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19.10.2019

Why does a 2 year old child have urinary incontinence? How and with what to help a child? Causes and methods of treating enuresis in children. Use proven tools

Urinary incontinence, or enuresis, can be diagnosed in people of different age categories. In most cases, the disease develops in children aged 5 years and older.

A five-year-old child begins to use volitional efforts to restrain the urge to urinate; if this fails, they resort to treatment for a disease that brings grief.

Urinary incontinence in children is treated using both traditional methods and traditional medicine.

Urinary incontinence in children is a secondary disease that results from mental trauma. Often the symptoms of a childhood illness irritate parents who do not understand that the child needs serious therapy.

Nocturnal enuresis occurs in children 10 times more often than daytime enuresis. Children often suffer from two forms of pathology.

Classification of the disease

Depending on what time of day the symptoms of enuresis appear, there are 2 types of the disease: bedwetting and daytime urinary incontinence.

Enuresis is also divided according to the frequency of symptoms:

  1. The primary form of pathology is determined if the child has virtually no breaks between exacerbations of the disease.
  2. The secondary form of the disease is determined if urinary incontinence does not occur for a long time, after which deviations occur again.

According to the manifestation of symptoms, they distinguish between monosymptomatic and polysymptomatic enuresis.

The monosymptomatic type of the disease is characterized by:

  • Lack of urges;
  • Painless urination.

The polysymptomatic type manifests itself:

  • Pain during urination;
  • Frequent urges;
  • The urge is so strong that it is impossible to hold it back;
  • Complications of the disease are often observed.

Nocturnal type of illness

If a child sleeps, when ill, he cannot control himself to wake up to empty his bladder, and in the morning they discover that he has peed.

More often, this happens after daytime psychological trauma that occurred or after physical overload, for example, when the baby ran and played a lot. Boys are much more likely to experience bedwetting than girls.

Daytime type of disease

The manifestation of daytime enuresis in children occurs due to inhibition of the cerebral cortex during the day. Representatives of the weaker half suffer from daytime urinary incontinence on a par with boys.

The causes of this type of enuresis are exhaustion as a result of emotional experiences or the presence of urological pathology.

Why does the disease develop?

The appearance of prerequisites for enuresis may be associated with the intrauterine development of the baby.

Risk factors are:

  • Preeclampsia,
  • Intrauterine infection
  • Umbilical cord entanglement.

It has been noted that the most affected by pathology are:

  • Low weight children
  • Those whose parents are overprotective
  • Children from unreliable families.

Urinary incontinence may have the following causes:

  • Heredity. Most often the disease is transmitted to the son from the father.
  • Immature central nervous system. The child does not feel the signal that the bladder is full and does not wake up.
  • Psychological discomfort. Stressful situations, unpleasant changes in the family, a constant feeling of fear.
  • Hormonal pathologies.
  • Infectious diseases of the genital tract.
  • Bladder weakness.
  • Frequent hypothermia.

Important! Sometimes parents look for reasons for urinary incontinence, associating them with some disease, which is very rare. Most children are diagnosed with primary enuresis, which is associated with a lack of control over bladder functions, starting from birth.

With secondary enuresis, the child is able to control urination, but there are some reasons for urinary incontinence due to the developed pathology.

Diagnostics

The main thing that attention is paid to when diagnosing enuresis in childhood is existing complaints and family history.

According to statistics, in 75% of cases, a small patient suffering from a disease has at least one parent who had the same pathology in the past.

Anamnesis

After clarifying the nature of the child’s upbringing, the following is recorded:

  • How often do cases of enuresis occur?
  • Type of urinary incontinence
  • There are frequent or rare urges.
  • Do you experience pain during urination?
  • What urinary tract infections have you had?

It also reveals the presence of previous diseases that contribute to increased irritability of the bladder.

Diagnosis of pathology includes urine examination: general and bacteriological analysis. Cystoscopy and excretory urography are also performed.

How to treat

None of the known methods provides a guarantee of a complete cure for childhood urinary incontinence.

Therapeutic techniques are conventionally divided into 3 groups:

  • Medication.
  • Psychotherapeutic.
  • Regime.

Successful treatment of enuresis is possible if there is the interested participation of parents and young patients.

Drug therapy

Treatment with medications is prescribed when the results of other types of treatment are negative. The medicine is selected according to the reasons that caused the disease, as well as the characteristics of the child’s body.

The most effective in treating pathology are drugs prescribed for the following medical indications:

  • If urinary incontinence is neurotic in nature, tranquilizers are prescribed: Hydroxyzine, Medazepam, Meprobamate.
  • If children have developmental delays or signs of neuroticism, use: Piracetam, Semax, Glycine.

Medicines are taken as prescribed under strict medical supervision.

Psychotherapy

Psychotherapy methods are designed to correct neurotic disorders. For suggestion and self-hypnosis, a ten-year-old child is offered to use formulas for waking up with the urge to urinate.

Before going to bed, the formula is pronounced: In the morning, my bed is always dry. I quickly get up on my own if I want to urinate. I'm great at it.

Lying in bed, the little patient mentally imagines the sensations of a full bladder and his further actions.

Physiotherapy

Physiotherapeutic methods are used to treat enuresis.

Young patients are treated:

  • thermal procedures,
  • circular shower,
  • electrical stimulation of the pelvic muscles,
  • massage.

Applicable:

  • laser therapy,
  • magnetotherapy,
  • acupuncture.

Regular treatment methods

With all known methods of treating urinary incontinence, behavioral treatment is considered the most effective.

