In the medical literature, involuntary urination is called enuresis. Most often, uncontrolled emptying of the bladder occurs during sleep. The reason for this condition may be the natural physiological development of the nervous system or pathology that affects the regulation of the genitourinary system. Enuresis negatively affects the mental state of adults and children, especially in the case of daytime urinary incontinence. With the help of neurological, neuropsychiatric and urological examinations, it is possible to accurately establish the cause of the disorder.

Doctors still have not defined the exact boundaries between physiological enuresis in childhood and a pathological condition. The fact is that in children, the conscious regulation of various functions gradually matures, so involuntary urination can persist for up to 5-6 years. At the same time, at this age, nocturnal enuresis is most often noted. Daytime urinary incontinence, even in young children, may be evidence of pathology. In adult men and women, bedwetting is always a sign of a disease.

The age range of admissibility of bedwetting in children requires clarification. Most often, conscious regulation of urination occurs between the ages of 3 and 5 years. Nevertheless, experts take into account the influence of negative mental factors that can cause a delay in the development of this function. Severe stress can cause involuntary urination, even in adolescents.

Definition of disease. Causes of the disease

Enuresis is a disease the main manifestation of which is urinary incontinence. At the same time, the ability to control the emptying of the bladder is either lost or has not yet been formed.

This disorder can occur at any age. It significantly affects the patient’s mental state and mood. The inability to carry out even relatively short trips, the presence of a “secret” about nighttime involuntary urination – all this and much more complicates a person’s life and gives him a lot of inconvenience.

The causes of bedwetting are not well understood. Until now, doctors of various specializations are conducting a huge amount of research on this matter. So far, only a few theories of the occurrence of this disease can be indicated. Although it should be noted right away that in the treatment of bedwetting, it is preferable to use a systemic approach that takes into account each of the theories proposed below.

One of them is maturation dysfunction – a delay in the development of the nervous system due to organic pathology or functional (psychogenic) disorders. This dysfunction is a violation or lag in the formation of certain functions in morphologically immature brain structures. Proponents of this theory believe that with a delay in the development of the nervous system, conscious control of urination is significantly hampered. For example, this is observed in the pathological course of pregnancy or neuroinfections.

The theory of heredity suggests that children whose parents had this disease suffer from enuresis much more often than children whose family did not have this disease.

Proponents of the hormonal theory point to a violation of the production of vasopressin, a hormone associated with water retention in the body. Its amount is inversely proportional to the amount of urine. Normally, the production of this hormone rises at night, so the volume of urine decreases. However, in the case of critically low secretion of the hormone at night, there is a high likelihood of nocturnal enuresis. A decrease in the level of vasopressin is observed in diabetes insipidus, including its nephrogenic (renal) form.

The psychogenic theory suggests that children who are exposed to stress factors more than others are most likely to experience bedwetting. Such stress factors include an unfavorable family environment, poor or unstable relationships with peers, fears, bullying (bullying), ADHD, inadequately low self-esteem, etc. These psychological disorders are usually considered only a factor in the development of bedwetting, since they a direct link with enuresis has not yet been proven. For example, in children with resolved enuresis and persisting psychological problems, relapses are mostly absent. In addition, nephrologist E.I. Chernorutskaya notes that after the situation with enuresis is resolved, the patient’s psychological state improves significantly.

As for the causes of bedwetting in adults, studies show that most often it is associated with various pathologies:

diseases of the nervous system – stroke, neurogenic bladder, spinal cord injury, multiple sclerosis
diseases of the urinary system – renal diabetes insipidus, chronic renal failure, infections leading to cystitis, prostatitis, stricture of the urethra (narrowing of the urethra), weakness of the pelvic floor muscles (more often occurs in women after childbirth), weakening of the tone of the muscles of the bladder (more often formed with age).

Also, bedwetting can be caused by taking anti-allergic or contraceptives.

The reasons for the appearance of enuresis in pregnant women include a strong increase in the size of the uterus, loss of tone and hyperextension of the pelvic floor muscles, active fetal movements, as well as its weight, the amount of amniotic fluid and the presence of multiple pregnancies.

