Enuresis (from Ancient Greek ????????? enoÃÆ'ºr? Sis ) is a recurring disability to control urination. The use of this term is usually limited to describe a person large enough to be expected to exercise such control. Unconscious urination is also known as urinary incontinence.
Video Enuresis
Classification and Type
The types of enuresis include:
- Nocturnal enuresis (wetting) that soaks that occur at night during sleep.
- Dripping diurnal enuresis that occurs during the day when the child is awake.
- Enuresis mix - Includes a combination of night and diurnal types. Therefore, urine is passed while awake and sleeping.
Classification
- Primary enuresis refers to children who have never been trained to control urination. This represents fixation.
- Secondary enuresis refers to children who have been successfully trained (for at least 6 months dry) but again wet the bed in response to stressful situations. This is a regression.
Maps Enuresis
Symptoms
Nocturnal enuresis usually present with urinary voiding during sleep in children who are difficult to wake up. It can also be accompanied by a daytime bladder dysfunction called non-mono symptom enuresis. During the day enuresis also known as urinary incontinence can also be accompanied by bladder dysfunction.
The symptoms of bladder dysfunction include
1. Urgent incontinence - a tremendous urge to urinate, frequent urination, trying to hold urine and urinary tract infections.
2. Canceling voiding - postpone urination in certain situations such as school
3. Stress incontinence - incontinence occurring in situations when increased intrabdominal pressure occurs like a cough.
4. Giggling incontinence - incontinence that occurs when laughing.
Secondary incontinence usually occurs in the context of exciting new life events such as parental abuse or divorce.
Cause
Nocturnal enuresis
After the age of 5 years, wetting the bed at night - often called bed wetting or bed wetting - is more common than day bed wetting in boys. Experts do not know what causes night incontinence. Young people who experience bedwetting at night tend to be physically and emotionally normal. Most cases may result from a mixture of factors including slower physical development, excessive urine production at night, lack of ability to recognize bladder filling while asleep, and, in some cases, anxiety. For many, there is a strong family history of bedwetting, indicating an inherited factor.
Slower physical development
Between the ages of 5 and 10, incontinence may be caused by small bladder capacity, long sleep, and the backwardness of body alarms in the brain that indicate a full bladder or emptying. This form of incontinence will fade as the bladder grows and the natural alarm becomes operational.
Excessive urine output during sleep
Usually, the body produces hormones that can slow the manufacture of urine. This hormone is called the antidiuretic hormone, or ADH. The body usually produces more ADH during sleep so the need for urination is lower. If the body does not produce enough ADH at night, urine production may not be slowed, leading to bladder overfilling. If a child does not feel the bladder filling and waking up to urinate, then the moistening will occur.
Anxiety
Experts suggest that events that cause anxiety that occurs in the lives of children aged 2 to 4 years can cause incontinence before the child achieves total bladder control. Anxiety experienced after age 4 may cause wetting after the child has dried for a period of 6 months or more. Such incidents include angry parents, unknown social situations, and extraordinary family events such as the birth of a brother or sister, or the death of someone very close.
Incontinence itself is an event that causes anxiety. Strong bladder contractions cause leaks during the day can cause the shame and anxiety that cause bed wetting at night.
Genetics
Certain genes inherited seem to contribute to incontinence. In 1995, Danish researchers announced that they had found a site on human chromosome 13 that was responsible, at least in part, to wet the bed at night. If both parents were enuretic, 77% of their children too; if only one parent is enuretic, then 44% of their offspring as well. Experts believe that other undetermined genes may also be involved in incontinence.
Obstructive sleep apnea
Night incontinence can be one sign of another condition called obstructive sleep apnea, in which the child's breathing is disturbed during sleep, often due to tonsils or adenoids that are inflamed or enlarged. Other symptoms of this condition include snoring, mouth breathing, frequent ear and sinus infections, sore throat, shortness of breath, and daytime drowsiness. In some cases, successful treatment of this respiratory disorder may also resolve the associated night incontinence.
Structural issues
Finally, a small number of cases of incontinence are caused by physical problems in the urinary tract system in children. A condition known as urine reflux or vesicoureteral reflux, in which the urine backs to one or both ureters, can cause urinary tract infections and incontinence. Rarely, bladder or blocked urethra can lead to overflow and leaky bladder. Nerve damage associated with spina bifida birth defects can cause incontinence. An ectopic ureter, misplaced ureter outside of the bladder, may also cause incontinence. In this case, incontinence may appear as constant urine droplets.