  1. The patient should feel tolerance from family members. Rudeness and punishment can lead to undesirable consequences. It is important to instill in the child confidence in victory over the disease and the effectiveness of the therapy used.
  2. The patient's relatives must strictly control their diet and the amount of liquid they drink before going to bed. You should limit dishes containing a high percentage of liquid (not only soups, but also vegetables and fruits), but the nutritional value should not suffer.
  3. The bed should not be soft.
  4. Be sure to visit the toilet before going to bed. There should be a potty near the crib. You should leave the lamp on, sometimes children are afraid of the dark.
  5. The child should not experience hypothermia.
  6. Parents must ensure that stressful situations and overwork of the little patient are avoided.

Along with behavioral therapy, medications are prescribed, and traditional methods are also used.

Folk recipes

To treat enuresis, both decoctions of one medicinal plant and herbal preparations are used. A proven method of traditional medicine in the treatment of enuresis in children is the use of dill seed.

Recipe 1. Brew 1 tablespoon of dill seed with 200 ml of boiling water. After infusion for an hour, drink the infusion in 2 doses. The course of treatment is 12 days.

Recipe 2. Take 2 teaspoons of dry crushed plants: knotweed, St. John's wort, immortelle. After mixing, pour a tablespoon of plants into a glass of boiling water and leave for 2 hours in a thermos. A small patient should drink 50 ml of decoction in 15 minutes. before every meal.

Recipe 3. St. John's wort and yarrow are mixed in equal proportions. Used as tea leaves.

Recipe 4. Pour 0.5 cups of dried lingonberry leaves into half a liter of boiling water and leave for 10 minutes. After infusion for an hour, filter. Give the child 100 ml of decoction per 10 minutes. before meals, except dinner. During the day there is increased urination, and at night the child sleeps peacefully.

When treating a child for enuresis, the active assistance of parents is of great importance.

To quickly rid your child of pathology, you should use the following recommendations:

  1. A favorable psychological atmosphere must be created in the family. Especially if the causes of enuresis are known.
  2. There must be a trusting relationship between parents and child. The child needs to know that a wet bed is a problem that many people have, and it will soon be solved. Children are afraid of ridicule, which leads them to withdraw into themselves.
  3. The child's nutrition should be complete. Semi-finished products, salty, spicy, vegetables and fruits containing a high percentage of water are excluded. Before going to bed, fluid intake should be kept to a minimum.
  4. It is necessary to reduce the time allotted for watching TV shows, sitting in front of a computer monitor, which negatively affects the child’s nervous system.
  5. Before going to bed, it is better to play calm games.
  6. Visiting the toilet before bed is a must.

– disorder of voluntary urination, the child’s inability to control the act of urination. Urinary incontinence in children is characterized by the inability to accumulate and retain urine, which is accompanied by involuntary urination during sleep or wakefulness. To find out the reasons, children undergo urological (ultrasound of the urinary system, cystoscopy, radiography of the kidneys and bladder, electromyography, uroflowmetry) and neurological (EEG, EchoEG, REG) examination. Treatment of urinary incontinence is carried out taking into account the causes and may include drug therapy, physical therapy, psychotherapy, etc.

General information

Urinary incontinence in children is persistently repeated involuntary (unconscious) urination during the day or at night. Urinary incontinence affects 8 to 12% of children, with the most common form of pathology in childhood being enuresis. The polyetiological nature of urinary incontinence in children makes this problem relevant for a number of pediatric disciplines: child neurology, pediatric urology, child psychiatry.

In children under the age of 1.5-2 years, urinary incontinence is considered a physiological phenomenon associated with the immaturity of somatovegetative regulatory mechanisms. Normally, a child develops the skills of holding urination when the bladder is full by the age of 3-4 years. However, if urinary control skills have not been established by this period, one should look for the reasons causing urinary incontinence in the child. Urinary incontinence in children is a social and hygienic problem, often leading to the development of psychopathological disorders that require long-term treatment.

Causes of urinary incontinence in children

Urinary incontinence in children can be caused by a violation of the nervous regulation of the function of the pelvic organs due to organic lesions of the brain and spinal cord: injuries (craniocerebral, spinal cord), tumors, infections (arachnoiditis, myelitis, etc.), cerebral palsy. Children with various mental illnesses (mental retardation, autism, schizophrenia, epilepsy) often suffer from urinary incontinence.

Urinary incontinence may be caused by anatomical disorders in the development of the child’s genitourinary system. Thus, the organic basis of urinary incontinence can be represented by cleft urachus, ectopia of the ureteric orifice, exstrophy of the bladder, hypospadias, epispadias, infravesicular obstruction, etc.

In some cases, urinary incontinence in children occurs due to sleep apnea syndrome, endocrine diseases (diabetes mellitus, diabetes insipidus, hypothyroidism, hyperthyroidism), and taking medications (anticonvulsants and tranquilizers).

In some cases, bedwetting is explained by a disturbance in the rhythm of secretion of the antidiuretic hormone (vasopressin). Due to insufficient concentration of vasopressin in plasma at night, the kidneys secrete a large volume of urine, which overwhelms the bladder and leads to involuntary urination.

Urinary incontinence can be accompanied by urogenital diseases (pyelonephritis, cystitis, urethritis, vulvovaginitis in girls, balanoposthitis in boys, vesicoureteral reflux, nephroptosis, pyelectasia), helminthic infestation. Allergic diseases can contribute to increased excitability of the bladder and urinary incontinence in children: urticaria, atopic dermatitis, bronchial asthma, allergic rhinitis.