The prevalence of enuresis in children aged 4 to 15 years is 2.3-30%. At the age of 5 years, nocturnal enuresis occurs in 15-20% of children, and by the time the child enters school, in 7-12% of children. For 18-year-olds and adults, nocturnal enuresis is characteristic in 1-1.5% of cases. It is important to note that 15-17% of children recover spontaneously by adolescence.

Physiology of urination, norm

It is legitimate to make this diagnosis to a patient over 4-5 years old. The lower age limit, according to some authors, is somewhat different. But in the medical community, it is accepted that the disease has clinical significance at the age of about 5 years and older.

The ability to retain urine in newborn babies and toddlers in the first years of life is absent. This skill begins to form closer to three years old, 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 outflow of urine.

The following mechanisms help keep urine normal:

Elasticity and normal tone of the organs of the genitourinary system.
Controlling influence of the central nervous system and PNS.
Sufficient development and activity of 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 the processes of control over urination, and enuresis develops in adults or in children.

Modern diagnostic methods

The effectiveness of treatment depends on the correct diagnosis and the causes of the disease. First of all, the patient is examined and interviewed. During this, the genitals are examined and the abdomen is probed.

It is imperative that the patient is sent for 2 ultrasound sessions of the pelvis (full and empty bladder) and the abdominal cavity.

Other diagnostic methods are also carried out:

Laura’s consultation (excludes chronic diseases);
cystoscopy and cystography
urography (intravenous);
urofluometry;
examines the rhythm and volume of emptying at night and during the day.

Risk factors

Negative psycho-emotional factors play an important role in the formation of enuresis. So, chronic stress can affect the autonomic regulation of internal organs and the conscious control of physiological functions, therefore, a patient suffering from enuresis may need to consult a psychotherapist. In addition, it is necessary to take into account other forms of predisposition to the disorder, due to the characteristics of the person’s lifestyle and primary diseases.

Key risk factors

Chronic stress and increased anxiety. In children, involuntary urination can occur even with a single exposure to a stress factor, while in adult patients, a mental disorder can be a possible cause of bedwetting.
Poor family history. If the patient’s relatives have been diagnosed with enuresis, the risk of individual development of the disease increases.
Attention deficit hyperactivity disorder. Uncontrolled emptying of the bladder can be a symptom of this pathology in children.
Too early or late childbirth, delay in the psychoemotional development of the child.
Carrying out diagnostic and therapeutic manipulations of an urological nature. This can be prolonged catheterization or surgery.
Improper diet and medication for mental health problems.
Unfavorable living conditions of the child.

Taking into account possible risk factors helps to prevent urinary disorders.

Consequences of bedwetting

Early diagnosis allows you to take the necessary measures in time to prevent the development of the disease. The easiest way to deal with it is before it has yet managed to gain strength and “make friends,” in the terminology of Tibetan medicine. Pulse diagnostics is a unique diagnostics that can reveal the peculiarities of blood vessels filling in different places of the wrist, which give a complete picture of the state of human internal organs. Pulse diagnostics determines that when the kidneys are “cold”, the pulse at the corresponding points on the wrists is felt “yin” (cold), its tremors are weakened. This is a signal to start treatment immediately. Enuresis can lead to a child’s inferiority complex, severe moral trauma for life. He may become withdrawn, stop communicating with peers,

But the main danger of bedwetting lies not only in the troubles that it causes on its own, but also in the fact that it contributes to an even greater increase in the “coldness” of the kidneys (after all, the child is often forced to lie in a cold, damp bed for a long time). Over the years, this can contribute to the development of diseases such as a kidney cyst, hydronephrosis, nephritis (pyelonephritis, glomerunephritis), and then urolithiasis, prostatitis, impotence.

Special exercises for enuresis

There are simple and effective exercises to get rid of bedwetting. They are applied on a gender basis: for women, Kegel exercises are used to stimulate the muscles of the pelvic floor and the sphincter of the bladder, men train the muscles of the perineum.

