Enuresis at night is a problem especially common among children under 10 years of age, but can occur even in adulthood.
We examine the causes, nature and possible means of preventing nighttime urinary incontinence.
What is nocturnal enuresis
The term enuresis refers to a disease that consists in involuntary urination during a night's sleep. Such cases should be repeated at least 2 times a week for 3 consecutive months, after 5 years. This is a “common” and fairly common occurrence in preschool children, but may affect even adults.
Although in most cases enuresis is not associated with pathological disorders, it can have a psychologically adverse effect on a child or adult, and sometimes limit his social life.
Age-specific enuresis statistics
As previously mentioned, enuresis is quite common in children of preschool and school age.
According to statistics, this disorder affects:
- 20% -27% of children 4-5 years old,
- 5-10% of children 6 years old,
- about 7% of children 7 years old,
- from 1% to 5% of children aged 9 to 10 years,
- 3% of children over 10 years old,
- 1% -2% of adolescents,
- 0.5% -0.8% of adults, in which, in most cases, is sporadic and random.
Healing from the disorder occurs spontaneously in 15% of children, in all other cases it is necessary to intervene using various strategies.
Classification of bedwetting
Enuresis can be divided into several categories, depending on how it manifests itself and what it is connected with.
The first unit is based on the relationship of enuresis with other diseases:
- Independent enuresis: appears independently and is not attached to other pathologies.
- Dependent enuresis: This type of bedwetting is associated with pathological conditions involving the nervous system, urinary tract or metabolic diseases.
Independent enuresis, in turn, can be divided into the following types (depending on clinical manifestations):
- Primary: all those people who urinate in bed constantly and without stopping fall into this category. Therefore, they cannot control the bladder or the sphincter of the bladder is not yet fully developed.
- Secondary: occurs when a subject who has gained control of the sphincter of the bladder between 3 and 6 months old begins to urinate again in bed.
- Enuresis with nocturnal symptomsThat is, urine loss occurs only at night. Bedwetting, as a rule, manifests itself in the first hours of sleep (approximately, during the first three hours), and rarely when urine loss occurs during the REM phase of sleep.
- Enuresis with daytime symptoms: in this case, symptoms occur even during the day. This type of bedwetting affects mainly girls under the age of 9 years and can be associated with various behaviors, such as keeping the urge to go to the toilet too long, going to the toilet too often or too rarely.
When enuresis appears in adults, it’s more correct to talk about urinary incontinence.
Pathological and psychological causes of enuresis
Causes of nocturnal enuresis in a child and adolescent, they are mainly associated with phenomena of a psychological nature, especially with regard to secondary enuresis.
In this case, the cause may be:
- Parents: tensions between parents, ongoing conflicts, separation or divorce, can cause episodes (sporadic or recurring) of enuresis in a child. Then urinary incontinence is a way of expressing the discomfort that the child experiences and which he cannot express in another way.
- The birth of another baby: the appearance of a younger brother or sister is a great stress for the child, especially if before that all the attention of the parents was on him. In this case, it is possible that the child is unconsciously trying to attract the attention of parents by urinating at night in bed.
- School: A visit to an educational institution may be the cause of nocturnal enuresis in both children and adolescents. In children, due to stress, the start of schooling (for example, the transition from kindergarten to primary school). In adolescents, nocturnal enuresis can appear as a result of unpleasant events that occurred at school, for example, bullying.
- Violence: Children and adolescents who are victims of physical or psychological abuse may experience night enuresis as a consequence of stress or a way to express their discomfort.
The situation is different in the case of primary enuresis, which, as a rule, has organic causes:
- Congenital Causes: such as delayed maturation of the sphincter of the bladder, the presence of an extrafinction ureter or other malformations of the urinary tract, can cause nocturnal enuresis.
- Hormone deficiency: some children are deficient in the hormone ADH (antidiuretic hormone or vasopressin). Under normal conditions, the production of this hormone results in significantly less urine production during the night than during the day. The lack of this hormone, for various reasons, can lead to episodes of nocturnal enuresis.
In the event that, in addition to night urinary incontinence, daytime symptoms also appear, then other pathologies may be the cause:
- Urinary tract infections: Persons suffering from a urinary tract infection, such as cystitis, have an increased frequency of urination and a strong urge to urinate, which can lead to episodes of nocturnal enuresis.
- Excessive urine output: metabolic disorders, such as diabetes mellitus, cause difficulty in retaining large amounts of urine and possible episodes of nocturnal enuresis due to loss of ability to restrain urge.
- Neurological disorders: diseases that affect the nervous system, such as epilepsy or sleepwalking, can lead to enuresis due to the inability to control the process of urination.
Causes of Adult Incontinence
Enuresis in adults - a rare phenomenon, and can be associated with both pathological and non-pathological reasons. Some causes are common with those in children, for example, associated with neurological diseases (spinal injuries, somnambulism, epilepsy) or lack of ADH.
While others are specific to adults, for example:
- Elderly age: The elderly, due to loss of muscle tone, including sphincters, often encounter the phenomenon of urinary incontinence, both day and night. In this case, therefore, enuresis is associated with incomplete closure of the sphincter of the bladder due to old age. In older people, enuresis is also often associated with diseases such as Alzheimer's disease or senile dementia, in which there is no neurological control of urination.
- Female: In women, the causes of nocturnal enuresis are different. The first reason is pregnancy: an enlarging uterus presses on the bladder and can cause involuntary and sudden urination both day and night. Another reason, loss of muscle tone of the pelvic floor musclesdue, in most cases, to childbirth. Women during menopause due to hormonal changes, they may also face the problem of enuresis. In addition, women are more at risk for infection and the development of cystitis, which can be the cause of nocturnal enuresis.
