Enuresis

Enuresis is a non-specific term that refers to any type of involuntary urinary incontinence. Although there are two types of enuresis, namely daytime and nighttime, the term "enuresis" is generally used worldwide to refer to involuntary urinary incontinence only during sleep. In the case of enuresis, nocturnal urinary incontinence is the only symptom.

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Epidemiology

Enuresis is one of the most common conditions in children and occurs in 5-10% of 7-year-olds.

Many authors believe that enuresis has a favorable course and disappears on its own within a year in 15% of children. However, in 7 out of 100 children with enuresis at the age of 7, this condition is observed throughout life. Enuresis is more common in boys than in girls, approximately in a ratio of 1.5-2:1.

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Causes bedwetting

It is important to understand that enuresis is a symptom, not a disease. Unfortunately, the cause of enuresis has not yet been precisely determined, and its pathogenesis has not been fully studied. It is believed that enuresis can be caused by various reasons. In particular, the following reasons are distinguished: impaired formation of CNS control over the function of the lower urinary tract, sleep disorders, impaired secretion of antidiuretic hormone during sleep. genetic factors.

Enuresis is often observed in children with developmental delays. Such children begin to talk and walk late. There is a strict correlation between the general development of the child and the timing of the formation of CNS control over the function of the lower urinary tract.

Sleep disturbance is one of the causes of enuresis. Children with nocturnal enuresis are in deep sleep, so the signals from the subcortical centers that suppress the urination reflex are not perceived by the cortical centers of the brain.

Involuntary urination can occur at any time of the night and during any phase of sleep.

It has been established that children suffering from enuresis have reduced nocturnal secretion of antidiuretic hormone. Therefore, such children produce a significant amount of urine at night and this can lead to enuresis.

Genetic factors are another cause of enuresis. Statistical studies show that enuresis is more common if parents had nocturnal enuresis in childhood. So, if both parents had nocturnal enuresis, then in 77% of cases the children have it too. If one of the parents has nocturnal enuresis, 43% of children have similar disorders. Changes in chromosome 13 have been established, which are often found in patients with enuresis.

Three factors play an important role in the pathogenesis of enuresis, namely: increased urine production during the night; decreased bladder capacity and increased detrusor activity; impaired arousal. Thus, there is a discrepancy between increased urine production and decreased storage capacity of the bladder during the night. This leads to the appearance of the urge to urinate. In the case of decreased ability to awaken, nocturnal urinary incontinence occurs.

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Symptoms bedwetting

As a rule, the conditioned reflex responsible for the function of the lower urinary tract is formed by the age of 3-4 years of the child's life, therefore it is generally accepted that the diagnosis of enuresis is valid in the case of nocturnal urinary incontinence in a child at least 5 years of age.

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Forms

Primary and secondary enuresis are distinguished. Primary enuresis is nocturnal urinary incontinence from the moment of birth and in the absence of a "dry" period for 6 months. Secondary enuresis is a condition that occurs after a period (more than 6 months) free of nocturnal urinary incontinence.

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Diagnostics bedwetting

Diagnosis of enuresis includes two stages. At the first stage, complaints and history of the disease are studied in detail, a physical examination is performed, urine sediment is examined and the functional capacity of the bladder is assessed based on the urination diary. During the survey, attention is paid to the obstetric anamnesis (birth injury, hypoxia during childbirth, etc.), the presence of enuresis in parents and relatives is clarified, and the conditions in the family are clarified. It is important to determine the presence of a "dry" period and its duration, the number of cases of enuresis (per week, month), pay attention to the nature of sleep (deep, restless, etc.). Physical examination should include a thorough examination of the sacral region and genitals. In case of developmental anomalies of the nervous system (meningocele), subcutaneous lipomas, areas of increased hairiness, skin retraction and pigment spots are often found in the sacral region. Neurological examination includes determination of cutaneous sensitivity, examination of lower extremity reflexes and bulbocavernosus reflex, and assessment of anal sphincter tone.

Based on the urination diary, the number of urinations and urinary incontinence episodes during the day and night are determined, and the bladder capacity is assessed. In cases where nocturnal urinary incontinence is the only symptom, treatment is prescribed.

In case of unsatisfactory treatment results, as well as detection of other disorders of the lower urinary tract (urinary incontinence during the day, frequent urination, etc.), neurological disorders, urinary tract infection and in cases of suspected urological diseases, a detailed examination is indicated. The purpose of such an examination is to identify diseases, one of the symptoms of which is nocturnal urinary incontinence. Ultrasound of the kidneys and bladder with determination of residual urine, descending cystourethrography, complex UDI and CT or MRI of the spine are performed. Consultation with a neurologist is indicated.

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Treatment bedwetting

The persistence of enuresis after 7 years has a negative impact on the child and his family members, which can cause mental disorders, so treatment of enuresis is necessary. It should be started with behavioral moments aimed at developing a conditioned reflex of urination. A detailed conversation with the child's parents is important to explain the causes of enuresis and treatment tactics. It is necessary to create a calm environment, a warm, hard bed and a decrease in fluid intake 1 hour before bedtime are recommended. Physical therapy and sports are useful.

Signal therapy is considered the best treatment for patients with impaired awakening and a slight increase in nocturnal urine output. Regular awakenings are prescribed or special signal devices are used. The latter are designed in such a way that urine released during involuntary urination closes an electrical circuit and a signal sounds. This leads to awakening and the patient finishes urinating in the toilet. This treatment forms a urination reflex. Successful results are noted in 80% of patients with enuresis.

Patients with enuresis who excrete large amounts of urine at night are recommended to treat enuresis with desmopressin. Desmopressin has a pronounced antidiuretic effect. The drug is available as a nasal spray and in tablets. It is recommended to start treatment with a minimum dose of 10 mcg per day, followed by an increase to 40 mcg per day. Positive results are noted in 70% of patients. Side effects of desmopressin are rare and usually disappear quickly after discontinuing the drug. In case of overdose, hyponatremia occurs, so it is recommended to periodically monitor the sodium content in the blood serum.

When the bladder capacity decreases, treatment of enuresis with anticholinergics is indicated. Previously, the most commonly used tricyclic antidepressant was imipramine, which has an anticholinergic effect. In recent years, oxybutynin (driptan) has been prescribed at 5 mg 2 times a day. The dose may be increased depending on age.

Forecast

In most cases, with proper treatment, enuresis disappears. If successful, it is recommended to continue treatment for enuresis for at least 3 months, as relapse is possible.

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