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Enuresis in children
Last reviewed: 23.04.2024
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Enuresis in children - involuntary emptying of the bladder at an undesirable moment or in an unsuitable place. Enuresis is considered pathological in children older than three years of age and ranges from 6 to 15%, depending on the population.
During the act of urination, the inner and outer sphincters of the urethra should relax, and at the same time the muscles of the bladder (detrusor) and the abdominal mass must contract. The act of urination is controlled by nerve endings. Sympathetic innervation of the bladder comes from the lumbar spinal cord (L 2 -L 4 ). Irritation of sympathetic nerves leads to inhibition of emptying of the bladder and retention of urine. Parasympathetic stimulation leads to its emptying: irritation of the sacral part of the spinal cord (S 2 -S 4 ) leads to relaxation of the urethral sphincters and a reduction in the detrusor, that is, to the excretion of urine.
Enuresis is not a diagnosis, but a symptom of various diseases. At the first admission to the hospital before the examination such a conclusion is permissible, but enuresis should not be the final diagnosis.
[Causes of enuresis in children
Enuresis may be a symptom of the following diseases and conditions:
- a neurosis;
- neurosis-like states;
- a consequence of urological pathology;
- pathology of the spinal cord (spinal bladder);
- combination of the above violations.
The most common cause of enuresis are neurosis-like conditions, neuroses and urological pathology. At the same time, prolonged preservation of enuresis in children up to 10-12 years may lead to the formation of a neurosis.
What do need to examine?
How to examine?
What tests are needed?
Treatment of enuresis in children
- Find out a detailed obstetric anamnesis for determining the "nature" of enuresis: neurosis or neurosis-like condition.
- Assign laboratory-instrumental methods of research:
- analysis of rhythm and volume of urination on Saturday and Sunday;
- trial according to Zimnitskiy;
- several urinalysis (3-5) of the common and Nechiporenko;
- Ultrasound of the urinary system to identify gross urological defects.
- If there are changes in the examination, according to clause 2, X-ray-uricologic examination (cystography, urography) is performed to reveal nephrologic and urological pathology.
- If there are no changes in the survey presented in paragraph 2 - conduct EEG and EchoEG, myography, prescribe a consultation and treatment of a nephrologist (with neurosis-like conditions) and a psychiatrist (with neurosis). In the absence of effect for 6-12 months. X-ray examination is also shown.
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