The sequence of Kegel exercises:

Squeeze the pelvic muscles, which are responsible for delaying the urine stream, and stay in this position for 5 seconds.
Relax for 10 seconds.
Repeat 3-4 times.
Contract muscles for 10 seconds.
Relax for 10 seconds, repeat 3-4 times.
Contract your pelvic floor muscles for 30 seconds.
Repeat 2 times.
Repeat the entire cycle 2 times a day.

Men are advised to interrupt urination 3-4 times during urination. With each “workout”, the urinary retention time increases. A pronounced result appears after a month of regular exercise. Physiotherapy for enuresis is aimed at strengthening the sphincter of the bladder and the pelvic floor muscles, which control urination. In order to train them, there are even special simulators (for women). But you can do this remedial gymnastics without any equipment.
Try to stop while urinating. Use your muscles to block the flow of urine from your bladder. Listen to your feelings, which muscles tensed at the same time? Now relax and continue emptying your bladder. Repeat the exercise every time you use the bathroom. Then you can do the same exercises just lying in bed. This is a very powerful method.

The prevalence of the problem

If we take into account all cases of the disease, then adults account for up to 1-1.5%. Most often, childhood urinary incontinence passes by adolescence. But if this does not happen, then the problem is much larger than it seems at first glance.

Enuresis is less common in adult men than in women. The prevalence is 3-24%, among residents of Russia – up to 5%. Enuresis in adult women is more common. In general, its frequency is 26-38%.

Urinary incontinence is mainly a disease of children and the elderly. If earlier it was found almost always in elderly people, now the disease has grown younger. Increasingly, urinary incontinence is detected in women under the age of 50, fortunately for men this problem is typical mainly in 60-70 years.

For older men, another problem is more inherent – difficulty urinating.

Symptoms of bedwetting

The main symptoms of the disease include urinary incontinence. This feature negatively affects the mental state of both the child and the adult. In children and adolescents, enuresis leads to shyness, isolation, complexes, as well as the manifestation of opposite qualities – excessive aggressiveness and emotional instability.

The dominant symptom of enuresis in children is involuntary emptying of the bladder during sleep, much less often during wakefulness. Usually episodes of urinary incontinence occur less frequently, but consistently (for example, several times a month or a week). Sometimes involuntary urination occurs several times during the night. Often, urine is involuntarily excreted in the first half of the night, when the child is immersed in a deep sleep phase, and the patient may not even wake up.

For featured the complicated enuresis in children include:

more frequent or less frequent emptying of the bladder;
lack of urge to urinate or control over them;
sluggish stream of urine, etc.

In some children with enuresis, the control of the pelvic organs is also impaired: constipation or encopresis (fecal incontinence), and psychological features are also observed – increased anxiety and sleep disturbances (cannot fall asleep for a long time, wakes up with difficulty, sleep becomes restless and superficial or excessively deep) …

Symptoms of bedwetting in adults are often frequent, uncontrollable urge to urinate, usually accompanied by urine leakage. In pregnant women, similar symptoms appear in the second and third trimester of pregnancy. They can be triggered by sudden movements, including coughing, sneezing, and laughing.

Treating pathology

In the treatment of pathology, various methods are used:

