Children's enuresis refers to the phenomenon that children over 5 years old can't control urination, often wet the bed at night and sometimes wet their pants during the day. Enuresis is common in childhood. According to statistics, 10-20% children have bed wetting at the age of 4 and a half, about 5% at the age of 9, and only 2% children still have bed wetting at the age of 15. This disease is more common in boys, and the ratio of male to female is about 2: 1. Children aged 6-7 have the highest incidence. Most children with enuresis can heal themselves after several years of onset, and the rate of self-healing in girls is high, but some children will continue to have symptoms into adulthood if they are not treated. Actually, Ma Bao, you can also go to Dou Dehui to study, and all this knowledge is in it! And there are many prenatal music, parenting materials, videos and so on. It can be downloaded for free! I wish the baby a healthy growth!

Etiology of enuresis in children

The causes of enuresis are partly caused by local stimulation of urogenital organs, such as phimosis, redundant prepuce, vulvitis, congenital urethral malformation and urinary tract infection. Followed by spina bifida, epilepsy, diabetes, diabetes insipidus and other systemic diseases. However, most children's enuresis has nothing to do with disease, but is caused by psychological factors or other factors.

hereditary factor

The family incidence of this disease is high. It has been reported abroad that 74% of boys and 58% of girls have a history of enuresis with one or both parents. Identical twins have more enuresis at the same time than identical twins. It is suggested that heredity has a certain relationship with this disease.

Functional bladder volume reduction

From 65438 to 0970, 63 children with enuresis were studied by measuring the internal pressure of bladder, and it was found that the bladder capacity was 30% less than expected. From 65438 to 0992, 44 children with enuresis were examined by B-mode ultrasound. Except 1 normal child, the bladder capacity of other children is less than normal in different degrees, with an average of less than 50%.

Sleep too hard

According to the reaction of many parents, such children sleep deeply at night and are not easily woken up. After waking up, you are often in a daze, half awake and half asleep, so it is relatively difficult to urinate when you wake up at night. The reason is that he slept too deeply, could not accept the urine discharged from the bladder and woke up with reflex urination, which led to enuresis.

psychologic factor

Sudden death and injury of relatives, noisy divorce of parents, long-term isolation between mother and child, fear and fright at night will all lead to enuresis of children.

Some children have not developed the habit and ability to control urination since childhood. I was scolded and beaten by my parents as soon as I wet the bed, and I was in a state of excessive tension for a long time. Before going to bed every night, they are always on tenterhooks for fear of wetting the bed again, which leads to inferiority complex and makes enuresis last for a long time.

Psychological factors can not only make children who have the ability to control small cases enuresis again, but also make a few children gradually form habits after enuresis, and some even adults can't change them.

Bad urination habit training

Some children have used diapers for a long time, so that they have not developed the habit of controlling urination since childhood. Some mothers don't train their children in the right way. After waking up the child at night, let the child sit on the bedpan and urinate at the same time. Finally, they put the children on the bed and didn't see if they urinated. In this way, it is impossible for children to associate urinating with sitting in the bedpan, which constitutes a conditioned reflex. Because children sometimes pee, sometimes they sit on the bedpan and play, but they don't pee, which will cause children to pee indiscriminately and can't form a rule. Other mothers often wake up their children at night and force them to urinate. No matter how hard children struggle and cry, they won't leave the bedpan without urinating, which will make children feel scared and nervous about urinating, and it is not conducive to cultivating regular urination habits.

Personality characteristics of enuresis in children

So far, although there is not enough evidence to show that enuresis has a clear relationship with the child's personality. However, most children with enuresis are timid, passive, oversensitive and easily excited. In addition, children with enuresis may feel ashamed of enuresis and don't want others to know, so they don't like to have more contact with other children and don't want to participate in group activities, and gradually form a shy, inferior, lonely and introverted character.

Treatment of enuresis in children

Matters needing attention

Adjust diet

Drink less water after 4 pm every day, and it is best to eat less liquid for dinner, which should be done in Xian Yi. Don't drink water before going to bed (except in summer), and don't eat fruits and milk such as watermelons, oranges and pears to reduce the amount of urine stored in the bladder at night.

Establish a reasonable living system

Children's life, diet and daily life should be regular. Children should avoid excessive fatigue and mental stress. It is best to take a nap to avoid sleeping too deeply at night, and it is not easy for adults to wake up and urinate.

Don't get too excited before going to bed.