In children, especially preschoolers, urinary incontinence can be of a stressful nature. Quite often, a psychologically traumatic situation is the divorce of parents, the death of a loved one, conflicts in the family, ridicule of peers, transfer to another school or kindergarten, change of place of residence, the birth of another child in the family. Recently, among the reasons contributing to urinary incontinence, pediatricians have cited the widespread use of disposable diapers, which delay the formation of a conditioned reflex to urinate in a child.

In most cases, urinary incontinence in children is caused by a combination of these factors.

Classification

In the event that involuntary leakage of urine occurs through the urethra, they speak of vesical incontinence; if urine is released through other unnatural channels (for example, genitourinary and ureterintestinal fistulas), this condition is regarded as extravesical urinary incontinence. In the future, only forms of vesical urinary incontinence in children will be considered.

In pediatric urology, it is customary to distinguish between incontinence and urinary incontinence: in the first case, the child feels the urge to urinate, but cannot hold urine; in the second, the child does not control urination because he does not feel the urge. In the event that urinary incontinence occurs during sleep (in children over 3.5-4 years old at least 2 times a month) in the absence of mental illness and anatomical and physiological defects of the urogenital area, they speak of enuresis (night or daytime).

Urinary incontinence in children can be primary or secondary. By primary (persistent) we mean a delay in the formation of the physiological reflex of the formation and control of urination. This usually occurs against the background of neuropsychic disorders or organic disorders of the urinary system. Cases of secondary (acquired) urinary incontinence include situations when the skill of inhibiting urination is lost after a period of urinary control for more than 6 months. Secondary urinary incontinence in children can have a psychogenic, traumatic or other origin.

According to the mechanisms of development, urinary incontinence can be imperative, reflex, stress, from bladder overflow, or combined.

With imperative (imperative) urinary incontinence, the child is unable to control urination at the height of the urge. This option, as a rule, occurs in children with a hyperreflex form of neurogenic bladder.

Stress urinary incontinence in children develops in connection with efforts accompanied by a sharp increase in intra-abdominal pressure (coughing, laughing, sneezing, lifting heavy objects, etc.). This type is most often caused by functional weakness of the pelvic floor muscles and urethral sphincter.

Reflex urinary incontinence in children is caused by the disconnection of the cortical and spinal centers that regulate the function of the pelvic organs, including voluntary urination. In these cases, there is an involuntary leakage of urine drop by drop or in small portions.

Paradoxical ischuria, or urinary incontinence associated with bladder overflow, can be small - up to 150 ml; medium -150-300 ml and large volume - more than 300 ml. This disorder is characterized by involuntary loss of urine due to overfilling and overdistension of the bladder in children with a hyporeflex neurogenic bladder and bladder outlet obstruction.

Symptoms of urinary incontinence

Urinary incontinence is not an independent disease, but a disorder that occurs in various nosological forms. Urinary incontinence in a child may be constant or intermittent; be noted only in a dream or also in a waking state (usually while laughing, running); have the character of a slight leakage of urine or complete spontaneous emptying of the bladder.

Children with urinary incontinence often have comorbidities such as recurrent urinary tract infections, constipation, or encopresis. Due to constant contact of the skin with urine, dermatitis and pustular lesions often occur.

Children with enuresis are characterized by emotional lability, isolation, vulnerability or irascibility, irritability, and behavioral abnormalities. Such children may suffer from stuttering, bruxism, sleep disorders, sleepwalking, and sleep-talking. Autonomic symptoms are typical: tachycardia or bradycardia, sweating, cyanosis and coldness of the extremities.

Diagnostics

A specialized examination of children with urinary incontinence is aimed, first of all, at identifying the causes of this condition. Therefore, a team of pediatric specialists, including a pediatrician, pediatric urologist or pediatric nephrologist, and child psychiatrist, can participate in the diagnostic search. A study of somatic status involves collecting a detailed history, assessing the general condition, examining the lumbar region, perineum, and external genitalia.

At the stage of uronephrological examination, the daily rhythm of urination is assessed, laboratory tests are carried out (general urine analysis, bacteriological urine culture, Zimnitsky's test, Nechiporenko, etc.), uroflowmetry, electroneuromyography.

Treatment of urinary incontinence in children

Depending on the identified etiological factors, treatment is carried out differentiated. For congenital malformations of the urinary tract, surgical correction is performed (urethroplasty, sphincteroplasty, suturing of a bladder fistula, etc.). If inflammatory diseases are detected, courses of conservative treatment of urethritis, cystitis, and pyelonephritis are prescribed. Treatment of children with mental disorders and psychogenic urinary incontinence is carried out by child psychiatrists and psychologists using drug therapy and psychotherapy. If the cause of urinary incontinence in a child is insufficient maturity of the nervous system, courses of nootropic drugs are indicated.

Regular aspects play an important role in the treatment of any type of incontinence: eliminating stressful situations, creating a friendly atmosphere, limiting fluid intake at night, forcing the child to wake up and sit on the potty at night, etc.

Physiotherapeutic methods are effective in the treatment of various forms of urinary incontinence in children: darsonvalization, diathermy, electrophoresis, electrosleep, magnetic therapy, IRT, electrical stimulation of the bladder, transcranial electrical stimulation.

Prevention

The diversity of preventive measures aimed at preventing urinary incontinence in children is due to the polyetiology of the disorder. General recommendations include maintaining a sleep-wake schedule, timely potty training, sanitary and hygienic education of children, and normalization of the psychological climate. Timely treatment of urinary tract infections, anomalies of the genitourinary system and other concomitant diseases is necessary. A favorable course of pregnancy plays an important role.

