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Etiology and treatment of enuresis (2.62KB)
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enuresis refers to children over 5 years of age there is still unconscious urination at night is a common childhood mental illness.
etiology of enuresis are: 1, bladder capacity is small. This is due to urinary control in children caused by retardation. Voiding times these children
A few more, and every time there is less urine. 2, sleep too deep. As children sleep too deeply, the brain can not accept the of urine from the bladder, can not sleep
Wake up. 3, the psychological factors. Sudden death of their loved ones, their parents divorced noisy, long-term separation of mother and child, frightened the night of fear, may lead to the child enuresis.
4, after the secondary to a disease. Such as urinary tract infections, genital inflammation, such as spina bifida. Must be pointed out that the vast majority of children with diseases unrelated to the emergence of enuresis
, But because of psychological or other factors.
We believe that the use of psychological, behavioral Enuresis, more significant effect.
from treatment start, first of all explain to parents


and children with the purpose of treatment, methods and precautions in order to achieve close cooperation of parents and children, elimination
In addition to children with tension, fear, emotions, and establish the confidence to cure the disease.
must be noted that enuresis in children can be shy, anxiety, fear and retreat. If parents and children regardless of self-esteem, find related res, the etiology and treatment of enuresis etiology and treatment of enuresis
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Overenuresis enuresis commonly known as bed-wetting, children usually involuntary urination while asleep. General to 4 years of age only 20% had enuresis, 10 5% at the age of enuresis, a small number of patients with enuresis symptoms persist into adulthood. No apparent organic disease of urinary tract or nervous system are known as primary enuresis, about 70% to 80%. Secondary to lower urinary tract obstruction (eg urethral valves), cystitis, neurogenic bladder (neuropathic bladder dysfunction) and other disease patients is called secondary enuresis, nocturnal enuresis in children in addition, the day often urinary frequency, urgency or dysuria, urinary symptoms such fine. First Affiliated Hospital of Huzhou Teachers College Department of Urology Chen Yu diagnosis of primary enuresis enuresis diagnosis is mainly the principle of exclusion of various causes of secondary enuresis. history: pay attention to whether genetic factors, urinary incontinence, whether the baby starts, who later appeared and daytime voiding symptoms may have secondary enuresis. Simultaneously in patients with constipation or nervous system disease may be secondary to neurogenic bladder. check: for more general physical examination, special attention is normal anal sphincter, with or without spina bifida, whether the reduction of perineal sensation and lower extremity is normal. laboratory tests: urinalysis, urine culture. X-ray examination: plain film to observe whether the spina bifida, bladder and urethra without mechanical obstruction contrast observation. urodynamics: urinary flow rate check to observe whether the lower urinary tract obstruction, the bladder pressure measurement has no observed inhibition of contraction. General treatment enuresis do not blame the general treatment and beatings of children, should be encouraged to make the determination of enuresis in children with a cure. Parents of children with a high degree of care and love given. Prohibit drinking after dinner, put bedtime urination, urination at night wake-up children get 1 or 2 times. Enuresis drug therapy imipramine: as stimulants, reduce the depth of sleep per night oral administration of 25 ~ 50mg, 3 to 4 consecutive months. Such as relapse after drug withdrawal can be administered. parasympathetic blockers: Propantheline or hydroxy cotinine (Oxybutynin, that is ditropan, urine spirit). Orally before sleep, can detrusor relaxation, inhibition of bladder contraction. ephedrine 25mg orally at bedtime. After the bladder neck and urethra may increase the contractility. Enuresis treatment of bladder training bladder training in the day told his children as possible voiding interval, and gradually by each 1 / 2 to 1 hour 1 time extended to 3 to 4 hours a time, to expand bladder capacity. Treatment enuresis conditioned reflex training in the training set of enuresis alarm device used to train before the children wake up in the enuresis. Decentralization in children with an electronic pad and the body of a bell connected, once the electronic pad is wet, the connection can be found in the circuit leaving bell sounds, waking children get urination; if results are poor, can be added to reduce the use of imipramine sleep depth. General 1 ~ 2 months of training can make 70 to 80% of primary enuresis be cured. Etiology enuresis (1) enuresis and nervous control system - namely, the cerebral cortex, brainstem and spinal cord micturition center and the primary to the urinary bladder, urethra, the vaginal nerves, ventral nerve, pelvic nerve, sacral nerve. As the brain and brain stem function developmental delay, central spinal cord to control the primary weak bladder or spinal cord and the nerve pathway disorders, control