Children should form the habit of going to bed on time. Parents should not tease their children before going to bed, make them excited, do not let them have strenuous activities, and do not watch thrilling and tense movies, so as not to make them overly excited.

Clean the urine before going to bed.

It is necessary to develop the habit of thoroughly discharging urine before going to bed every day to empty the urine in the bladder. Families with conditions should try to bathe their children before going to bed, so that they can sleep comfortably and reduce bed wetting.

Change wet bedding and underwear in time.

Children's bedding should be clean, warm and moisture-proof, and should be replaced in time. Don't let children sleep in wet bedding, which will make it easier for children to wet the bed.

It must be pointed out that enuresis can make children shy, anxious, fearful and cringe. If parents ignore their children's self-esteem, they will use the means of beating, cursing, threatening and punishing, which will make their children more wronged and depressed and increase their psychological burden. The symptoms will not be alleviated, but will be aggravated. We believe that it is very important to treat children with enuresis only with comfort and encouragement, which is the premise of success or failure in treatment.

For children with enuresis, the following treatment methods can be used.

behavior therapy

Make a timetable

From the first day of treatment, parents are required to make a timetable for their children so that they can record it every day (you can use a calendar). When wetting the bed, try to find out the factors that may lead to bed wetting and record them on the schedule, such as not sleeping on time, being too excited before going to bed, being too excited during the day, and taking too much liquid at night. When the child does not wet the bed, draw a star on the schedule and give verbal praise or material rewards. See the doctor once a week.

Establish conditioned reflex

From the beginning of treatment, parents are required to wake up the child with an alarm clock at 1 hour every day before the child often wets the bed at night, so that the bell to wake up the child can be presented at the same time as the stimulation of bladder filling. After a period of training, conditioned reflex can be established, and children can be awakened through the stimulation of bladder filling to achieve the purpose of self-control urination. In addition, children should be encouraged to urinate by themselves, so that they can excrete urine cleanly when they are awake.

Bladder function exercise

Urge children to drink more water during the day, and try to extend the interval between urination to increase urine volume and gradually increase bladder capacity. Encourage children to stop urinating in the middle of urination, counting from 1 to 10, and then completely discharge urine to improve the control ability of bladder sphincter.

medicine

Take clomipramine 1 time 0 hour before going to bed every day. For those under 7 years old, take clomipramine 10+20 every time, take it for 3 months after it takes effect in the same shipyard, and then gradually reduce it, and take the same dose every two days before going to bed for 1 month and a half. Then take the medicine once every three days for a month and a half, or even stop taking it. The total course of treatment is 6 months.

Low dose clomipramine is used in combination therapy. Its mechanism of action is that the drug has anticholinergic effect on bladder, which expands bladder capacity, stimulates cerebral cortex and makes children wake up easily to urinate. In the course of use, it was found that in the initial stage of treatment, some children may have symptoms such as restless sleep, loss of appetite, irritability, etc., and generally disappear after about 1-2 weeks without treatment.

If the child's enuresis improves, don't stop training, or the conditioned reflex that has been established will disappear, so all previous efforts will be in vain. This also suggests that consolidation therapy is of great value in the whole treatment process of enuresis.

Relationship between enuresis and sleep

In recent years, the sleep EEG and polysomnography of children with enuresis were recorded, and it was found that bedwetting occurred in the first three stages of sleep. At that time, I was in the deep sleep of 3-4 stages of non-rapid eye movement sleep.

Enuresis can have a series of processes, starting with body agitation, increased muscle tension, accelerated heartbeat, shortness of breath and decreased skin resistance, which are a group of signs of awakening. Accordingly, high amplitude δ wave appeared on EEG. After dozens of seconds or minutes, the child wets the bed in deep sleep. So it is difficult to wake up the child who wets the bed. Sometimes, adults will pick up the child who wets the bed and put on dry clothes and pants. He's still not awake. When I woke up the next morning, the child had no memory of wetting the bed.

Because people who wet the bed often wake up in wet dream, such as falling into a river in their dreams, people have long thought that bed wetting happens in their dreams. In fact, wetting the bed at that time was not a dream. Most children with enuresis don't have REM sleep before bed wetting, but most children don't have their first REM sleep until 2 hours after bed wetting. Normal people have 4-6 times of REM sleep every night, while children with enuresis are peeing. Therefore, some people speculate that bed-wetting has replaced dreamy REM sleep. Experimental research has proved that bed wetting is the first, and dreaming is the last. The dream of a bed wetter incorporates the feeling that clothes and sheets are wet, which is the so-called "wet dream". Children whose clothes and sheets have been changed in time will not have "wet dream".

