infantile enuresis
Introduction
Introduction to children's enuresis Enuresis, also known as non-organic enuresis or functional enuresis, usually refers to children who still involuntarily urinate after 5 years of age and wet their pants or beds, but there is no obvious organic cause. There are two classification methods for enuresis. The first classification is based on the time of enuresis. When the enuresis occurs in children (including nighttime sleep and nap), but during the day can control urination, and the bladder function is normal, it is called It is a single symptom of nocturnal enuresis, and when children have enuresis when they are awake during the day, but no neurological diseases such as spina bifida, spinal injury, etc., it is called daytime enuresis, the second classification is called primary and Secondary enuresis, the so-called primary refers to the child has been enuresis from childhood to the time of treatment, and secondary refers to the child has stopped enuresis for at least 6 months, and then enuresis occurs. basic knowledge The proportion of children: the incidence rate of children under 6 years old is about 0.03%--0.07% Susceptible people: children Mode of infection: non-infectious Complications: anxiety
Cause
Pediatric enuresis
Genetic factors (20%):
Children with enuresis often have a family history. The probability of co-occurrence of twins with twins is higher than that of twins. Parents with enuresis, 77% of those with enuresis are found in the offspring; one of the parents has In enuresis, children have enuresis of 44%. However, children with enuresis only during the day seem to have nothing to do with heredity, and those with enuresis during the day and night have a significant male family genetic history, Shaffer et al. (1984) A positive family history was found to be common in primary enuresis and secondary enuresis, suggesting that genetic factors play a role. Some recent studies in Denmark have confirmed that the dominant gene for enuresis is on chromosome 13, the finding is Further evidence is provided by genetic studies of enuresis.
Premature delivery (15%):
Epidemiological studies of enuresis confirm that preterm birth is the most significant risk factor for children's daytime enuresis. In addition to enuresis, these premature infants are often accompanied by other problems, such as attention deficit hyperactivity disorder. Some scholars suggest that this may be It is the cause of minor nerve damage.
Can't wake up from sleep (10%):
Parents of children with enuresis often report that their children have excessive sleep and difficulty in awakening. In fact, nocturnal enuresis has nothing to do with sleep depth. Enuresis can occur in any stage of sleep. The main problem is that when the bladder is full, the child cannot Awakening during sleep, according to whether the child wakes up at night to go to the toilet to urinate, whether to wake up or wake up.
Psychological and social factors (5%):
Strong stress factors such as early childhood problems (parental divorce, death, sudden separation of children from parents, hospitalization or accidents due to illness), initial admission to a new learning environment can lead to children in the critical period of controlling urination Due to psychological stress and enuresis, children with enuresis often have more behavioral problems and emotional problems, such as hyperactivity, tics, disharmony, shyness, eccentricity, etc. It is reported that about 10% of children with enuresis have attention deficit disorder. More boys than girls.
Small bladder capacity (10%):
The bladder capacity of children with enuresis is smaller than that of children of the same age without enuresis. The normal urine volume of children is about 10ml/kg, and the urine volume of children with enuresis does not reach the capacity of the bladder. Generally, these children The average urine volume per time is less than 10ml/kg, frequent urination during the day (>7 times), there is urgency, the number of enuresis can be more than one at night, and the amount of urine can be more or less.
Constipation (5%):
Children with enuresis often have constipation problems, especially those with enuresis in the daytime. This is because during constipation, the fecal mass of the rectum ampulla strongly stimulates the sensory nerves, affecting the brain's perception of the filling of the bladder and causing enuresis.
Lack of vasopressin (10%):
Vasopressin is elevated at night, which reduces the amount of urine in children during sleep. Some children who have only nocturnal enuresis have a normal circadian rhythm due to vasopressin deficiency, resulting in an increase in nocturnal urine output, exceeding the capacity of the bladder, causing enuresis. Children often have enuresis soon after falling asleep. Generally, enuresis occurs in the first 1/3 of the nighttime sleep, and the urine stain is large. If the parents wake up the child to urinate, there is no urine.
Prevention
Pediatric enuresis prevention
Children should be established from a young age to establish a good work schedule and hygiene habits, master the law of night urination, wake up regularly or use an alarm clock, so that children gradually form a time conditioning, and develop children's self-care ability, in addition, should provide a good living environment. Avoid enuresis caused by bad environmental stimuli. When children are faced with setbacks and accidents, parents should be good at facilitating and helping children to eliminate psychological tension. When children have enuresis, they should not blame or corporal punishment. They should look for reasons and symptomatic treatment.
When training children to urinate, they must first understand the willingness to urinate after "urine", and have an unpleasant feeling after urinating. Children's urination training should be coordinated with their developmental level to guide parents to pay attention to children's response to urination training. If the child refuses, parents should not intervene mandatoryly, and the training time should be postponed appropriately.
Complication
Pediatric enuresis complications Complications
Generally no complications, but can cause mental stress, inferiority, anxiety.
Children with enuresis often have such characteristics as solitude, melancholy and inferiority. When there are some major changes in life, such as enrollment, they are not used to it, and with the strict requirements of the teacher, the burden of thought is too heavy and the enuresis is caused. Some parents find that their children are wet and shackled, often insulting and beating children. On the contrary, they increase their emotional stress, resulting in a sense of shame and guilt. It is easy to re-emergence and form a vicious circle.
