What Is Diurnal Enuresis?

Enuresis is commonly referred to as bedwetting, and usually refers to a child's involuntary urination while asleep. Generally, only 20% have enuresis by the age of 4 and 5% by the age of 10, and a few patients have symptoms of enuresis that persist into adulthood. Those with no obvious urinary tract or nervous system organic disease are called primary enuresis, accounting for 70% to 80%. Patients secondary to diseases such as lower urinary tract obstruction, cystitis, and neurogenic bladder (neuropathy caused by neuropathy) are called secondary enuresis. In addition to bedwetting at night, children often have symptoms such as frequent urination, urgency or difficulty urinating, and fine urine flow during the day.

Basic Information

nickname

Wetting bed

English name

enuresis

Visiting department

Pediatrics, Urology

Multiple groups

Toddler

Common causes

Delayed cerebral cortex development, deep sleep, psychological and genetic factors

Common symptoms

Involuntary urination while asleep, in addition to nighttime bedwetting, frequent urination during the day, urgency, difficulty urinating, fine urine flow, etc.

Causes of enuresis

The main causes of primary enuresis can be the following: Delayed development of the cerebral cortex: unable to inhibit the spinal micturition center, detrusor muscles show uninhibited contraction after sleep, and excrete urine; too deep sleep: failed to Wake up immediately when the bladder swells after falling asleep; Psychological factors: If the child psychologically thinks that he cannot get the parents' love and loses care, the child's temper is often weird, shy, lonely, timid, and out of group; Genetic factors: Patients have a higher incidence of enuresis in their parents or siblings.

Clinical manifestations of enuresis

Children urinate involuntarily while asleep. In addition to nighttime bedwetting, there are often symptoms of frequent urination, urgency or difficulty urinating, and fine urine flow during the day.

Enuresis test

Medical history

Note whether there are genetic factors, whether enuresis starts from the infant, and those who only appear later and who have symptoms of urination during the day may have secondary enuresis. At the same time, patients with constipation or neurological disorders may have secondary enuresis.

2. Medical examination

For a detailed physical examination of the whole body, pay special attention to whether the anal sphincter tone is normal, whether there is spina bifida, whether the perineum feels diminished, and whether the lower limbs are normal.

3. Laboratory inspection

Urine routine, urine culture.

4.X-ray inspection

Plain film was used to observe the presence of spina bifida, and bladder urethrography was used to observe mechanical obstruction.

5.Urodynamic tests

Urine flow rate was examined for obstruction of lower urinary tract, and intravesical pressure was measured for obstructive contraction.

Enuresis diagnosis

The principle of diagnosing primary enuresis is to exclude various causes of secondary enuresis. Diagnosis can be made based on medical history, clinical symptoms and laboratory test data.

Enuresis treatment

General treatment

Develop a good work and rest system and hygienic habits, avoid overwork, master the time and regularity of bedwetting, and use the alarm clock to wake up the child to get up and urinate 1 or 2 times at night. Sleep for 1 to 2 hours during the day and avoid excessive excitement or strenuous exercise during the day to prevent excessively deep sleep at night. Build confidence throughout the treatment process. Gradually correcting emotions or behaviors such as shyness, anxiety, fear, and cowering, taking care of patients' self-esteem, providing more comfort and encouragement, less reprimand and punishment, and reducing their psychological burden are the keys to successful treatment. We must properly handle the mental factors that cause enuresis, understand the psychological causes and possible psychological contradictions that lead to enuresis through medical history, and solve the mental stimuli that can be resolved as soon as possible. For the contradictions and problems that have occurred or that can't be solved subjectively, we must focus on patiently educating and explaining the patient, so as to eliminate mental tension and avoid causing emotional uneasiness. Avoid drinking water after dinner and emptying the urine in the bladder before going to bed can reduce the number of bed wetting.

2. Behavioral therapy for bedwetting of children

(1) Urination interruption training encourages the child to interrupt urination in the middle of each urination, counting from 1 to 10, and then urinating, which can train and improve the ability of the bladder sphincter to control urination.

(2) Urinary training allows the child to drink more water during the day. When he has a urge to urinate, let him hold back the urine for less than 10 minutes each time. Train 1 or 2 times a day to expand the bladder and increase capacity, thereby reducing nighttime urination. Times.

(3) Timed training. In the past, we often used bedtime half an hour earlier to wake up with an alarm clock and artificial wake-ups, and let them walk back and forth indoors, or wash their faces with cold water, so that urine can be drained in a conscious state. The purpose is also to help Establish conditional reflexes.

Parents should find the child's bedwetting in time, urge the child to empty the residual urine, dry the part, change underwear and dry the bed.

3. Drug treatment

(1) Imipramine is suitable for arousal type.

(2) Oxybutyn is also known as urinary multi-spiral, which is suitable for urinary frequency.

(3) Ephedrine can be used in mixed type.

(4) Desmopressin is a synthetic anti-diuretic hormone, also known as dialysis, and is suitable for nocturnal polyuria.

The combined application of amitriptyline, desmopressin, and oxybutynin is a triple drug currently considered to be effective in the treatment of refractory mixed enuresis. The advantage is that the effectiveness is close to the SNM therapy described below. The disadvantage is that it has different degrees of side effects, and it is easy to relapse after stopping the drug. The above drugs are prescribed drugs. Imipramine and amitriptyline are antidepressants. The dosages shown are for adults. Children should be calculated per kilogram of body weight.

4. Physical therapy

Alarm clock can be used to wake up regularly, acupuncture, massage and other methods.