Many people dream that they can't find the toilet in a hurry, that is, they have a "dream of finding the toilet". When they wake up in anxiety, they may have some wet pants and sheets, but most of the urine is still in the bladder and has not been solved. This is because the signal of bladder filling is programmed into a dream, which is the dream of normal people. Children with enuresis generally don't have such dreams.

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Overview of diseases

A few children are caused by pinworm, spina bifida, other spinal cord diseases or brain hypoplasia. Most children's enuresis is caused by dysfunction of cerebral cortex and subcortical center. The common causes of functional enuresis are mental factors, such as sudden shock, excessive fatigue, changing environment, losing parental care, incorrect parenting habits, etc.

Key points of self-diagnosis

Children's nocturnal enuresis often occurs at a certain time, sometimes several times a night, and they often pee in their dreams. Enuresis can be temporary, can also last for months, sometimes disappear, sometimes reappear; It lasts for several years and disappears naturally before sexual maturity. There was no dysuria or residual urine in clinic.

Treatment suggestion

When you reach a certain age, you can heal yourself without special treatment. If you need treatment, you can use Chinese patent medicine:

1. The subordinate elements of deficiency-cold type should be warmed up, and the next element should be consolidated. Jinsuo Gu Jing Pill, Rosa laevigata Ointment and Qing 'e Pill can be used.

2. It belongs to spleen and lung qi deficiency type, and should nourish qi and replenish qi, supplemented by astringent essence. Acanthopanax senticosus tablets, gecko essence, shrinking spring pills and so on can be used.

3. It belongs to damp-heat type of liver meridian, and it is advisable to purge liver and clear heat. You can take Jianerle, Longdan Xiegan Pill and Longdan Tablet.

Matters needing attention

1. Empty the bladder before going to bed and wake up the sick child to urinate before the hour when the child often urinates. Older children can wake up with an alarm clock. Children should be encouraged when enuresis decreases.

2. Generally, you don't need a special diet, but you should pay attention to avoid liquid diet after 4 pm, reduce the salt content of dinner dishes, drink less water and reduce bladder urine.

3. Children diagnosed with functional enuresis should focus on education and explanation to eliminate mental burden.

4. It is particularly important to replace reprimand and punishment with exhortation and encouragement for enuresis, so that children can build confidence and understand that this is a temporary dysfunction and can be cured.

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Prescription for treating infantile enuresis

Braised dog meat with medlar: dog meat 100g, medlar 10g. Wash dog meat, cut it into cubes, stir-fry with vegetable oil (vegetable oil or peanut oil), add salt, cooking wine and medlar, and simmer. Take it once a day for ten days.

The above dietotherapy prescription is suitable for children with deficiency of kidney-qi and cold, and the following two prescriptions can be used for those with deficiency of spleen and lung:

Black beans and glutinous rice: 30g black beans, glutinous rice 100g, 20g brown sugar. Wash and soak black beans for later use. Wash glutinous rice and drain. Stir-fry glutinous rice with 10g peanut oil until it becomes thick, then add black beans, add appropriate amount of water, simmer with low fire, and add brown sugar and mix well. Serve. Eat it once a day after dinner for ten days.

Treatment of infantile enuresis with chicken intestine

A cock sausage, 250 grams of flour, a little oil and salt.

Usage: Cut chicken intestines into sections, wash them, bake them, grind them into powder, mix them with flour, add water evenly to form dough, add less salt, add oil in the pot and make pancakes. Eat in batches.

Braised glutinous rice with pork tripe: pork tripe 1, glutinous rice 100g, lotus seed 30g. Wash the pork belly for later use, remove the heart of lotus seeds, soak in glutinous rice, filter dry, mix well with a little salt, put it in the pork belly, steam it in water, and eat it after meals, daily 1 dose, ten days as a course of treatment.

In addition to the above diet, we should also pay attention to the good habit of regular urination and reasonable living habits from an early age. At the same time, "night wake-up therapy" should also be adopted. Wake up the child regularly every night to urinate. Children should not be overtired during the day and generally should not drink too much water after dinner. Encourage children to establish confidence in curing enuresis, and never blame it, otherwise it will be more difficult to cure the disease.