Mode change. It is imperative that adults diagnosed with enuresis need to avoid stress. Caffeine, alcoholic beverages and products that have a diuretic effect are completely excluded from the diet. After lunch, you need to reduce the amount of fluids consumed, and a few hours before bedtime, do not drink at all. To prevent embarrassment, you should develop a schedule for emptying the bladder, including at night.
Psychotherapy. Psychological therapy is applied regardless of the type of disease. The most powerful factors are hypnotic, indirect, post-hypnotic, and self-hypnosis.
Abdominal muscle workout. During urination, it is necessary to hold the stream flow for a while (30 – 60 seconds is enough) each time. If weakness of the pelvis and pelvic floor is noted, then a course of Kegel exercises is additionally used.
Point massage. In this case, pressure is exerted on the reflex zones, which contributes to the activation of important processes in the body.
Healing mud. They are applied every other day on the kidney area and lower abdomen before bedtime. The course of using mud is no more than 8 procedures.
Hydrotherapy. This implies taking a pine or nitrogen bath to improve blood circulation and relaxation. And also the use of a shower with a pressure of different intensities. The procedures also allow you to restore the nervous balance.
Animal therapy. The use of animals for treatment, in particular horses, dolphins and dogs, helps to get rid of diseases based on mental disorders. Different groups of drugs are used to treat bedwetting. In order for the effect of them to be maximized, it is necessary to strictly adhere to the dose prescribed by the doctor and take them regularly.
- If enuresis is caused by inflammation in the genitourinary organs, then antibiotics are required: Monural, Norfloxacin.
- For the treatment of kidney diseases, nitrofuran drugs are used: Furamag, Furadonin.
- Tranquilizers for normalization of sleep: Radedorm, Eunoktin. They have a calming effect, help get rid of negative emotions, and tune in to a positive mood.
- Nootropics: Glycine, Piracetam, Picamilon. They improve the functioning of the nervous system, contribute to the development of a conditioned reflex.
- Antidepressant Amitriptyline. Relieves patients from strong experiences that have caused psychogenic enuresis.
- M-anticholinergics: Sibutin Driptan. Relaxes tense muscles of the bladder, relieves spasms. This allows you to increase its volume and restrain the urge to urinate. He will be able to hold more urine. Therefore, a person will be able to sleep until the morning without having to go to the toilet.
- Artificial hormone desmopressin. It helps to reduce the amount of urine that is passed at night. Adiuretin-SD – nasal drops based on this hormone. Very easy to use form. In severe cases, desmopressin is given intravenously. This increases its efficiency several times.

Physiotherapy

With urinary incontinence in adults, physiotherapy is helpful, such as:

exposure to pulsed alternating current on the affected area (Darsonval apparatus is used) to strengthen the sphincter;
low-frequency alternating current directed to the area of the brain (normalizes sleep);
acupuncture by introducing thin needles into special points responsible for reflexes to improve sleep, the nervous system and normalize the emotional state;
magnetotherapy to reduce the urge to urinate, which is achieved by relaxing the muscles in the walls of the bladder;
electrophoresis with anticholinergics, which helps to increase the muscle tone of the sphincter, relax the walls of the bladder and increase its filling.

Conservative therapy

Drug therapy is prescribed only after identifying the cause of the disease. If a child is found to have excessive anxiety, increased activity syndrome or sleep disturbances, sedatives are prescribed. At the initial stage, it is enough to correct the neurological state of the child to solve this delicate problem.

In adults, treatment is aimed at eliminating the identified concomitant pathology. Urological drugs, nootropics, anti-inflammatory drugs can be prescribed. Funds are selected individually. Herbal preparations give a good effect with a moderate course of the disease.

Drug treatment

Treatment of bedwetting with drugs used in adults involves the use of:

antibacterial agents for the infectious nature of the disease;
synthetic analogs of the pituitary hormone vasopressin to reduce night-time urine production;
antidepressants for psychogenic pathology;
tranquilizers that normalize sleep and soothe;
drugs of the nitrofuran group;
M-anticholinergic drugs that relieve muscle tension;
nootropic drugs that improve cerebral circulation, promote the development of a conditioned reflex and normalize the nervous system.

What does traditional medicine advise?

Traditional methods offer such means of combating enuresis:

A spoonful of honey before bed.
Corn tea. Its preparation is based on steeping a spoonful of corn silk and the same amount of honey. Before using on an empty stomach, it should be infused for about 30 minutes. The course of treatment with such a remedy is a month.
Decoction of dill. A glass is consumed once a day for two weeks, before brewing dill, two tablespoons of raw materials are fried in a pan. The product should be infused in 500 ml of boiling water for 4 hours.

Sleeping position plays an important role in the treatment of bedwetting, the correct position of the spine is required, for this you need to use a firm mattress.

Forecast and prevention

It should be remembered that the treatment of bedwetting of almost any etiology is a long process. Parents need to be patient and not wait for immediate results from therapy. Pressure on the child and heightened expectations can make the child neurotic and complicate the treatment process.