Diurnal Enuresis
Day incontinence unrelated to urinary tract infections or anatomical abnormalities is less common than night incontinence and tends to disappear much earlier than the evening version. One possible cause of daylight incontinence is an overactive bladder. Many children with daytime incontinence have an abnormal urination habit, the most common rarely of micturition. This form of incontinence is more common in girls than in boys.
Overactive bladder
The muscles that surround the urethra (the tube that secretes urine from the bladder) have the task of keeping the part closed, preventing urine from leaving the body. If the bladder contracts firmly and without warning, the muscles surrounding the urethra may not be able to hold urine. This often occurs as a consequence of urinary tract infections and is more common in girls.
Rarely void
Rarely sowing refers to voluntary voluntary urine for a long time. For example, a child may not want to use the toilet at school or may not want to interrupt a fun activity, so he ignores the body signals from the full bladder. In this case, the bladder can overflow and excrete urine. In addition, these children often develop urinary tract infections (UTIs), leading to an irritable or overactive bladder.
Other causes
Several of the same factors that contribute to night incontinence can act together with rarely urinate to produce daylight incontinence. These factors include small bladder capacity, constipation and foods containing caffeine, chocolate or artificial coloring.
Sometimes too strict toilets can make the child unable to relax the sphincter and pelvic floor to completely empty the bladder. Maintaining urine (incomplete emptying) determines the stage for urinary tract infections.
Diagnosis
Clinical definitions of enuresis are urinary incontinence outside the age of 4 years for daytime and more than 6 years for the night, or loss of continence after three months of drought. Current DSM-IV-TR Criteria:
- Urinary discharge to bed or clothing (whether accidental or intentional)
- Behavior should be clinically meaningful as indicated by frequency twice a week for at least three consecutive months or any significant clinical or clinical disturbance or damage in the social, academic (occupational), or other important areas of functioning.
- Chronological age of at least 5 years (or equivalent developmental rate).
- This behavior is not due to the direct physiological effects of a substance (such as a diuretic) or a general medical condition (such as diabetes, spina bifida, seizure disorders, etc.).
All these criteria must be met to diagnose an individual.
Treatment
Many children overcome incontinence naturally (without treatment) as they grow older. The number of incontinence cases fell by 15 percent for each year after the age of 5 years.
Humidity Alarm
At night, the humidity alarm, also known as the bedwetting alarm, can wake someone up as she begins to urinate. These devices include water-sensitive sensors that are cut off on pajamas, wires connected to battery-driven controls, and an alarm that sounds when water vapor is first detected. In order for the alarm to be effective, the child must wake up or wake up as soon as the alarm sounds. This may require other people to sleep in the same room to wake the bedwetter. The wetting alarm has been in existence since 1938, when O. H. Mowrer and W. M. Mowrer first discovered "bell and pad". This behavioral training is one of the safest and more effective treatments.
Drugs
Night incontinence can be treated by increasing ADH levels. This hormone can be driven by a synthetic version known as desmopressin, or DDAVP, which is currently available in pill form. Patients can also spray the fog containing desmopressin into their nostrils. Desmopressin is approved for use by children. There was difficulty in keeping the bed dry after the drug was stopped, with an 80% recurrence rate.
Another drug, called imipramine, is also used to treat bedwetting. Act in both the brain and the bladder. Unfortunately, the total drought with one of the available drugs is achieved in only about 20 percent of patients.
If a young child experiences incontinence due to overactive bladder, the doctor may prescribe medications that help calm bladder muscles, such as oxybutynin. It controls muscle spasms and includes a class of drugs called anticholinergics.
Bladder training
Techniques that can help daylight incontinence include:
- Urine on schedule, like every 2 hours (this is called timed blanking)
- Avoid caffeine or other foods or beverages that can cause child incontinence
- The following suggestions for healthy urination, such as relaxing the muscles and taking your time Epidemiology
In the United States, about 15 to 20 percent of children aged 5 years will develop symptoms related to the disorder. Prevalence changes significantly with age. To be specific, approximately 33 percent of 5-year-olds, 25 percent of children aged 7 years, 15 percent of children aged 9 years, 8 percent from 11 years, 4 percent from 13 years, and 3 percent from 15 to 17 years. Figures indicate that diurnal enuresis is much less frequent. Overall, about 60 percent of those who suffer are men. However, this also depends on age. From the age of 4 to 6 years, the number of boys and girls is almost the same. However, the ratio changes so that at the age of 11 there are twice as many boys as women. Incidents vary with social class with more incidents among those with low socioeconomic status. No evidence was found to be associated with ethnic differences. Approximately 85% of children with enuresis have primary enuresis because they never maintain consistent bedwetting behavior for at least 6 months.
History
Found evidence of mention in Egyptian medical texts as early as 1550 BC.
References
External links
Source of the article : Wikipedia
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