- Male: Enuresis in men often correlates with benign prostatic hypertrophyin which an enlarged prostate gland presses on the bladder and changes the flow of urine.
|Drug name||Mechanism of action||How to use||Effect of taking|
|Preparations for improving the functioning of the nervous system|
|Ramedorm||Relieves muscle spasm, calms and normalizes sleep||1 tablet in the evening, half an hour before bedtime. Children's dose - half a tablet.||Helps to fall asleep and relaxes the muscles of the bladder, increasing its volume.|
|Pantogam||Helps develop a steady “watchdog” reflex||Adults take 1-2 tablets half an hour after a meal, 3 times a day. For children, the dose is halved. The course of treatment is 3 months.||Brain function improves. After 2 months, the fullness of the bladder wakes up.|
|Glycine||It has a calming effect, relieves depression. Normalizes sleep.||Dissolve behind the cheek or under the tongue 2-3 times a day. The course of treatment is from 2 weeks to a month.||Improves mood, helps to relax and fall asleep. But the dream remains sensitive and a person can feel that the bladder is full.|
|Phenibut||Improves the state of the brain and metabolic processes in its cortex. Promotes restful sleep.||Take 1 tablet at night for 7-10 days. The dose for children is prescribed individually.||Relieves anxiety, which often occurs before bedtime due to enuresis.|
|Melipramine||Makes sleep less deep, increases the volume of the bladder and blocks the outflow of urine using the sphincter.||Take 1 tablet 3 times a day, regardless of food. The duration of treatment is at least two weeks.||The bladder relaxes and the outflow of urine is tightly blocked. Sleep becomes calm, but sensitive.|
|Bladder relaxing anticholinergics|
|Spasmex||Reduces the tone of the smooth muscles of the bladder, and at the same time increase the tone of the sphincter.||1 tablet 2-3 times a day before meals. The course of treatment is 3 months.||Prepares the bladder to hold more urine.|
|Driptan||Increases bladder capacity, reduces the number of contractions, makes its receptors less sensitive.||1 tablet 2-3 times a day. Take the last dose overnight. |
Children's dose of 0.5 tablets in the morning and evening.
|Helps relax the bladder and reduces the need to use the toilet at night.|
|Synthetic analogues of antidiuretic hormone|
|Desmopressin||An analogue of the hormone that is produced in the body at night. Its function is to reduce the amount of urine during sleep.||The dose is prescribed individually, but not more than 10 tablets per day for adults. The course of treatment is 2-3 months.||During a night’s sleep, the bladder does not fill up.|
|Minirin||Regulates the functioning of the kidneys so that less urine is released.||Take 1 time before bedtime for no more than 3 months.||The amount of urine is reduced. There is no need to wake up at night to empty the bladder.|
How can enuresis be treated at home?
Eneruz in most cases is treated at home. But it is worth remembering that for effective and quick treatment of this ailment alone medications are not enough. An integrated approach is needed to combat enuresis.
- Calm and composure
Incontinence in most cases is the result of disturbances in the functioning of the nervous system. It arises as a result of stress, fear, emotional experiences. Therefore, all incontinence sufferers should avoid stressful situations. They need to maintain peace of mind.
Do your favorite thing. Read interesting books. Some experts recommend art therapy and meditation. It is necessary to add to the diet soothing decoctions of herbs (lemon balm and mint).
An important step in the treatment of enuresis is systematic exercise and special gymnastics. There are many options: from morning exercises to specialized physical complexes.
The most effective are Kegel exercise (for women) and perineum muscle training (for men).
Kegel exercise - designed to stimulate the muscles of the pelvic floor and sphincter of the bladder in women.
Squeeze the pelvic muscles that stop the flow of urine and stay in this state for 5 seconds. Rest 10 s, then the next approach. Perform 3-4 approaches. The next step is to squeeze the pelvic muscles and hold for 10 seconds, then the same time the muscles are in a relaxed state. So 3-4 times. Next cycle: tighten muscles for 30 s. Repeat 2 times. Exercise must be done 2 times a day. Kegel exercise will help get rid of enuresis quickly.
For men, exercises to train the muscles of the perineum are a simple and effective method to overcome enuresis. In the process of urination, it is necessary to make 3-4 interruptions at each visit to the toilet for "little" need. Each time it is necessary to increase the interrupt time. Within a month, the result becomes noticeable.
In addition, some domestic and foreign doctors recommend doing yoga, wushu.
Despite the many alternative methods of treatment, with enuresis, you do not need to give up medication. Depending on what caused nightly incontinence, various drugs are prescribed. Before you start taking any medications, you should consult with your doctors.
Listen to the people.
Alternative methods of treating incontinence in children and adults are considered one of the most effective. Preparation of decoctions, teas and infusions will not be difficult. The most popular among the people is considered cherry and blueberry decoctions. Tincture of oak bark, seeds of repeshka, sunflower stalks.
A special place in folk medicine is honey. Therefore, even if you do not believe in folk remedies, then a spoonful of honey for morning and evening tea will not be superfluous.
Follow the day regimen ...
When treating urinary incontinence at home, it is very important to develop self-discipline. This is achieved by strict adherence to the daily routine. It is important to eat and go to bed by the clock.
Particular attention is paid to the drinking regimen. It is necessary to control what, when and how much you drink.
Try to limit fluid intake after dinner. 85% of the total daily intake of fluid should be drunk before 15:00.
When treating enuresis at home, in no case should you give up walking in the fresh air.
An ideal place would be a forest, mountains and the sea. Moreover, the time for walking should be gradually increased (by 5-10 minutes per day). This helps to restore the balance of the nervous system, stimulates blood circulation in the body, improves well-being.
With an integrated approach, after 1-2 months you will forget what enuresis is.