Dr. Komarovsky on the treatment of enuresis in children

Enuresis in children is a common phenomenon, and it is not always possible to establish its exact size, because, due to the special sensitivity with the problem of such a plan, mothers are often embarrassed to contact a pediatrician.

However, the problem exists, and therefore there are methods of getting rid of it. About this tells the famous doctor Evgeny Komarovsky.

Enuresis in medicine is called a type of urinary incontinence, prone to recurrence and most often occurring at night, that is, in a dream.

According to some data, up to 20% of five-year-olds are written in their sleep, up to 15% of seven-year-olds and even about 5% of adolescents. Most often, incontinence in sleep occurs in boys, among all children with such a problem, the share of the small representatives of the stronger sex is about 60%.

Statistics in Russia is disappointing - up to 30% of parents punish and scold their children for episodes of bedwetting. And this is much worse than enuresis itself, said Komarovsky.

No punitive and pedagogical methods can solve the problem., which has no relation to the conscious actions of the baby. What happens at night - involuntarily, happens by itself, and therefore the child is not guilty of anything. However, ignore nocturnal enuresisBy correct actions, parents can help your child cope with this unpleasant problem.

To understand how serious it is, you need to answer the question of what kind of enuresis the baby has.

There are primary and secondary incontinence:

• primary a problem is called if it has always existed, almost since birth;
• secondary enuresis is a condition that has arisen after some traumatic events, illness, after at least a six-month break in the night "incident."

Most often, eight out of ten children have exactly the primary form. In addition, enuresis is monosymptomatic, when the only manifestation is wet sheets and pajamas in the mornings and polysymptomatic when and during the day the child experiences very frequent urination. The polysymptomatic form is found in about 15% of babies.

By the time of day, day, night and combined enuresis are distinguished. In the overwhelming majority of children (at least 85-90%), incontinence occurs only at night.

Dr. Komarovsky believes that the main cause of childhood nocturnal enuresis lies in the immaturity of the central nervous system, and affect the process of its maturation is quite difficult. But at a certain time, when the nervous system matures, there will be no trace of the problem. In this scenario, everything is 85% of the guys.

• Doctors have long paid attention to the fact that children whose parents were written in a dream, with a probability of 50 to 75% will also suffer enuresis. But even if the parents never, even at the most tender age, did not suffer from the same, the risk of developing incontinence is still from 15 to 20%. Komarovsky emphasizes that this can happen with absolutely everyone.
• As a concomitant symptom, enuresis can occur in various diseases of the nervous system, in case of problems with hormones and health of the urinary system, and also in certain mental disorders.
• Neurotic enuresis can be a response of the nervous system to stress experienced, psychological trauma (occurs in about 5% of cases), endocrinopathic enuresis is a result of hormonal disorders, for example, children with severe obesity, as well as diabetes mellitus, are more often affected. Epileptic enuresis is one of the symptoms of epilepsy.
• Enuresis can develop after severe illness, after inflammatory diseases of the urinary tract (for example, after cystitis or pyelonephritis). The causes of "night trouble" can be a neurogenic bladder and some abnormalities in the structure of the urinary organs.

Official statistics states that up to 95% of cases of enuresis do not have the pathological causes that we have listed. The child is examined, but no deviations are found in him, which confirms the version thatThe main reason for this is still due to the age peculiarities of the nervous system..

When asked at what age a child should normally stop writing at night, Dr. Komarovsky answers that it is only natural if the problem persists for up to 5-7 years. Daily enuresis should be normal by 4 years. But the rules are quite conditional.

Most often, enuresis is manifested by a single or repeated urination at night. The kid may not write every night and, according to Komarovsky, it is the dynamics that play an important role - how many dry nights were in a month at 3 years, at 4 years and beyond. Normally, the dynamics must be present, and it must be positive. Most often, children are written in the phase of deep sleep, in the first half of the night. After emptying the bladder, they do not wake up.

If child's enuresis is complicated, then daytime problems are added to night urination: the baby often or rarely goes for a little need to the toilet, the urine stream is weak. Quite often, children are characterized by increased nervous excitement, suffer from nightmares or other forms of sleep disturbance. In the neurosis-like form, there may be a delay in the development of speech, stutteringtiki.

Yevgeny Komarovsky advises parents to drop false shame and turn to a pediatrician with a problem. If necessary, the pediatrician will be able to to attract to the assistance of narrow specialists - urologist, neurologist, endocrinologist or child psychiatrist.

In a special notebook you need to note the number of dry and wet nights, as well as indicate the total number of urination per day and circumstances. For example, on this day, fell ill with the flu or went to the circus, where he received a lot of new impressions.

From diagnostic tools and methods urinalysis and complete blood count, biochemical analyzes, urine counting will be useful and informative. To exclude anatomical problems, do an ultrasound of the bladder, ureters and kidneys. Other methods may also be prescribed: cystometry, sphincterometry. According to special indications, they can prescribe urethroscopy or cystoscopy, as well as an x-ray of the bladder.

Treatment will depend on the identified cause. One child is shown hormone therapy, and the other - the use of sedatives and psychotherapy sessions (from 10 years).

• In all forms, it is recommended to teach the child be sure to go to the toilet before you go to bed. Komarovsky recommends limiting your baby’s fluid in the afternoon. In the first half of the night, you can wake the crumb in order to plant it on the pot.
• According to Komarovsky, the so-called motivational therapy is very effective. It includes encouraging a child for every night that has passed in a dry setting. Encouragement can be any - toys, sweets, going to the park or the zoo.

• Food does not affect whether Koranov writes a night crib in bed at night or not, says Dr. Komarovsky. And because there is absolutely no reason to give the child salty food before bedtime, as advised by some experts in the field of alternative medicine. After a salty child, on the contrary, will want to drink, and the circle closes.
• To train the bladder is an interesting measure, but ineffective, according to Komarovsky. But if parents have time and desire, then they can allocate some time for such training, it will not be worse for sure. They are to suffer a little from the moment the child requested the pot. 1-2-3 minutes will be enough to gradually teach the child to endure. This usually helps to get rid of daytime incontinence, but it does not have any effect on involuntary enuresis at night.
• Recently, in Russia, the so-called urinary alarm clocks. Their Komarovsky considers a useful and effective device. Such devices consist of a sensor and the alarm clock itself. The moisture sensor is placed in panties, and when the first drop appears, it sends a signal to the alarm clock, eventually the child wakes up, interrupts urination and goes to finish everything on the pot.

Alarm clocks are wired and wireless. Their cost is quite high - from 2800 rubles. According to Evgeny Olegovich, such devices allow to cope with the problem of enuresis in a short time, it all takes about a month. Gradually, a clear relationship is developed between the desire to pee and the need to wake up without a device that can wake up in time.

Enuresis is not a reason to form complexes in a child.

Dr. Komarovsky’s talk about childhood enuresis with the baby’s parents is presented in the video below.