Enuresis changes the psyche of the child, leads to an exacerbation of the feeling of their own inferiority. Patients are ashamed of their peers, withdrawn into themselves, strive for solitude. A chronic traumatic situation can cause low self-esteem, shyness, isolation, indecision. Sometimes children become aggressive. Changes in character can go unnoticed by parents and only show up in adolescence. In order to minimize the negative impact of bedwetting on the psyche, the child should be supported in every possible way. Any manifestations of condemnation or disgust are unacceptable.

The method of treating bedwetting with a conventional alarm clock

Approximately 50-80% of the effectiveness has a method using a conventional alarm clock, when the child is forced to wake up a little earlier than he usually wet the bed. Here, just as in the previous method, a conditioned reflex is developed, linking urination with the alarm clock. The application of this method is impossible without the participation of the child’s family members and without his conscious attitude.

The necessary conditions:

The begun course of therapy cannot be interrupted, it is carried out under the supervision of a physician;
A parent who helps to wake up should sleep with the child in the same room, help him wake up at the signal of the alarm clock;
The pronounced effect occurs after 6-8 weeks, after which the course is continued until the child wakes up in a dry bed for 2 weeks in a row.

Every 3-5 days, the alarm is started 15-20 minutes in advance until the wake-up time of about 7 a.m. is reached. If the time shift leads to failure, you should return to the previous boundaries.

Treatment of bedwetting with plowed clover

The use of herbal remedies helps to gently and gently get rid of the problem of nocturnal enuresis. It is important to remember that before treatment, you should check the child’s reaction to the drug collection, so as not to cause an allergy attack in him. To do this, apply a minimum amount of herbal infusion on the wrist, behind the ear, on the elbow. Redness of the skin suggests that you cannot not use the drug.

Plow clover is a common plant, its other names are: cat, hare clover, porridge, cat ears.

It is appreciated for its rich composition, which includes:

Essential oils;
Tanning compounds;
Mineral salts;
Quercetin;
Organic acids;
Vitamins C, E.

You can collect the clover yourself, or you can purchase a ready-made pharmacy collection. The preparation Trifolium arvense was created on the basis of plowed clover. For enuresis use tea from this plant – 1 tbsp. l. clover herbs are poured with a glass of boiling water, drunk with sugar, like ordinary tea. The infusion is very effective, it helps quickly.

Clinical picture

Symptoms of bedwetting can occur in patients of any age: in children over 4-5 years of age, in adolescence, in young people or the elderly. The main symptom of the disease is urinary incontinence. Wet bed during sleep, urine leakage during the day – such complaints can be addressed by patients (their parents) to a doctor.

Involuntary urination can occur unnoticed for the patient: if the process is typical for the night, then awakening during 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, superficial sleep is characteristic.

The difference between enuresis in women and men

The main difference is the etiology of origin. Enuresis in older women is in most cases caused by hormonal changes, in men – by diseases of the genitourinary system.

The fairer sex is also characterized by urinary incontinence caused by the tension of the abdominal muscles. Involuntary urination occurs during the daytime when you sneeze, cough, or exercise. Moreover, the probability of its occurrence does not depend on the intensity of the stress.

Nocturnal enuresis is more common in young men. It is mainly caused by psychological problems. The reason may be childhood trauma, complexes, for example, insecurity, failure as a man. Female enuresis at a young age is more often a consequence of difficult childbirth.

Daily regime

At home, it is important to follow some rules that will help prevent this symptom:

try to prevent stressful situations in the child’s life, because even the slightest negative emotions can cause nighttime urination disorders;
observe the daily regimen, namely, try to put the baby to bed strictly at 9 o’clock in the evening, especially if he is not yet 10 years old;
in the evening, especially starting at 5 o’clock, it is necessary to limit fluid intake (for children under 5 years old – 100 ml, which can be drunk before bedtime);
it is forbidden to play active games with a child before bedtime, because excessive emotionality does not in the best way affect nocturnal enuresis;
to reduce the pressure on the bladder during sleep, you need to make sure that the pelvis is slightly raised (you can put a roll of a rolled towel under the mattress);
avoid hypothermia, because it negatively affects the entire body as a whole;
at night it is recommended to wake up the child at least 2 times, and he needs to empty himself before going to bed.