of bladder and urethra missed appointments and enuresis. (2), enuresis and bladder - delayed due to development of bladder function, can not exercise self-control and safe storage of urine there was no inhibition of the contraction, the bladder capacity is small, high sensitivity, compliance is poor; perception of bladder filling phase and the systolic capacity is not high, the stimulation intensity below the cerebral cortex of sleep arousal threshold; bladder baroreceptor dysfunction, can not provide early warning information to make unawakened first urine. (3) Enuresis and urinary tract - the urethra closed dysfunction, urinary tract that is caused by unstable enuresis; urinary tract malformations such as congenital stenosis. (4), enuresis and sleep arousal dysfunction - sleep-wake function of growth retardation, arousal dysfunction is one of the main enuresis, and dysfunction can be due to the perception of bladder filling and systolic dysfunction or fatigue caused by too deep to sleep can also be voiding dysfunction or growth retardation caused. (5) enuresis and antidiuretic hormone (ADH) secretion decreased - normal ADH secretion during the day than at night (at 1:25), urine secretion of ADH with opposite changes occurred (during the day and night urine volume ratio of about 3 -4:1), part of enuresis in children due to inadequate secretion of ADH at night (1:1.4) To increase in amount of urine at night, resulting in diluted urine, adding to the burden of bladder enuresis. (6) enuresis and genetic - enuresis, about 30-40% of patients with family history, the study considered to be polygenic, the probability of occurrence of race, there are some differences in different regions. Parents, children usually occurs in patients with enuresis was 77%, incidence of single parent children enuresis 44% of patients, parents, child angels had no enuresis incidence rate of 15%. (7) enuresis and mental, psychological and behavioral disorders - sudden mental stimulation, such as fear, shock, rage, sadness, a strong psychological depression and behavioral disorders, confusion, etc. can cause enuresis. These factors will be sustained growth of children and adults the causes of refractory enuresis. (8), urinary incontinence, and disease - a disease caused by enuresis from multiple systems, there are organic, inflammatory, metabolic, and traumatic and so common are: nervous system disease: seizures, encephalopathy, brain tumor, cerebrovascular disease, cerebral spinal multiple sclerosis, spinal cord inflammation and tumors, bleeding, spina bifida, lumbosacral spine cracked and so on. Urinary system disease: malformation (urethral stricture, urethral stenosis, hypospadias, urethral valves, bladder neck obstruction, and male circumcision, phimosis, etc.), inflammation (nephritis, pyelonephritis, cystitis, urethritis, balanitis), stones, kidney damage. Other diseases: such as chronic diarrhea, abdominal pain, Cough trachea, lung disease; and metabolism of ectopic posterior pituitary, pituitary and renal diabetes insipidus, diabetes mellitus; and blood-related severe anemia, high blood calcium, low potassium, etc.; and bad habits of masturbation, inert; other sleep breathing disorders, allergic disorders such. (9) enuresis and internal organs - the motherland medicine enuresis and functional development of organs imperfections, such as bladder growth retardation, functional weak, especially the spleen, kidney, lung weakness caused. Kidney is the root of human life it is called birth of the kidney essence, the main development, reproduction, marrow, through the brain. Kidney and bladder relative to table, sufficient warm air bladder kidney, diuresis, bladder astringent power, opening and closing of a degree; kidney Qi is the Vital Huoshuai, chi heyday, it is "the next focus dried up the left female incontinence; kidney qi deficiency is fighting heart and kidney, heart dry irritability; kidney qi deficiency is not healthy bone, bone marrow is not the brain is not healthy, not fat, slow-growing or strong, low intelligence and clumsy. Spleen enuresis. The spleen is acquired, the of the blood of Health of China, Spleen healthy and vigorous, can be prepared from water, Shengqingjiangzhuo. spleen yang deficiency is to reduce gastric motility, delayed gastric emptying time, reducing the value of induced gastric secretion, salivary amylase and pancreatic amylase reduced appetite caused by poor transport of non-performing Mizutani, blood biochemistry and not passive conservation birth of the bladder caused by kidney deficiency, enuresis. lung deficiency enuresis. lung primary gas, but also for the Sheung Shui , has declared through Su-down features, such as loss of lung Qi is declared down, flooding caused by liquid water running from the left bladder and missed appointments; such as lung inflammation fire burns Yin Ye must not be caused by rising water drop will come to the next hot coke, lead to dry stool, bladder damp heat, short of urine, known as intrinsic phlegm, sleep addicted to wake up call should not, often can enuresis. liver heat enuresis. liver heat, hot from the force of bladder also left. (10 ) unscientific bladder training - in addition to genetic factors in children's bed-wetting, spina bifida or spinal cracked, the final extension as an important reason is that parents enuresis unscientific bladder training. unscientific bladder training include: 1. in non- over-filling