Children should never be scolded for urinary incontinence - this can increase the child's feelings of shame and inferiority.

The term enuresis (from the Greek enureo - “to urinate”) is commonly used to describe bedwetting in children over 5 years of age. Therefore, the definition of “nocturnal enuresis” is essentially a tautology, although it has taken root in speech. In addition to enuresis, there is another urinary pathology - daytime urinary incontinence. If a 7-year-old child pees during the day, then this most likely has nothing to do with enuresis. This disease has its own mechanisms, developmental features and causes. For involuntary urination at night, the reasons are completely different.

Causes of nocturnal enuresis in children 7 years old.
One of the most common reasons is heredity. If at least one of the parents had the same disease in childhood, the probability that it will be passed on to the child is about 45%. If both mom and dad suffered from enuresis, then this figure rises to 75%!

Often the source of enuresis is birth trauma or trauma the mother received during pregnancy. This leads to disturbances in the child’s nervous system, which, in turn, inhibits his development of skills to restrain the urge to urinate.

Sometimes pathologies of the internal organs of the urinary system, an injured, underdeveloped or weakened bladder or ureters prevent urine retention.

Urinary tract infections can also cause urinary incontinence and excessive urination.

Not so long ago, doctors identified another reason - hormonal. Enuresis can be caused, as it turned out, by insufficient production of the hormone vasopressin by the pituitary gland. It is this hormone that helps the body sleep peacefully, despite the urine produced by the kidneys. Vasopressin makes its concentration higher and its quantity lower. With a lack of vasopressin, the same non-concentrated fluid accumulates in the bladder as during the day, in the same volume that a child’s bladder cannot cope with.

Treatment of enuresis in a 7-year-old child.
If a 7-year-old child regularly pees in bed at night, this causes him severe discomfort. Due to age characteristics, 7-year-old children are very susceptible and vulnerable, so the situation with urinary incontinence negatively affects the child’s psychological balance, self-esteem and communication with peers.
Considering that 7 years is the age when a child has just entered school life, such a blow to the psyche can affect all further development and the process of socialization. That is why you should not delay the treatment of enuresis. Of course, a doctor should treat urinary incontinence in a 7-year-old child, since self-medication may not only not be beneficial, but also harm the child’s health. Therefore, you should not expect that the child will “outgrow” everything, especially if the enuresis is secondary (that is, it appeared after a long “dry” period).
The main thing in treatment is to correctly identify the cause. To determine the source of the disease, the specialist carefully examines the patient. The child's urine and blood are tested, the bladder and kidneys are examined using ultrasound, and the rhythm of urination episodes and the volume of urine excreted are monitored. You may also need to consult a neurologist and psychologist if the doctor sees the need for this.
After diagnosis, the specialist prescribes treatment. Drug treatment most often consists of influencing the hormonal system and psychological state of the child. The lack of the hormone vasopressin is compensated by the drug Minirin, which is desmopressin - a synthetic analogue of the “native” vasopressin. An herbal sedative may also be prescribed to reduce stress levels.
Specific medications are prescribed in each case - for example, antibiotics for urinary tract infections, etc.
The outcome of treatment largely depends on the parents’ attitude towards the child’s illness. An atmosphere of support and participation will help the patient quickly cope with psychological discomfort and have a positive impact on his well-being.
Mothers can also help the doctor during the examination by keeping a diary with a schedule of the child’s “dry” and “wet” nights. By the way, today a specially developed application for smartphones “Dry nights - happy days” is already available, which allows you not only to note “unsuccessful” nights, the number of episodes of urination per day, but also the amount of liquid the child drinks. So with this new product it is also convenient to control your drinking regime.

Many children over six years old experience a pathological condition such as. Moreover, this disease has been known since ancient times.

Factors influencing the development of this disease are various infections suffered by the baby, developmental defects, performance disorders, frequent stress and all kinds of mental disorders. In medicine, this disease has another name - enuresis in children.

There can be many reasons for enuresis in a child: severe infections, stressful situations, neuroses, as well as other mental disorders.

This problem is very serious and requires an immediate solution. At the moment, it is believed that until the child is five years old, the formation of the reflex to urinate continues.

If by this age he continues to go to bed to relieve himself, then he has serious problems. Most often, urinary incontinence in children is not a serious disease, but such moments can negatively affect their mental state.

In addition, they can contribute to the development of such an unpleasant disease as. Typically, nocturnal enuresis is directly related to delayed maturation of the central nervous system. In this case, the brain does not receive a signal about the filling of the bladder and the urgent need to empty it.

Typically, increased urine production, mainly at night, is accompanied by serious mental trauma, fear, as well as the placement of a child in an unfamiliar environment.

In this case, enuresis is only a component of the existing dysfunction of organs and systems.

As you know, diagnosis and treatment must be carried out in an appropriate medical institution. There is no need for immediate hospitalization unless the illness is associated with serious pathologies of the bladder.

The appearance of another child in the family can significantly affect the development of this unpleasant disease. Another option is the arrival of a new adult child in the family, which can be very stressful for the baby.

This is possible even if there are no significant reasons for this. If enuresis occurs, the child urgently needs treatment.

Symptoms

In many children, the development of the disease is associated with a poorly developed ability to master this essential skill due to too young an age. With childhood enuresis, urination may be unconscious and involuntary. It mainly appears at night, but can also occur during the day.

The main symptoms of enuresis include:

  • poor and restless sleep;
  • urinary incontinence;
  • developmental delay;
  • nervousness;
  • involuntary urination, mainly at night.
Treatment of the disease should be carried out only on the basis of a diagnosis, which can be made at an appointment with a specialist.

