Enuresis

Enuresis

Enuresis is involuntary urination during sleep. In medical practice, the term enuresis traditionally means involuntary urination during sleep more often than 1 r / month in girls over 5 years old and in boys over 6 years old. The frequency is 40% of children at the age of 3 years, 10% at the age of 6 years, 3% at the age of 12 years and 1% at the age of 18 years.

Etiology

    • primary enuresis. In healthy babies, by the age of 1.5-2 years, a conditioned reflex connection is formed: the urge to urinate leads to awakening. If the formation of this connection is delayed, they speak of primary enuresis.
    • Enuresis is not traditionally associated with psychiatric, neurological and anatomical disorders.
    • One of the causes of enuresis is considered to be an insufficient level of physiological maturity.
    • Insufficient bladder capacity (traditionally functional)
    • Psychological factors
    • Assume the relationship of enuresis with a violation of the cycle of secretion of ADH; children with enuresis have decreased morning vasopressin levels
    • One of the possible reasons is a sleep disorder.
    • Secondary enuresis. Violation of an already formed conditioned reflex leads to secondary enuresis
    • Somatic diseases: diabetes mellitus, urinary tract infections
    • Stressful situation.

Genetic aspects. Enuresis is familial and is often associated with mental disorders. Nocturnal enuresis type 1 (*600631, 13ql3-ql4.3, gene?MS, R), nocturnal enuresis type 2 (*600808, 12ql3-q21,reH?M

    • 2, 9{).

Risk factors

    • Heredity
    • If one of the parents suffered from enuresis, the incidence of the disease in the child is 44%
    • If both parents suffered from enuresis, the incidence rate is 77%
    • More often children from the first births suffer.

Laboratory research. General urine test: when a secondary infection is attached, characteristic changes are detected. Special Studies

    • Determining the size of the bladder: the child retains urine until a constant urge to urinate appears, then the volume of urine excreted is measured
    • Uroflowmetry
    • Ultrasound of the kidneys
    • Cystoscopy – according to indications
    • Intravenous pyelography – according to indications
    • Radiography of the spine – according to indications for differential diagnosis. Differential Diagnosis
    • Genitourinary malformation (eg, epispadias)
    • Urinary tract or spinal cord injury
    • Malformations or tumors of the lumbosacral spinal cord
    • Tumors of the pelvic organs
    • diabetes insipidus
    • Diabetes
    • Tubulopathies
    • sickle cell anemia
    • Chronic constipation.

Treatment

    • Motivational Treatment
    • Desirable encouragement for dry nights
    • Do not punish the child for wet nights. Stopping fluid intake 2 hours before bedtime.
    • Use of specialized alarm clocks. Complete cure occurs in 70% of cases. The alarm clock beeps when the first drops of urine are released – a conditioned reflex connection is formed, the child begins to wake up with the urge to urinate. To consolidate the reflex, the alarm clock will need to be used for another 3 weeks later in the last episode of enuresis.
    • Drug therapy. In most babies, untreated enuresis goes away by 6-10 years, so it is recommended, if possible, to avoid the use of drugs in order to avoid unwanted side effects.
    • Imipramine 1-2 mg/kg (up to 50 mg) an hour before bedtime, amitriptyline 50 mg at night. The drugs are effective, but in 60% of patients, after the withdrawal of the drug, a relapse occurs. Precautions
    • Imipramine can cause arrhythmias or blockade of the conduction system, so an ECG is shown before prescribing
    • Imipramine overdose  is one of the leading causes of child drug-related death in the United States.
    • Desmopressin (adiuretin SD), an analogue of vasopressin, is prescribed to children over 6 years of age at an initial dose of 20 mcg (up to 40 mcg) intranasally at night. The drug is effective, but relapses are possible after its withdrawal.

Complications

    • Urinary tract infections
    • neurotic disorders.

Synonyms

    • Bed-wetting
    • Nocturnal enuresis

See also Urinary incontinence in women

ICD

    • F98.0 Inorganic enuresis
    • R32 Incontinence

urine, unspecified

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