of the bladder called the urine or the urine; 2. in the bladder filling phase is not called urine or the urine, such as long-term use diapers and other changing mat; 3. bedwetting after the reprimand or punishment. science is still the treatment of children with bladder training enuresis important measures can not be ignored. therapeutic side of enuresis in children, enuresis, commonly known as "bed-wetting" refers to children over 3 years old, sleep in the urine from the left, behind the feel of a wake up condition. From the Chinese point of , and more from insufficient kidney, Xiayuan Deficiency or illness infirmity, Insufficiency of Qi due. it has some therapeutic effect. enuresis diet of dog meat stew Qi Zi Qi Zi stewed dog: dog meat, 100 grams, wolfberry 10 grams. will dog wash, and cut the box, with vegetable oil (vegetable oil, peanut oil can) Heat meaty fry, add salt, cooking wine, medlar, rotten stew slow fire, one day, once served, and even clothes for ten days. more therapeutic side, suitable for kidney deficiency, Xiayuan Deficiency in Children, The Insufficiency of Qi who can use the following two parties: enuresis diet of black beans sticky rice sticky rice black beans: black beans 30 grams, 100 grams of glutinous rice, brown sugar 20 grams. the black beans soaked wash stand, glutinous rice, wash and drain water to 10 grams of peanut oil, fried sticky rice to the next black beans, add water, amount, a small fire cook, add brown sugar, mix well and serve. day after dinner feeding time, and even served for ten days. enuresis diet of pigs Tripe Tripe stew pork sticky rice sticky rice: Pig Tripe 1, 100 grams of glutinous rice, lotus seeds 30 grams. take pigs Tripe wash stand, lotus seeds to the heart, glutinous rice soaked filter dry, with a little salt and mix well into the pig Tripe, the steam cooked, after eating at dinner, day 1, ten days for treatment. with enuresis treatment of night eating aroused by the therapeutic treatment addition to outside , attention should be timed from the early age to develop good habits of urination and a reasonable lifestyle. At the same time, should also take the "night to arouse therapy." wake-up time every night time urination in children. Children should not be too tired during the day and dinner general should not drink too much after the water. Encourage your child to build confidence in curing enuresis, do not add random accusations, or more difficult to cure the disease. clinical type of primary enuresis, Jiangyin City, Jiangsu Province, board Bridge Clinic specialist enuresis enuresis based on the primary clinical features of the disease is divided into four types of treatment options, have reference value. diurnal urinary frequency type: nocturia more times, o 1, accompanied by frequent urination during the day. pathologic regulation mechanism is functional micturition disorders. arousal disorder type: arousal disorders prominent, no frequent urination during the day. pathologic nerve conduction mechanism is adjustment disorder. nocturnal polyuria type: more urine at night, but not more than the number of bed-wetting, frequent urination during the day without. pathological mechanisms are nocturnal secretion of antidiuretic hormone dysregulation. Mixed: a. urinary frequency day and night awakening disorders, b. urinary frequency day and night, nocturnal polyuria, c. arousal disorder nocturnal polyuria. general treatment of primary enuresis develop good the rest system, and health habits, avoid fatigue, master bed-wetting time and the law to get up at night with the alarm clock wake-up voiding in children 1 to 2 times. 1 to 2 hours during the day and sleep during the day to avoid over-excitement or strenuous exercise, sleep through the night to prevent deep. Throughout the course, we must build confidence. gradually correct the shy, anxiety, fear and shrink, and other emotions or behavior, to take care of the patient's self-esteem, to encourage more comfort, less blame, punishment, reduce their psychological burden, which is successfully treated the key. to correctly handle the spiritual factors that cause enuresis, bedwetting caused by a history of understanding the spirit of incentives and possible psychological conflicts can be resolved in the spirit of the stimulus should be resolved as soon as possible, the original objective has occurred or subjective reality can not resolve the contradictions and problems, we should focus on patient education, explaining to eliminate stress, so as not to cause emotional upset. After dinner, avoid drinking, sleeping in the front row empty the bladder urine, to reduce the number of bed-wetting. original behavior therapy onset enuresis 1. urination interrupt training: Encourage your child to urinate in the middle of each interrupt urination, itself from the number 1 to 10, and then drained the urine, which can train and improve the capacity of the bladder sphincter control urination 2. bear the urine Training: let the children drink more water during the day, when this urge, let him hold back urine, the urine each tolerance of not more than 30 minutes a day training for 1 or 2 times, so that the bladder expansion, increase capacity, thereby reducing the frequency of urination at night 3. Time Training: In the past, regular night time bed-wetting alarm half an hour earlier with a combination of man-made wake-up, giving him room to move around, or wash your face with cold water, so that in the conscious state to drain the urine The purpose is also conducive to the establishment of conditioned reflex. 