Classification

At the moment, there is a classification of this disease, according to which it can be primary and secondary.

The first type is the most common and is diagnosed only if the child who suffers from urinary incontinence is already quite old.

Typically, “adulthood” means under five years of age. Usually it is by this age that it should be fully mastered.

The diagnosis is made only when the patient does not have any diseases associated with the nervous and genitourinary systems. And all because in this case, urinary incontinence is considered as a symptom of any disease associated with one of the above body systems.

But secondary enuresis is diagnosed only if previously the child had everything in order regarding reflexes. In this case, we consider such a picture of the course of the disease in which it develops approximately six months after the moment of mastering this skill.

The exact cause of the disease is not fully known. That is why treatment of enuresis in children usually comes down to a preliminary search for the main stress factor.

There is also a mixed form of this disease, which combines nocturnal and daytime enuresis. In addition, there are uncomplicated and complicated forms of this disease (they are only possible if the patient has a health disorder associated with the presence of this disease).

How can parents help?

It is important to note that enuresis also occurs. There can be many reasons for this phenomenon. But in this case, we are talking about this serious problem in a child.

As a rule, to begin with, a set of special measures is carried out, which is called empirical treatment.

It is based on many years of experience and begins with an impact on the causative factor that played a major role in the development of this disease. Before starting therapy, it is necessary to find out the causes of enuresis in order to prescribe the correct treatment.

Parents of children who want to have a guarantee that this illness was not caused by any anatomical defect should not forget that any examination and correct determination of the causes requires a certain amount of time.

As for the role of parents in providing the child with the first measures to eliminate an unpleasant phenomenon, they must ensure the following:

  1. complete exclusion of external stimuli from the child’s life. Children's enuresis can be overcome only when it is possible to provide the child with the most comfortable living conditions and being in society without difficult and unwanted stressful situations. Also among the additional measures is a warm and hard bed. The baby only needs to sleep on his back, with a special cushion under the knees to reduce pressure on the bladder. It is imperative to exclude the possibility of hypothermia. One hour before bedtime, he should go to the toilet every twenty minutes. At night, the child needs to be woken up to go potty at approximately the same hour so that his body begins to get used to it. It is advisable to carefully monitor at what time unwanted urination occurs. This will allow you to wake up your baby at the same time to go to the toilet;
  2. ensuring balanced nutrition. In order to find out how to treat enuresis, you need to visit a doctor, who will prescribe a special diet for this. The last meal should be approximately three hours before bedtime. It is important to completely exclude from the diet foods that can cause rapid urine loss. These include fermented milk products, fruits, and coffee. Dinner can include porridge, eggs, sandwiches, weak tea and bread with salted herring. The last dish can play a key role: since salt retains fluid in the body, this will help avoid uncontrolled urination during sleep;
  3. competent and loyal attitude of family members to this problem in the child. Parents should not show aggression towards him for this offense, since this can only aggravate it. It is important to remember that punishment for this is one of the causes of enuresis in children;
  4. urination training. For this, there are special exercises that allow you to control the process;
  5. . It makes it possible to strengthen the muscles of the body.
In order to overcome the disease, the direct participation of parents is necessary.

Treatment

Medication

The process of treatment with drugs depends on the nature of the disease.

There are several causes of the disease, each of which requires its own treatment method:

  1. neurosis. Before going to bed, you need to take two tablets of the drug Sanasol. As additional measures, drugs that calm the central nervous system are used, such as motherwort tincture, Persen, Passit, Novopassit;
  2. primary enuresis. It is necessary to use drugs that improve blood supply to the brain. These include nootropics and glutamic acid.

Folk remedies

Enuresis is treated with folk remedies, which essentially contain useful. You can use a special decoction of plantain leaves, which should be given to the child one spoon three times a day.

Dill seeds have a good effect on enuresis.

Also, enuresis in both boys and girls can be quickly cured with the help of a useful decoction of centaury with St. John's wort. An excellent remedy in the fight against the disease can be called dry, a tablespoon of which should be poured into a glass of hot boiled water and given to the child to drink it.

Vanga's recipes for bedwetting in children

This recipe should be used only by those children who do not have serious problems with the musculoskeletal system, in particular the spine.

To prepare the decoction, you need to pour one kilogram of water beetle with five liters of purified water and bring this mixture to a boil.

The cooled decoction should be used for therapeutic baths up to the waist. But the herb removed from the decoction must be thoroughly ground with pork fat and compresses made from this composition. This remedy is ideal for the treatment of nocturnal enuresis in children and adolescents.

Video on the topic

Dr. Komarovsky about when and how to treat enuresis in children:

It is possible to save a child from this disease only with the help of special comprehensive treatment, which combines appropriate medications, physical activity, proper nutrition, folk remedies and parental support, which in this case plays a major role.

Before starting therapy, you need to consult a doctor to identify the causes of the disease, which can be very different. Only during an examination can the doctor prescribe appropriate treatment, which allows you to forget about this disease as soon as possible.