Symptom
Pediatric enuresis symptoms common symptoms habitual diaper night terror depression children tic disorder
According to reports, primary enuresis accounts for the majority, especially nighttime enuresis is the most common, more common in boys, nighttime remnerators about half of the night bedwetting, or even 2 to 3 times per night of enuresis, excessive activity during the day, excitement, fatigue Or after physical illness, the number of enuresis is often increased, and enuresis is rare in the day. Children with enuresis are often accompanied by night terrors, sleepwalking, hyperactivity or other behavioral disorders.
Examine
Pediatric enuresis check
Blood, urine, routine examination is normal, general laboratory examination is normal, urinary tract infection, chronic kidney disease, etc. should be excluded, urine or urine culture should be checked, urine specific gravity can rule out enuresis due to vasopressin deficiency .
Spinal bone examination should be performed, and if necessary, urography should be performed to exclude organic diseases.
Diagnosis
Diagnosis and diagnosis of enuresis in children
diagnosis
1. Assessment of children and families
In the process of evaluation, the trust of children and families is obtained, which is a prerequisite for the treatment of enuresis.
2. Medical history
The medical history should be collected in detail, including the time when enuresis begins to occur, the frequency of occurrence, whether it is enuresis or nocturnal enuresis during the day, whether it is primary or secondary, and how much urine, such as nocturnal enuresis, the number of enuresis per night Wait, the reason for the parents to bring the child to see a doctor and when to start a visit.
In the medical history, you need to know about the psychosocial problems, such as how the child feels about enuresis; in the family, parents and children, who is most troubled about this; whether the parents punish the child for enuresis; whether the child asks for treatment, the family There are recent or frequent emotional conflicts; enuresis has no effect on children's lives; whether children can not participate in group activities such as summer camps, spring tours, etc. due to enuresis; parents' understanding of enuresis and their requirements for children are reasonable.
The medical history should also include family history and past treatment, whether parents or close relatives have a history of enuresis, if any, when it disappears; the date of previous treatment, duration and efficacy; treatment includes medication or other measures, in addition, The number of times of urination when the child is awake every day should be asked, whether there is urgency or urinary flow, etc., in order to eliminate the organic disease of the urinary system, and also to understand the stool condition of the child, whether there is constipation or fecal matter; In terms of sleep, it is necessary to understand whether a child is easily awakened during sleep, and other relationships such as food allergy and enuresis need to be considered.
3. Physical examination
The focus of the physical examination is the palpation of the abdomen, the examination of the genitals, and the examination of the nervous system. In addition, the appearance of the lower end of the spine should be observed for the appearance of pits and skin abnormalities. For example, there is an abnormality in urinating in the medical history, and the urination of the child needs to be observed. Most children with enuresis have no abnormal findings during physical examination.
4. Laboratory inspection
Urine routine or urine culture examination should be performed to exclude urinary tract infections, chronic kidney disease, etc. Urine specific gravity excludes enuresis caused by vasopressin deficiency. The cause of most enuresis children is not complicated, but there are also a few cases that need Make a detailed inspection.
5. Diagnostic criteria
According to ICD-10 classification of mental and behavioral disorders (diagnostic criteria for research, WHO, 1993, Chinese version), the diagnosis is based on:
(1) Children age and mental age are at least 5 years old.
(2) Involuntary or intentional bedwetting or wet pants, at least 2 times a month under 7 years old, at least 1 time every month over 7 years old.
(3) It is not enuresis caused by seizures or neurological diseases, nor is it a direct consequence of urinary tract structural abnormalities or any other non-psychiatric diseases.
(4) There is no evidence of any other mental disorder that meets the ICD-10 category criteria, such as mental retardation, anxiety, depression, etc.
(5) The course of disease is at least 3 months.
Differential diagnosis
Enuresis should be identified with the following diseases:
1. Nervous system disorders
Enuresis is also seen in patients with dysplasia of the ankle and meningocele. It is generally difficult to identify, but it is often overlooked for some recessive patients. In addition to the performance of enuresis, these children often have weakness in the lower extremities. X-ray film, neurological examination can often confirm the diagnosis.
2. Urinary tract infection
Urinary tract infection can induce enuresis. If the urinary tract symptoms disappear after treatment, the enuresis will disappear.
3. Incontinence
Urinary incontinence is often caused by structural factors or structural abnormalities of the urinary system, such as phimosis, urethral stricture, diabetes, etc. Persistent urinary incontinence can be seen in bladder valgus, hypospadias and ectopic ureteral opening, ectopic ureteral opening More common in girls, the opening may be in the distal urethra and in the vagina.
4. Urinary tract obstruction
The most common site of urinary tract obstruction is the posterior urethral valve, which accounts for 50% of male neonatal urinary tract obstruction, often accompanied by no contractile contraction of bladder detrusor, 25% of which have urinary incontinence, clinically common symptoms It is a fine stream of urine, urinary leakage from infancy, late urinary tract dysfunction, urography and bladder examination can often make a diagnosis.