4. the parents discover their children to wet the bed, push their children to empty their urine, dry part, the replacement of underwear and dry-bed treatment. 5. Summary records: requiring the parents to record wet the bed every day reasons, the number of bed-wetting on the calendar, do not wet the bed are making a mark, a weekly summary, find out why, when the child should be to encourage progress. drug treatment of primary enuresis, according to the clinical Western dialectical use type 1. imipramine for arousal disorder type. 2. oxybutynin, alias urine spirit, for day and night urinary frequency type. 3. ephedrine can be used mixed. 4. to the ammonia pressure elements: a synthetic antidiuretic hormone, alias Mi condensate for nocturnal polyuria type. joint application amitriptyline, desmopressin and oxybutynin is that the treatment of refractory enuresis mixed effective triple drug (Reference: Chinese Journal of Pediatrics July 2008 Volume 23 No. 7 135 *). to 3 months for a course, the advantage of the SNM with the following effective treatment approach, the disadvantage is have different degrees of side effects and easy to relapse after drug withdrawal. These drugs are prescription drugs, imipramine and amitriptyline as antidepressants, as shown in the amount of dose for adults, children should be calculated per kilogram of body weight. IV. Physical therapy: to use alarm clock awaking time, acupuncture, massage, acupuncture, equipment and other methods are effective. primary enuresis physical therapy physical therapy the role of non-payment of drugs, less recurrence, initiated by the United Nations, WHO the preferred method. equipment calibration is not yet widely used in the present bed-wetting, enuresis alarms in the United States have applied correction. It is through a long period of "bed-wetting Jibei wake up" to form a conditioned reflex, to achieve the purpose of treatment. General Treatment takes about half a year. 2006, China has its own IP-related products, such as: the equivalent of U.S. nocturnal bed-wetting alarm reminder, for adult massage type enuresis treatment, for children TENS treatment for low-frequency pulse-type enuresis. SNM (sacralneuromodulation) therapy that sacral neuromodulation therapy, foreign scholars in 2001 to 2005 derived by the treatment of God and non-neurogenic lower urinary tract dysfunction, to obtain good clinical results. In recent years, use of neuromodulation therapy that TENS transcutaneous nerve stimulation therapy characteristics, simple, the effect certainly is a promising method of treatment. Shanghai Children's Hospital of Fudan University and Chongqing University of Medical Pediatrics in 2006 and 2007, respectively, years (Reference: Clinical Pediatric Surgery April 2006 Volume 5, No. 2, October 2007 Volume 6, No. 5) SNM of low frequency current therapy for children with primary nocturnal enuresis in clinical studies, that is a safe, effective treatment, the treatment principles that are: to increase the bladder afferent sacral nerve to the central uplink channel information to enhance neural excitability, significantly improved sleep-wake disorders, increased bladder capacity and inhibit contraction of detrusor instability caused by overactive bladder. Jiangyin City, Jiangsu Province, leaving only the Institute of Electronics successfully developed in 2006 with our own intellectual property characteristics of TENS therapy device ~ ZY-E and ZY-F type of enuresis treatment, the low-frequency pulse-type enuresis TENS therapy device is in the original equipment on the basis of the treatment time and the urine sensor superimposed on automatic control circuit, the timing of treatment of bladder filling during the night of the automatic, immediate results achieved breakthrough progress. use, the micro-instruments placed in special small pocket underwear, night surveillance and treatment process is automatic, neither drug side effects, acupuncture and other invasive and avoid pain, medical institutions can achieve in the purpose of neuromodulation therapy, and easy enough no household in the family self-help therapy. both in the awake state for sacral neuromodulation therapy SNM, but also in the sleep characteristics of TENS therapy is used to automatically, but also to remind patients in advance, or wet the bed at that time to prevent wet beds. on ineffective drug therapy equally effective in refractory enuresis. primary enuresis enuresis recipe Dinggui quote sps in warm navel umbilical Shenque on night one, easy to use, drug stores for sale, easy to buy, is Umbilical an easy cheap drug pocket. Ephedra 3 to 10 grams, Shuijianbi, there have been reports, short-term effects can still be, should not Jiufu. psoralen 10 g crushed fried eggs, even eat for 10 days, Chinese psoralen kidney temperature spleen, kidney deficiency caused by treating frequent urination, enuresis, drug side effects, loss of appetite, anemia, decreased white blood cells and toxic hepatitis. So diabetes, SLE, porphyria and liver dysfunction were hanged. outdoor activity time is longer, before the event on the 3rd stop on internal. treatment time not eat limes, celery, mustard, carrots, etc. mature ginkgo daily 5 to 7, ate 10 days ginkgo a small drug, not Jiufu.


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