Enuresis

General information about a disease

Enuresis is a spontaneous emission of urine during sleep in night (night enuresis) and day time. Most often enuresis occurs at children. It is necessary to notice that enuresis it is lawful to make the diagnosis at manifestation of symptoms of a disease at children in 4 years, at the child the skill of detention of urine already has to develop at desires. At normal development, in 6 months at 80% of children the incontience disappears during sleep in the afternoon. Aged one and a half years at 70% of children cases of such incontience have more incidental character (once in seven days), and involuntary urinations do not occur at night any more.

Also enuresis occurs at adults. The reasons of such deviation lie more in the physical nature of a disease, than psychological: enuresis is most often caused in adults by spine injuries or a bladder, various diseases of urinogenital system accompanying them surgical interventions.

Several types of enuresis at children are allocated: simple form, neurotic, neuropathic, endokrinopatichesky, epileptic, dysplastic. Also such forms of enuresis at adults are known: urgentny, stressful and mixed. At each of the specified forms the clinical picture.

Clinical picture of day and night enuresis

At a simple form of enuresis at children, constants (from 2 to 5 rubles a week) cases of an involuntary urination in the first half of night are observed rare, but, during a phase of a deep sleep. Such form of enuresis at children has most often hereditary character and passes unnoticed for them, without causing psychological experiences.

And here the neurotic form of enuresis at children, on the contrary, causes in them emotional reactions of negative character. The child worries because of "defect", on this soil even attempts of a suicide were recorded. Such form of night enuresis meets seldom, and it is accompanied by various neurotic manifestations – irritability, lability of mentality, a sleep disorder, tics, a capriciousness and tearfulness, fears. The neurotic form of enuresis at children is shown wavy as directly depends on an emotional condition of the child.

Neuropathic enuresis at children develops against the background of children's nervousness which has inborn character and forms at changes of a nervous system, frequent colds in early age. At this form of enuresis the sleep disorder and the dream wakefulness mode is noted. Besides, except night enuresis at the child the incontience is possible during a day dream, and the quantity of such cases increases at cold.

Generally night involuntary urination with the accompanying endocrinopathies – obesity, rises in temperature of paroxysmal character, diabetes is peculiar to Endokrinopatichesky enuresis.

The epileptic form of enuresis develops at epilepsy. The incontience occurs in the form of similar to explosion of emission of a large amount of urine. At the same time twitching of extremities, breath holding, vegetative disturbances is observed.

Dysplastic enuresis forms at organic disturbance of regulation of mochevyvoditelny function. To this form of night enuresis the incontience during sleep in the afternoon and энкопрез is characteristic (an incontience a calla).

The clinical picture of enuresis at adults looks so: the urgentny form is expressed in the incontience caused by "imperative" (very strong) desire, at the same time the patient does not even manage to reach a toilet. Very often the urination occurs suddenly, and a desire either very short, or it is absent at all.

Stressful enuresis call an urination in time during physical impacts on an abdominal cavity owing to which there is pressure upon a bladder. It can be run, a raising of weights, even cough and laughter. At such form of enuresis at adults the desire to an urination is absent.

The mixed enuresis at adults assumes existence at the patient of several forms of an incontience, with the mixed symptomatology at once.

Separate rare form of enuresis at adults is the incontience of overflow which is connected with disturbance of outflow of urine and occurs, generally at men elderly, with prostate diseases.

Treatment of enuresis

Process of treatment of enuresis at adults and children differs.

The following methods are applied to treatment of enuresis at children: medicamentous, non-drug (physical therapy, psychotherapy, dietotherapy), regime method.

The medicamentous method is used generally in cases of infection of mochevyvoditelny ways and as a part of treatment of neurotic enuresis at children. In the first case for treatment use antibacterial drugs, and in the second case the child is given tranquilizers with effect of sleeping pill (эуноктин, Radedormum) – for recovery of depth of a dream. In cases of stability to these drugs, give милепрамин, amitriptyline, Sydnocarbum. Also in medical schemes use nootropic drugs: Phenibutum, семакс, инстенон, глиатилин, piracetam, glycine. The good result at treatment of enuresis at children is observed after acceptance of drops Adiuretin-SD - it is a form of an artificial analog of vasopressin – hormone which is responsible for allocation and absorption of free water.

Non-drug method of treatment of day and night enuresis. The physical therapy is usually applied together with reception of medicines. It can be laser therapy, acupuncture, a musicotherapy and other methods of impact on a nervous system of the child having enuresis.

The psychotherapy also acts as a part of complex treatment, serves for correction of neurotic frustration.

The dietotherapy is a development of the day menu with limited consumption of liquid.

Regime way of treatment of enuresis at children. This method represents a package of measures, carried out by the child's parents in house conditions: establishment of a specific mode of food and dream.

At adults apply medicamentous, non-drug methods and operations to treatment of enuresis.

Drug treatment of enuresis with use of antidepressants and spasmolytic drugs is applied generally to treatment of an urgentny form of an incontience.

Non-drug treatment of enuresis at adults consists in performance of gymnastics for pelvic muscles, a bladder training.

Operative measure is practiced in the basic for treatment of enuresis at adults in a stressful form and an overflow incontience.

Prevention of day and night enuresis

For prevention of emergence of enuresis in children it is necessary to implement the following recommendations:

1. To refuse timely diapers (since two years);

2. To control consumption by the child of liquid within a day (considering season and temperature indoors, on the street);

3. To train the child in rules of care of generative organs, to control their performance;

4. To timely carry out treatment of infections of urinary tract.

Prevention of enuresis at adults is also timely elimination of various diseases of urinogenital system, whenever possible restriction of excessive exercise stresses, observance of safety rules on production or rest – in order to avoid spine injuries and pelvic area.