Of course, any technique will be most effective only when the child himself wants to get rid of such a problem.

Treating enuresis with honey water

Honey is a universal remedy for the treatment of bedwetting. In this case, the property of honey is used to retain fluid in the body. To prevent nocturnal enuresis, the child should drink honey water before falling asleep. It is prepared very simply – add a teaspoon of honey to 1/2 cup of water. The course of treatment is short – only 3 days. You can divide 100 ml into 3 doses, taking 30 ml three times a day.

A longer course of treatment with honey is 3 months. Honey is added to the infusion of a mixture of medicinal herbs (chamomile, centaury, mint, knotweed, St. John’s wort, birch leaf). To prepare a medicinal drink, 15 g of a mixture of herbs is poured with boiling water, insisted for 10-12 hours, filtered. In 1/2 glass of broth, honey should be put, repeat taking the product 3-4 times a day.

Additional symptoms

Uncontrolled urination during sleep is not always the only symptom. In adult patients, this condition is often accompanied by other disorders of the excretory system.

Other pathological signs:

daytime urinary incontinence;
fecal incontinence;
restless sleep, nightmares;
constant anxiety, panic attacks
pain in the pubic region and perineum;
burning and itching in the urethra during urination;
discharge of cloudy fluid from the urethra;
high body temperature;
frequent urge to urinate and an abnormally large volume of urine.

The appearance of other symptoms allows you to clarify a possible diagnosis in the early stages of the examination.

Classification

There are several classifications of this pathology.

Due to the appearance:

Primary. This is an independent nosological disease. Arises from childhood. With this form, there are no manifestations of organic damage or psychoemotional nature. Most often it is nocturnal enuresis.
Secondary. It arises as a symptom in kidney pathology, against the background of neurological, endocrinological, 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; with age, the incidence of secondary pathology arising against the background of previous somatic diseases increases.

By the time of onset of symptoms:

Night. Symptoms come on at night. This is the most common form; of all cases, nocturnal enuresis accounts for up to 85%.
Day. In 5% of cases, clinical symptoms occur during the day.
Mixed. In about 10% of patients, incontinence can occur both during the day and at night.

By the presence / absence of complications:

Uncomplicated. The form in which the patient has no abnormalities in laboratory tests of urinalysis during the examination, as well as no changes in the somatic, neurological status, no psychological disorders were found.
Complicated. If, during examination, a patient reveals somatic diseases, anatomical and physiological abnormalities in the structure of the genitourinary system, or neurological disorders, this form of enuresis is considered complicated.

By the frequency of manifestations:

Frequent. Urination occurs involuntarily every night or daily.
Moderate. Nocturnal enuresis occurs several times a week (2-3).
Rare. Episodes of incontinence are possible 2-3 times a month.

Special forms

Special forms of enuresis should be noted:

Neurotic enuresis. This pathology is more common in shy, fearful children, with superficial sleep and its disturbances. Such children are extremely acutely and painfully experiencing the presence of their disease. It arises for the second time against the background of the transferred psychotrauma or lability of the nervous system: visiting a kindergarten, doctor, school, divorce of parents or other changes negatively affecting the child’s psyche.
Urgent. It is characterized by a strong, intolerable urge to urinate, which a person cannot contain. This form is found in spinal cord injuries, brain injuries, 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 small patients before adolescence, in contrast to neurotic enuresis in children, are relatively indifferent to episodes of incontinence. Later, there is criticism and increased feelings about this. Often found with nervous tics, stuttering, phobias.
Neurogenic. A form of incontinence that occurs secondarily with a neurogenic bladder.

Which doctor treats bedwetting in adults?

Treatment of bedwetting in adults can take place with the participation of a urologist, nephrologist, neurologist, and even an endocrinologist. Sometimes it is required to consult a psychologist and a psychotherapist. Nocturnal enuresis in adult men can be treated with the assistance of an andrologist, in women – a gynecologist.

Pathogenesis of enuresis

The cerebral cortex is endowed with the function of conscious control of physiological functions. Normally, a signal is sent from there to the sphincter of the bladder, which allows the muscles to relax and empty the organ.

