic hormone), the appointment of a synthetic analogue - Minirin( 1 tab( 100mkg) before bed, 1 month) is indicated. Thus, at night, less urine will be produced, and this will have some effect.

In the complex it is also desirable to use physiotherapy procedures, phototherapy, music therapy, etc.

When enuresis benefits aerophytotherapy: the room is sprayed with a mixture of essential oils of sage, lavender, coriander in a ratio of 3: 2: 1.For each procedure use 2 to 5 drops of a mixture of oils in 30 ml of one of the listed fees. For nebulization use an ultrasonic inhaler. The session lasts 5 to 15 minutes daily or every other day. The first session lasts 1 - 2 minutes. The course of treatment is 15 - 20 sessions.

In cases of spinal cord injuries or urolithiasis - surgical treatment.

In adults, is based on the treatment of enuresis - treatment of a disease that led to involuntary urinary incontinence.

Enuresis in the elderly

In older people, more often in the background of chronic diseases( prostate adenoma, diabetes, hypertension, osteochondrosis, etc.), the nerve fibers become thinner, atrophy, and they become unable to carry out a nerve impulse to the cerebral cortex, and henceurination occurs, as in infants, through the spinal cord. It is extremely difficult to correct such cases, such is nature. It is almost impossible to go against the laws of nature. Most often, all ends with the installation of cystostomy( in other words, the tube into the bladder).

Remember: never start treatment yourself! Everything is strictly according to the doctor's prescription, and under his control!

Forecast

Summarizing all of the above, it should be noted that in children, enuresis is a functional one, and with timely access to a doctor, the prognosis is overwhelmingly favorable. Therefore, if you notice a wet mattress in your child, do not get upset at all, be patient, go to the hospital, and everything will be fine.
But in adults, even with serious illnesses, injuries, enuresis is always amenable to correction. The main thing to remember: the success of treatment always depends on a timely appeal to doctors!

Doctor Soloyan D.V.