enuresis in children
Introduction
Introduction to enuresis in children Children's enuresis refers to the fact that children over the age of 5 can't control their urination, and their beds are often wet at night. Sometimes they have urine pants. Enuresis is more common in childhood. According to statistics, there are 10-20% of children with bedwetting at 4 and a half years old, and 5% at 9 years old, and only 2% of those who still have bedwetting at 15 years old. The disease is more common in boys, the ratio of boys to girls is about 2:1, and the incidence of children aged 6-7 is the highest. Most children with enuresis can have a higher self-healing rate after a few years of onset, but some children, if not treated, will continue to adulthood. The family incidence of this disease is very high. According to foreign reports, 74% of boys and 58% of girls have a history of enuresis between their parents or unilateral. In the twins and single-child twins, the enuresis is twice as high as that of the twins. The disease has a certain relationship. Children with urinary enuresis have symptoms such as frequent urination, urgency or dysuria in the white routine. They must also have enuresis at night, so this is just a customary name. basic knowledge Sickness ratio: 2% Susceptible people: children Mode of infection: non-infectious complication:
Cause
Causes of enuresis in children
The exact cause of enuresis is still not fully understood and is considered to be related to the following factors:
Genetic factors (23%):
The family incidence of this disease is very high. According to foreign reports, 74% of boys and 58% of girls have a history of enuresis between their parents or unilateral. In the twins and single-child twins, the enuresis is twice as high as that of the twins. The disease has a certain relationship.
Psychological factors (15%):
The family has changed, the parents have been snoring for a long time, the fear of the night is frightened, and the nervousness can cause the child to have enuresis. Psychological factors can not only cause children who have had the ability to control small cases to re-emerge, but also make a small number of children gradually form habits after enuresis, and some even can not be changed by adults.
Sleep too deep (15%):
This is a more common factor. These children often play tired before going to bed, sleep very deeply, are not easy to wake up, and also bedweed in dreams. If you drink more water before going to bed, it is more likely to have bedwetting.
Delayed bladder function maturity (10%):
Some children with enuresis have a smaller bladder than normal children. These children usually have a relatively high number of urinations, but the amount of urine is not much. This is because the urine in the bladder is not much, it shrinks and urinates. Some people have used intravesical pressure measurement and bladder B-mode ultrasound to find that the bladder capacity of children with enuresis is 30% to 50% less than normal.
Child personality characteristics (5%):
So far, although there is not enough evidence to show that there is a clear relationship between enuresis and the character of children. However, most children with enuresis have timid, passive, overly sensitive and excitable personality traits. In addition, children with enuresis may feel disgraceful because of enuresis, and do not want to let others know. Therefore, they do not like to have more contact with other children, and they are not willing to participate in group activities, and gradually form a character of shame, inferiority, loneliness and introversion.
Poor urinary habit training (10%):
Parental training is not in place, or often wake up the child at night to force urination, etc. These make the child fear of urinating, which is not conducive to the cultivation of regular urination habits.
Disease factors: Enuresis caused by organic diseases is rare. Urinary infections, malformations, and spina bifida, meningocele, etc. can cause enuresis. In addition, asymptomatic bacterial urine and high calcium urine can also cause enuresis, which should attract people's attention.
Relationship between enuresis and sleep (5%):
Children with enuresis and sleep: After doing a sleep EEG and multi-channel physiology tracing on these children, it was found that bedwetting occurred in the first third of sleep. At that time, I was in the deep sleep of 3-4 periods of non-eye fast moving sleep.
Enuresis can have a series of processes, starting with restlessness, increased muscle tone, rapid heartbeat, shortness of breath, and reduced skin resistance, a set of signs of awakening. Correspondingly, high-amplitude delta waves are emitted on the EEG. After about a few tens of seconds or a few minutes, the child was in bed to sleep. It is therefore difficult to wake up children with enuresis. Sometimes it is often the adult who picks up the child who has wet the bed and puts on the dry underwear and the trousers. He still does not wake up. When he wakes up in the morning, the child has no memory of the bedwetting.
The difference between children with enuresis and normal people:
(1) Because the person who wets the bed is often in the "wet dream", such as falling into the river in a dream and waking up, people think that the bedwetting is happening when they are dreaming. In fact, the bedwetting is not in the dream, most enuresis Before the bedwetting, the child has not had rapid eye movement sleep, and most of them are in the first eye 2 hours after bedwetting, the first eye has a rapid sleep sleep, normal people have eye rapid sleep 4-6 arrays per night, and enuresis On the night of bedwetting, only children with symptoms of rapid eye movement sleep 2-3.
(2) Many people have dreamt of urgency to find a toilet can not find, that is, "dream of finding a toilet", wake up in anxious, may be wet with pants and sheets, but most of the urine is still in the bladder , did not solve it. This is because the signal of bladder filling is programmed into a dream, it is a dream of normal people, children with enuresis usually do not dream.