However, first, the process of filling the bladder is performed with the excitation of the receptors of its walls. When the bladder is at least a quarter full, a signal is sent from its receptors to the brain. In this case, the person will feel the urge to urinate. But even in the case of an overcrowded bladder, sphincter control remains at a conscious level.

Domestic and foreign researchers agree with the opinion that the basis of the pathogenesis of urinary incontinence is a delay in the formation of reflex control of urination. Nephrologist T.V. Otpuschennikova points out that with the normal development of the child, such control can be formed by 3-4 years old, when the baby’s bladder increases in volume, and the number of urinations per day decreases to 7-9 times. This allows children to consciously start or restrain the process of urination, adhere to the necessary hygiene rules, and also wake up when the bladder is full.

In the case of a delay in the functional maturation of the central nervous system of a child by a certain age, the necessary functions are not formed and the process of development of conscious control of urination slows down. This leads to the development of enuresis. In addition, it has long been proven that often with enuresis in children, various options for delayed development are associated – problems with controlling defecation, delayed motor and / or speech development. These processes are interconnected, therefore they cannot develop separately from each other or at different rates. The spontaneous disappearance of the manifestations of urinary incontinence in children may indicate the final and successful formation of control over the urination process. This can happen between the ages of 5 and 8-9.

The pathogenesis of enuresis in women is usually associated with the muscles of the pelvic floor. In the case of their weakening, not only enuresis can occur, but also prolapse or even prolapse of the pelvic organs. Weakening of muscles can be caused by frequent childbirth, repeated lifting of weights, overexertion of muscles, as well as operations on the pelvic organs.

In other adults, the mechanism of enuresis development may be associated with acquired dysfunction of nerve endings. Such changes are observed, for example, in diabetes and multiple sclerosis.

conclusions

Nocturnal enuresis can heal spontaneously until the child is 7 years old, there is no need to take serious steps.

Since the pathogenesis of enuresis is a multifactorial phenomenon, various methods are used for its therapy, none of which is ineffective if used in isolation. Bedwetting is not an intentional and involuntary process. Treatment requires a conscious attitude of the patient to the therapy process. The harm from the side effects of different treatments should not exceed the benefits.

Behavioral therapies are used first (bladder training, motivation method).

If the patient suffers from the pressure of the family, society, more serious methods are used:

“Urinary alarm”;
Drug therapy;
Control of fluid intake.

The drugs are used most often when the patient visits public institutions, camps, sanatoriums, overnight stays at a party.

In children under 7 years old, simple methods of treatment of enuresis are used, but first they are tried to convince them that, most likely, the cure will come spontaneously. In this age category, monitoring of “dry” nights, control of the amount of fluid consumed, and training of the bladder are used.

If within 3-6 months simple methods do not lead to the desired effect, drug therapy is used, the “urinary signaling” method, which has a minimum of side reactions.

If urinary signaling is not effective, oral desmopressin can be used for a short-term stay outside the home. The peculiarity of using the drug is the refusal of any liquid 1 hour before and 8 hours after its use.

Tricyclic antidepressants work in a similar way. These drugs have pronounced side effects, after their use relapses are frequent.

Treatment of bedwetting in children is carried out by a pediatrician, in difficult cases, a nephrologist, a pediatric urologist

Sources used and useful links on the topic: https://www.nrmed.ru/rus/dlya-vzroslykh/urologiya/enurez/ https://ProBolezny.ru/enurez/ https://neuromed.online/enurez-eto/ https://UroHelp.guru/mochevoj-puzyr/enurez/u-vzroslyx.html https://naran.ru/bolezni/urologicheskie-zabolevaniya/enurez/ https://www.ayzdorov.ru/lechenie_enurez_nar.php https: //nefrologiya.pro/mochevydelitelnaya-sistema/enurez/u-vzroslyh/ https://www.polyclin.ru/articles/enurez/ https://www.KrasotaiMedicina.ru/diseases/zabolevanija_urology/enuresis https: // med -post.ru/zdorove/kak-vylechit-enurez

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