Enuresis is not a disease, but a symptom caused by a variety of factors, including genetics, psychological and social factors, sleep status, and functional bladder capacity.
Causes of morbidity.
1, genetic factors: children with enuresis often have a family history, and some studies in Denmark have confirmed that the dominant gene for enuresis is on chromosome 13, a finding that provides further evidence for the genetic study of enuresis.
2. Prematurity: Epidemiological studies of enuresis have confirmed that prematurity is one of the most significant high-risk factors for daytime enuresis in children. These preterm children often have other problems in addition to enuresis, such as attention deficit hyperactivity disorder, and some scholars suggest that this may be due to mild neurological damage.
3.Inability to wake up from sleep: Parents of children with enuresis often report that their children have excessive sleep and difficulty waking up. In fact, nocturnal enuresis has nothing to do with sleep depth, and enuresis can occur in any stage of sleep, and its main problem is that when the bladder is full, the affected child cannot wake up from sleep. Clinically, it depends on whether the affected child wakes up at night to go to the toilet to urinate by himself, and whether he has to be woken up by others or by himself.
4, psychological and social factors: strong stress factors such as bad encounters in early childhood (parental divorce, death, sudden separation of children from their parents, hospitalization due to illness or accidents), inability to adapt to the new learning environment at the beginning of school, etc. can lead to urine loss due to psychological tension during the critical period of urinary control, children with enuresis also often have more behavioral problems and emotional problems, such as hyperactivity, tics, misfits, shyness It is reported that about 10% of children with enuresis have attention deficit disorder, more in boys than in girls.
5. Small bladder capacity: The bladder capacity of children with enuresis is smaller than that of children of the same age without enuresis, and each urine volume of normal children is about 10ml/kg, while the urine volume of children with enuresis does not reach the capacity of the bladder as it should. The volume of urine may be more or less.
6.Constipation: Children with enuresis often have constipation, especially children with daytime enuresis. This is because when constipation occurs, the fecal mass in the rectal jug abdomen strongly stimulates the sensory nerves, affecting the brain’s perception of bladder fullness and causing enuresis.
7, lack of vasopressin: vasopressin rises at night, so that children urinate less during sleep. Some children who only urinate at night lack the normal circadian secretion rhythm of vasopressin, resulting in an increase in the amount of urine at night, which exceeds the capacity of the bladder, resulting in enuresis, and children often urinate soon after going to sleep. If the parents wake the child up to urinate, there will be no urine loss.
How to treat pediatric enuresis?
I. General treatment
Develop a good work and rest system and hygiene habits, avoid overwork, master the time and regularity of bedwetting, and wake up the child with an alarm clock at night to urinate 1 to 2 times. Sleep 1 to 2 hours during the day and avoid overexcitement or strenuous exercise during the day to prevent sleeping too deeply at night. Throughout the course of treatment, build up confidence. Gradually correcting emotions or behaviors such as shyness, anxiety, fear and shrinkage, taking care of the patient’s self-esteem, more comfort and encouragement, less reprimand and punishment, and reducing their psychological burden are the keys to successful treatment.
To correctly deal with the mental factors that cause enuresis, understand the mental triggers and possible psychological conflicts that lead to enuresis through medical history, and for the mental stimuli that can be solved, they should be solved as soon as possible, and for the conflicts and problems that have originally occurred or that are realistic and objective and cannot be solved subjectively, we should focus on patient education and explanation to eliminate mental tension so as not to cause emotional disturbance. Avoid drinking water after dinner and emptying the urine in the bladder before going to bed can reduce the number of bedwetting.
Second, behavior therapy
1. Urination interruption training: Encourage your child to interrupt urination in the middle of each urination, count from 1 to 10, and then finish the urination, which can train and improve the bladder sphincter’s ability to control urination.
2. Urine tolerance training: Let your child drink more water during the day, and when he has the urge to urinate, let him hold back urine for no more than 30 minutes each time, and train once or twice a day to expand the bladder and increase its capacity, thus reducing the number of nighttime urination.
3.Timing training: In the past, the time when the child often wet the bed at night is half an hour earlier with an alarm clock combined with artificial wake up, let it walk back and forth in the room, or wash the face with cold water, so that in a state of mental clarity to urinate out, the purpose is also to help establish the conditioned reflex.
4.Parents should discover their children’s bedwetting in time and urge them to empty the residual urine by themselves, dry the area, change the underwear and dry the bed for treatment.
5.Summary record: Parents are required to record the reasons and times of bedwetting every day, make a mark on the schedule for bedwetting and not bedwetting, summarize once a week to find out the reasons, and give encouragement when the child makes progress.
Third, drug treatment
Western medicine commonly used drugs are.
1, promethazine, a central stimulant, can reduce the depth of sleep, for wakefulness disorder type.
2, Oxybutynin, alias urinary polyphenols, can reduce the internal bladder pressure, increase the volume, reduce involuntary bladder contraction, applicable to the diurnal urinary frequency type.
3.Ephedrine, which can increase the contraction force of bladder neck and posterior urethra and also has excitatory central effect, can be used for mixed type.
4.Desmopressin: It is a synthetic antidiuretic hormone, alias mydriasis, which is suitable for nocturnal polyuria type. Combined application of amitriptyline, desmopressin and oxybutynin is currently considered the “golden partner” in the treatment of nocturnal enuresis. The advantage is that it works quickly, but the disadvantage is that it has different degrees of side effects and is easy to relapse after stopping the medication.
Fourth, physical therapy.
SNM (sacralneuromodulation) therapy, which is sacral neuromodulation therapy, was used by foreign scholars from 2001 to 2005 to treat neurogenic and non-neurogenic lower urinary tract dysfunction, with good clinical results. In recent years, neuromodulation therapy has adopted transcutaneous nerve stimulation, i.e., TENS characteristic therapy, which is simple and easy to use, and the effect is sure to be a promising treatment method.