Prevention
Child enuresis prevention
Precautions for the treatment of children with enuresis
1. A reasonable living system. Should develop the habit of sleeping on time, parents should not tease children before going to bed, do not let children excited, do not let children play vigorously, do not watch thrilling video films, so as not to make children over-excited. Paying attention to the child's toilet training is the basic measure to prevent enuresis. Training time is best after the child is one and a half years old. It is too early to start training. Because the child's nervous system is not very mature, the control mechanism of the cerebral cortex to the subcortical central reflex urination is not perfect, and it often causes failure, which will inevitably hit the child's self-confidence. For the child's toilet training, the positive reinforcement method is adopted, and the child should be rewarded immediately for each success.
2. Requirements for diet. After dinner, eat less sweets and high-protein drinks. Don't be too salty to avoid thirst. Drink less water and drinks, milk, etc. after dinner, and eat a small amount of fruit. At the same time, parents should give encouragement to their children and remind them to wake up at night to urinate. Do not punish or blame your child for enuresis.
Complication
Child enuresis complications Complication
1. Personality: Most children with enuresis are timid, passive, too sensitive and prone to excitement, and are reluctant to participate in group activities, and gradually form a character of shame, inferiority, loneliness and introversion.
2, psychological feelings: enuresis can make children shy, anxious, fear and wince. If parents do not care about the child's self-respect, using the means of snoring, threatening, and punishing will make the child more aggrieved and depressed, and increase the psychological burden. The symptoms will not be alleviated, but will increase.
Symptom
Children's enuresis symptoms Common symptoms Children's enuresis enuresis Urinary urgency Urinary muscles without reflex Children's bedwetting urine flow thinning or interruption
Enuresis usually occurs in children aged 5 to 10 years old, and boys are more common.
Clinical manifestation
1, according to the time of onset:
1 primary enuresis: It is pointed out that people who have been bedwetting after birth, about 70-80% of children with enuresis. Most of the enuresis associated with sleep disorders is primary enuresis.
2 secondary enuresis: refers to the child within 5 years old, there was a period of time (about 3 to 6 months) without bedwetting, and then enuresis. About 20-30% of children with enuresis.
The disease usually heals itself, and the enuresis disappears with age, and most of them stop bedwetting after 8 years of age.
2, according to enuresis time: as a classification method of enuresis is not strict.
Nocturnal enuresis (commonly known as bedwetting) and enuresis. Children with urinary enuresis have symptoms such as frequent urination, urgency or dysuria in the white routine. They must also have enuresis at night, so this is just a customary name. Children who have enuresis in the day and night can be postponed to adulthood without disappearing if they are not treated in time.
3, according to the cause of the disease:
(1) Functional enuresis: Involuntary urination of children over 3 years of age caused by non-organic lesions, and enuresis as the only symptom.
(2) organic enuresis: due to neurological or urinary systemic lesions caused by involuntary urination in children over 3 years of age.
The primary enuresis must be functional enuresis, functional enuresis can be primary enuresis or secondary enuresis, so it has the original functional enuresis and secondary functional enuresis. Secondary enuresis may be functional or organic. Enuresis caused by organic disease at birth can only be called organic enuresis, no primary or secondary.
Examine
Child enuresis check
Must meet the following 3 items:
1, 5 years old or older (or mentally older than 4 years old) repeatedly involuntarily urinate (day or night).
2, the severity of enuresis: 5 to 6 years old children, at least 2 enuresis every month, children over 6 years old at least 1 enuresis every month.
3, not due to nervous system damage, epilepsy, physical diseases or drugs caused by enuresis.
Diagnosis
Diagnosis and diagnosis of enuresis in children
Identification
According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.
Differential diagnosis
Identification is secondary enuresis or enuresis caused by psychological factors.
1, secondary enuresis: secondary enuresis regardless of day and night, bed or non-bed, awake or non-awake state can occur, in addition to bedwetting, there are other more obvious clinical symptoms and pathological manifestations, mostly for the instrument Sexual lesions, such as lower urinary tract obstruction, cystitis, urethritis, cystitis or other organ diseases, after surgery, especially febrile diseases, affecting the nervous system or the child's general weakness caused by dysfunction, can also appear temporary Enuresis. Once the primary disease improves, the general condition improves and the enuresis disappears.
2, enuresis caused by psychological factors: such as fright, threats, severe criticism of punishment or long-term nervousness or sudden unfortunate events leading to changes in urination habits. Psychological factors can not only cause children who have had the ability to control small cases to re-emerge, but also make a small number of children gradually form habits after enuresis, and some even can not be changed by adults. For children with secondary enuresis, it is necessary to actively treat various primary diseases and improve the general condition of the children. Secondary enuresis can be cured quickly.