Enuresis(from the Greek enureo to urinate) is a term for urinary incontinence. In children, the following forms of this disease are distinguished: nocturnal enuresis(occurs most often, and this article will talk about it) and daytime urinary incontinence. There is also permanent urinary incontinence, but this is a completely different disease associated with damage to the central nervous system as a result of injury or infection. Under nocturnal enuresis This means that a child over 5 years of age has involuntary urination during night sleep. The formation of complete control over urination in a child occurs between the ages of 1 and 3 years and ends by the age of four. Depending on age and the amount of fluid drunk, the number of urinations normally ranges from 7 to 9 per day (no more and no less), and during night sleep there is a break in urination. However, this does not happen in 10 - 15% of children aged 5 - 12 years, and after a night's sleep they wake up wet. That is, they suffer nocturnal enuresis. As they grow older, the prevalence of this disease decreases, but 1% of children carry it into adulthood. Moreover, enuresis occurs 1.5 - 2 times more often in boys than in girls. There are two main types of nocturnal enuresis: primary nocturnal enuresis(PNE) - a disease in children who have never woken up consistently dry; and secondary or recurrent (recurring) nocturnal enuresis, a condition in which patients repeatedly begin to wet the bed after a significant period of remission (no signs of the disease).

Reasons for the development of enuresis

The causes of bedwetting are varied. One of the main factors is damage to the fetal brain during the pathological course of pregnancy and childbirth due to hypoxia (insufficient supply of oxygen to the brain) or injury. These pathologies contribute to a delay in the maturation of the child’s central nervous system and disruption of the production of hormones, including vasopressin (see below), which leads to the development of enuresis. Chronic infections of the urinary system, disorders of the nervous regulation of the bladder, congenital anomalies of the genitourinary system, and a delay in the development of neatness skills are also considered to be causes of bedwetting. Exacerbations of nocturnal enuresis are possible, developing against the background of acute respiratory viral infections, hypothermia, which provokes an infection of the urinary system. This often happens in autumn and spring, that is, during periods of unstable weather. Stressful situations in a child’s life can also cause recurrences of the disease. The mechanism of development of primary nocturnal enuresis (PNE) is not completely clear. It is believed that genetic predisposition is an important factor in the development of the disease. Certain genes responsible for this pathology have been identified. If one of the parents suffered from bedwetting, then the risk of developing enuresis in the child is 45%, and if both parents, this probability increases to 75%. In recent years, convincing evidence has emerged that the main cause of PNE is disturbances in the rhythm of secretion of the hormone synthesized in the brain (in the hypothalamus) vasopressin. Its other name is antidiuretic hormone, from which the main function becomes clear: reducing the excretion of urine by the kidneys. The antidiuretic (or antidiuretic) effect of the hormone is necessary to maintain water-salt metabolism in the body. Normally, the concentration of vasopressin in plasma depends on the time of day: at night it is higher than during the day. Therefore, at night, the kidneys excrete a smaller volume of urine, but with a higher concentration. That is, in healthy people at night, small portions of urine enter the bladder, but do not overfill it, and there is no urge to urinate. In primary enuresis, the secretion of vasopressin at night is reduced, which leads to increased formation of unconcentrated urine. Its amount exceeds the physiological capacity of the bladder, it overflows, and involuntary urination occurs. Often parents, apparently out of a desire to justify themselves, associate this with the child’s sound sleep. However, it turned out that in terms of the nature of their sleep, children suffering from nocturnal enuresis do not differ from other peers. Another cause of nocturnal urinary incontinence may be disturbances in the nervous regulation of the bladder with a predominance of increased smooth muscle tone, and then enuresis is accompanied by frequent urination in small portions or large, rare urination, as well as daytime urinary incontinence. If the tone of the bladder is reduced, the child urinates rarely, in large portions, the bladder becomes full, and involuntary urination occurs. A situation has also been noted where children, due to attending various classes and sections, are almost unable to drink normally in the first half of the day, but at home, before going to bed, they drink the daily norm of liquid and do not hold urine at night. Sometimes this is also regarded as enuresis.

Necessary examinations

There is an opinion that there is no need to consult a nephrologist (or pediatrician) with the problem of nocturnal enuresis: they say, the child will “outgrow” it, and everything will go away on its own. But this point of view is wrong. When examining children with bedwetting, various pathologies of the kidneys and urinary system are often revealed. Therefore, first of all, it is necessary to establish the cause of the disease. To do this, specialists prescribe certain examinations: blood tests, various urine tests, ultrasound examination of the kidneys and bladder; They study the rhythm and volume of urination and do electroencephalography. A more extensive examination of the urinary system is often required: cystography, intravenous urography, nephroscintigraphy, cystoscopy, urofluometry. Based on the results of the examination, the nephrologist, if necessary, can refer the child for consultation with other specialists, for example, a neurologist, psychologist, or for additional examination in the nephrology or urology departments. Only after the cause of enuresis has been established can the correct treatment be prescribed.

