What is enuresis

I believe everyone is very familiar with enuresis, which is what we often call bedwetting. Enuresis usually occurs in children. So what are the factors that lead to enuresis? We need to understand the factors of enuresis. Only then can we make appropriate treatment according to the factors causing enuresis. In addition, parents should also know how to prevent and deal with enuresis in their children.

There are generally many reasons why we may suffer from enuresis, generally including factors of the cerebral cortex and genetic factors. In addition, deep sleep and psychological factors may also lead to the occurrence of enuresis. Let’s take a look at the introduction to enuresis below.

Enuresis, commonly known as bed-wetting, usually refers to the involuntary urination of children while they are asleep. Generally, only 20% of children have enuresis by the age of 4, and 5% have enuresis by the age of 10. In a small number of patients, enuresis symptoms persist into adulthood. Those without obvious organic lesions of the urinary tract or nervous system are called primary enuresis, accounting for about 70% to 80%. Patients with enuresis secondary to diseases such as lower urinary tract obstruction, cystitis, neurogenic bladder (urinary dysfunction caused by neuropathy) are called secondary enuresis. In addition to bed-wetting at night, children often have symptoms such as frequent urination, urgency or difficulty urinating, and a thin urine stream during the day.

The main causes of primary enuresis may be the following:

① Delayed development of the cerebral cortex: the spinal cord urination center cannot be inhibited, and the detrusor muscle contracts without inhibition after sleep, expelling urine;

② Sleeping too deeply: failing to wake up immediately when the bladder expands after falling asleep;

③ Psychological factors: For example, the child may feel that he or she is not loved or cared for by his or her parents, and may have a strange temper, be shy, lonely, timid, and unsociable.

④Genetic factors: The child’s parents or siblings have a higher incidence of enuresis.

1. General treatment

Develop a good work and rest system and hygiene habits, avoid overwork, control the time and regularity of bedwetting, and use an alarm clock to wake up the child to urinate 1 to 2 times at night. Sleep 1 to 2 hours during the day, avoid excessive excitement or strenuous exercise during the day to prevent deep sleep at night. Build confidence throughout the treatment process. Gradually correcting emotions or behaviors such as shyness, anxiety, fear and timidity, taking care of the patient's self-esteem, giving more comfort and encouragement, less scolding and punishment, and reducing their psychological burden are the keys to successful treatment. It is necessary to correctly deal with the mental factors that cause enuresis, understand the mental triggers and possible psychological conflicts that lead to enuresis through medical history, and resolve the mental stimulation factors that can be resolved as soon as possible. For contradictions and problems that have already occurred or exist objectively in reality and cannot be resolved subjectively, we should focus on patiently educating and explaining to the patient in order to eliminate mental tension and avoid emotional distress. Avoid drinking water after dinner and empty your bladder before going to bed to reduce the frequency of bedwetting.

2. Behavioral therapy for bedwetting in children

(1) Urination interruption training: Encourage your child to interrupt urination in the middle of each urination, count from 1 to 10, and then urinate completely. This can train and improve the bladder sphincter's ability to control urination.

(2) Urine retention training: Let your child drink plenty of water during the day. When he feels the urge to urinate, let him hold his urine for no more than 10 minutes each time. Do this training 1 to 2 times a day to expand the bladder and increase its capacity, thereby reducing the number of urinations at night.

(3) Regular training

In the past, if the patient often wets the bed at night, you can use an alarm clock to wake him up half an hour in advance, let him walk back and forth in the room, or wash his face with cold water, so that he can urinate while being conscious. The purpose is also to help establish a conditioned reflex.

(4) Parental supervision Parents should promptly detect bedwetting in their children and urge them to empty any remaining urine, wipe the area dry, change underwear and dry the bed.

(5) Summary and record. Parents are required to record the reasons and frequency of bed-wetting every day, and mark the bed-wetting and bed-not-wetting on the calendar. Summarize once a week to find out the reasons, and encourage the child when he or she makes progress.

3. Medication

(1) Imipramine is suitable for arousal disorder type.

(2) Oxybutynin, also known as Urodol, is suitable for frequent urination during the day and at night.

(3) Ephedrine can be used in mixed form.

(4) Desmopressin is a synthetic antidiuretic hormone, also known as desmopressin, which is suitable for nocturnal polyuria.

The combination of amitriptyline, desmopressin, and oxybutynin is currently considered an effective triple drug for the treatment of refractory mixed enuresis. The treatment course is one month. The advantage is that the efficacy is close to the SNM therapy described below. The disadvantage is that there are side effects of varying degrees and relapse is likely after discontinuation of the medication. The above drugs are prescription drugs. Imipramine and amitriptyline are antidepressants. The dosage shown is for adults. Children should calculate it per kilogram of body weight.

4. Physical therapy

You can use methods such as setting an alarm clock to prompt awakening, acupuncture, and massage.

Above we introduced what enuresis is and the causes of enuresis. We know that there are many factors that lead to enuresis, which are generally caused by psychological factors, genetic factors, delayed development of the cerebral cortex and deep sleep. The above article introduces the treatment methods of enuresis in detail. I hope the introduction in the above article will be useful to everyone.