Treatment

Convincing data on disturbances in the rhythm of vasopressin secretion during primary nocturnal enuresis served as the basis for the use of synthetic analogues of this hormone - MINIRINA (DESMOPRESSIN). Doses of the drug for the treatment of PNE in children over 5 years of age are selected by the doctor individually; the medicine should be given before bedtime. When treating primary nocturnal enuresis, a special drinking regime should be observed - the last fluid intake should be at least 2 hours before bedtime. At the same time, the child should receive enough fluid throughout the day. It is unacceptable to use vasopressin analogs on your own, since nocturnal enuresis in a child may be associated with a completely different pathology, for example, an infection of the urinary system. And this requires the appointment of antibacterial therapy, after which the phenomena of nocturnal enuresis disappear. If the cause of enuresis is a violation of the nervous regulation of the bladder, with a predominance of increased tone of its smooth muscles, leading to a decrease in bladder volume, DRIPTAN is used. It increases bladder capacity and reduces spasm, making spontaneous muscle contractions less frequent and eliminating urinary incontinence. In some cases, treatment with MINIRIN in combination with DRIPTAN is indicated. If the tone of the bladder is reduced, it is recommended to adhere to a regime of forced urination every 2.5 - 3 hours during the day. It is important that the child empties his bladder before bedtime. MINIRIN AND PRAZERIN are prescribed as therapy, increasing the tone of smooth muscles. To improve metabolic processes in the brain, as well as in neurosis-like conditions, drugs such as NOOTROPIL, PICAMILON, PERSEN, NOVOPASSIT are recommended. In addition, courses of vitamin therapy (B6, B12, B1, B2, A, E) are indicated. The treatment of enuresis includes physiotherapy, in the form of effects on the bladder with various currents, ultrasound and thermal procedures (paraffin or ozokerite), which regulate the functioning of the nervous system. General strengthening massage and therapeutic exercises aimed at strengthening the pelvic floor muscles are also used. Treatment of nocturnal enuresis is a long process, it takes months and sometimes years, so parents need to be patient. In order to prevent the disease, it is better to teach your child to use the potty in a timely manner and ensure that the child regularly and completely empties the bladder. Compliance with the drinking regime is mandatory. It is unacceptable for a child to get used to drinking before bed and at night. A child who suffers from bedwetting should not be forced to wake up to empty his bladder. The baby should sleep at night. He needs to be treated, and then he will be able to control his body, and the symptoms of enuresis will disappear. The right psychological attitude in the fight against any disease is no less important than the course of medications. And in the case of children's nocturnal enuresis, this point is of particular importance. The more correct and attentive adults are to the baby, the less painful the problem will be for the child’s developing personality.

Illness and character

For many children, regardless of age, enuresis, like any long-term illness, causes a feeling of inferiority. Even the little ones have a hard time with this problem. Shy than their healthy peers, they often strive for privacy and withdraw into themselves in order to avoid the ridicule and disgust of others. Feelings of insecurity often appear or worsen in kindergarten or school age and can lead to the development of low self-esteem, self-rejection, up to a complete inability to learn and be realized in various areas of life. Children who have urinary incontinence for a long time, under the influence of experiences, in some cases change in character. Some become more aggressive, others become more timid, indecisive, withdrawn, and withdrawn. There are also those who, at first glance, do not worry about their illness in any way, but they may experience various changes in adolescence.

Forms and causes of the disease

Urinary incontinence, as a consequence of delayed formation of urinary control or destruction of an already formed function due to organic and infectious diseases or traumatic lesions of the nervous system, is called neurosis-like. The presence of neurosis-like enuresis, caused by organic damage to the child’s nervous system during the period of intrauterine development, does not depend on anxiety and other psychological factors, but increases with overwork, physical ailments, and hypothermia. When an already formed function is destroyed, urinary incontinence does not appear at an early age, but after an injury (for example, a concussion) or an infection (for example, meningoencephalitis - inflammation of the membranes and substance of the brain). At the same time, enuresis is, as a rule, monotonous, monotonous in nature. In cases where the rate of onset of compensation is slow or there are additional negative factors that interfere with recovery, neurosis-like urinary incontinence can drag on for years and in adolescence sometimes leads to pathological personality formation. In such cases, the doctor may recommend long-term sessions with a psychologist along with drug treatment. The urinary function can also be destroyed under the influence of various psychological reasons (due to acute mental trauma). In this case, they talk about neurotic enuresis. This form of the disease can be either short-term or longer-term. For example, if a child has involuntary urinary incontinence due to fright. Typically, a neurotic reaction with enuresis lasts several hours or days and disappears as mental stress disappears. In cases where emotional unrest persists for several weeks or months, and painful manifestations become established, they speak of a neurotic state. Its reasons may be:

  • family moves from one place of residence to another, where the child acutely experiences the loss of friends and acquaintances and faces the need to adapt to a new kindergarten or school;
  • death of close relatives or friends;
  • the birth of a brother or sister in the family;
  • long-term chronic illness of loved ones;
  • chronic conflicts in the family;
  • divorce of parents or pre-divorce and post-divorce situation;
  • death of a pet - cat, dog, parrot

In such cases, the child has a hard time experiencing internal conflict and his protracted illness. A clear dependence on the mental state leads to the fact that the neurotic course of enuresis, in contrast to a neurosis-like disorder, can manifest itself inconsistently - either disappearing or intensifying depending on the emotional state of the child. Such enuresis can be flickering in nature and last from several weeks to several months. But the strength of the child’s experiences is very intense. In these cases, qualified psychocorrection of his internal conflict is effective.

What adults can do

It is important for parents to know that enuresis, like any disease, occurs differently in each child. To date, more than 300 independent methods of its treatment are known. Correct recognition of the disorder and individual selection of appropriate methods for each specific child guarantees a complete recovery in the shortest possible time. And following all the specialist’s recommendations and prescribed procedures, coupled with the connection of psychological family resources, quickly leads to a lasting positive effect.

  1. In case of sudden enuresis, first of all, it is necessary to eliminate the situation that is traumatic to the child’s psyche. Ensure maximum peace in the family, remove the conflict atmosphere, and normalize the psychological climate.
  2. Chronic conflict in the family often leads to aggravation of the problem. The child needs to pay more attention: read books together, go for walks, especially in the evening.
  3. Children suffering from enuresis are prescribed a certain diet and fluid intake: 2 hours before bedtime, the amount is reduced or drinking is stopped altogether. It is important to follow these rules and teach your child new eating patterns, for example, limiting salty and spicy foods, which increase thirst. You can replace juices, tea, compote with a slice of orange or apple. If the baby persistently asks for a drink, you can distract him with something, give him a small spoon of the drink. Gradually, this diet becomes familiar to the child and does not cause difficulties in compliance.
  4. If your baby categorically refuses to sleep during the day, there is no need to make bedtime a stressful situation. The baby can spend the afternoon in a chair listening to a familiar fairy tale or cassette.
  5. During treatment, it is important to reduce or temporarily abandon prolonged viewing of television and computer games, which greatly affect the child’s fragile nervous system. In this case, a book can replace a TV.
  6. Before going to bed at night, it’s a good idea to ritualize your activities as much as possible, that is, perform the same actions with your child in the same order every evening. For example, putting toys away, swimming, telling a fairy tale or a spontaneously invented story with continuations, following the doctor’s evening recommendations.
  7. Jealousy of a younger brother or sister is also often the cause of enuresis in an older child. In this situation, parents need to analyze their attitude towards the elder and, if necessary, reconsider his role in the family. A mother, even if she has a newborn in her arms, needs to pay a little more attention to her firstborn. It may be difficult for him to play the role of the older brother or sister assigned by adults. Or maybe he is not emotionally involved enough in the relationship between the parents and the baby, which causes burning jealousy. The child wants to feel small, unique and loved again. Some parents put an enuretic child into bed with them in order to wake him up at night or take him to the toilet. This is strictly not recommended, since the presence of adults does not allow him to develop the habit of waking up on his own at night. The baby and parents should sleep in different beds and in different rooms. This helps the child sleep peacefully and gradually teach him to control his sphincters or wake up at night when he needs to go to the toilet.
  8. In the evening, it is better to refrain from active, energetic games so that the child does not become overtired. Before going to bed, it is better to play board games, such as lotto, mosaic, cubes or construction sets. They not only develop the baby, but also stabilize his nervous system.
  9. Drawing has a beneficial effect on the child's psyche. The younger the child, the more interesting it is for him to paint with gouache paint with thick brushes on large sheets of paper of different shapes, white and colored. Many children like to create pictures with their fingertips or their entire palm. Parents do not always welcome such creativity, dooming children from an early age to cliches and templates. But when it comes to treating enuresis, it is necessary to liberate the child’s thinking and relax his body as much as possible. And in painting with their fingers and the whole palm, children most fully reflect their emotional state.

The power of suggestion

It is quite possible for parents to conduct autogenic training aimed at relieving the child’s muscle and nervous tension, creating an atmosphere of calm and relaxation, and setting him up to relieve the problem of enuresis. Here is one of the options for conducting such training for preschool children in a poetic and soft play form. This game is not difficult for either parents or children. Classes should be done every evening before bed. The duration of the workout varies from 15 to 30 minutes. The words of auto-training should be read to the baby in a calm, slow and quiet voice. Over time, when the child learns them by heart, he can conduct the lesson every evening independently, without the participation of an adult. Before starting training, you need to learn with your child the names of all parts of the body. When conducting an evening lesson, an adult needs to take care of his internal mental balance. If mom or dad are overstressed or upset, then the activity should be entrusted to someone close to you, since in a relaxed state the induction (transfer of an emotional state) from one person to another is very strong, and in the end the opposite result may occur: the baby will not only not calm down , but on the contrary, will become overexcited. All words should be pronounced in a soft, calm voice, slowly, with long pauses, and when naming parts of the child’s body, gently touch them with your palm (to the head, knees, feet, and so on). Individual formulas of suggestion are repeated 2-3 times with a change in logical stress. With proper autogenic training, the baby relaxes and may even fall asleep.

Game "Magic Dream"

(autogenic training for preschool children in poetic form). Now I will read poetry, and you close your eyes. A new game "Magic Dream" begins. You won’t really fall asleep, you’ll hear everything, but you won’t move, you’ll just relax and rest. Listen carefully to the words and repeat them to yourself, with inner speech. No need to whisper. Relax quietly with your eyes closed. Attention, the “Magic Dream” is coming...
Eyelashes droop...
Eyes are closing...
We rest peacefully (2 times)…
We fall asleep in a magical sleep...
Breathe easily... evenly... deeply...
Our hands are resting...
The legs also rest...
Relax...fall asleep...(2 times)...
The neck is not tense and relaxed...
Lips part slightly...
Everything is wonderfully relaxing...(2 times)...
Breathe easily... evenly... deeply... (A long pause is made and words are spoken aimed at correcting the problem): I sleep dry today...
Tomorrow I'll wake up dry
The day after tomorrow I'm dry
Because I'm dry...
As soon as I feel it, I’ll wake up,
I'll definitely wake up! - Your body is relaxed, but you know that you sleep dry... Tomorrow you will wake up dry... - If you want to go to the toilet at night, you will feel it and wake up, you will definitely wake up... - In the morning you will wake up dry. You are the master of your body and it obeys you. - You're doing great, you sleep dry. If you want to go to the toilet, you will wake up, you will definitely wake up and go to the toilet. Your bed is dry. You're doing great, you'll succeed." Adults should understand that eliminating enuresis in a child is a painstaking and sometimes lengthy process, but a positive result can only be achieved with the active participation of specialists and family. Parents are required to have special tact and respect for their baby . After all, in the end, enuresis is cured, you just need to be patient. I would like to draw special attention to parents: you should not try to independently correct the child’s mental state with some kind of psychological games. The problem of enuresis in children is quite complex and complex, even if it is not noticeable at first glance Therefore, it is better to turn to specialists. Inept actions of parents can lead to a complication of the situation - the disease will worsen and require more time to heal.
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