Rus Articles Journal

Complex of a wet bed: bed wetting at children of

It is so unpleasant and it is a shame... To wake up every morning on the got wet sheet in wet panties. The organism brought again, “call“ did not work, and now the kid does not want to leave further the room, it is ready to fail under the earth... Unfortunately, this artful disease can have both medical, and psychological reasons. How to help the child to cope with an illness?

Enuresis (from Greek enureo - to urinate) - the term designating an urine incontience. At children allocate the following forms of this disease: night enuresis (meets most often, and in article the speech about it will go) and a day incontience of urine. There is still a constant incontience of urine, but it is perfect other disease connected with defeat of the central nervous system as a result of a trauma or an infection. Night enuresis is meant as presence at the child 5 years of an involuntary urination are more senior during a night dream. Formation of complete control over an urination at the child happens aged from 1 till 3 years and comes to an end by four years. Depending on age and amount of the drunk liquid the number of urinations normal fluctuates from 7 to 9 in days (no more and not less), and during a night dream is observed having rummaged in urinations. However at 10 - 15% of children of 5 - 12 years of it does not occur, and after a night dream they wake up wet. That is have night enuresis. In process of a growing prevalence of this illness decreases, but 1% of children “carries away“ it in adulthood. And enuresis occurs at boys by 1,5 - 2 times more often than at girls.

are Allocated by two main types of night enuresis: the primary night enuresis (PNE) - a disease at children who never woke up steadily dry; and the secondary, or recidivous (repeating), night enuresis - a state at which patients repeatedly begin to urinate in a bed after the considerable period of remission (lack of symptoms of a disease).

of the Reason of bed wetting are various

of the Reason of development of enuresis. One of major factors is injury of a brain of a fruit at the pathological course of pregnancy and childbirth at the expense of a hypoxia (insufficient supply of a brain with oxygen) or a trauma. These pathologies promote a delay of maturing of the central nervous system of the child and violation of production of hormones, including a vazopressina (see further) that leads to development of enuresis. Also chronic infections mochevyvo - dyashchy system, violation of nervous regulation of a bladder, congenital anomalies of urinogenital system, delay of development of skills of neatness are considered as prerequisites of bed wetting.

the exacerbations of night enuresis developing against a SARS, the overcooling provoking an infection of an urinary system Are possible

. Often it occurs in the fall and in the spring, that is in the period of unstable weather. Stressful situations in the child`s life can also cause repetitions of a disease.

the Mechanism of development of primary night enuresis is up to the end not clear to

. It is considered that an important factor in development of a disease is genetic predisposition. The certain genes responsible for this pathology are revealed. If one of parents had bed wetting, then the risk of development of enuresis in the child makes 45% and if both are this probability increases to 75%.

there were convincing data that violations of a rhythm of secretion of the hormone synthesized in a brain are the main reason for PNE (in a gipotalamus) in recent years - a vazopressina. Its other name - antidiuretichesky hormone from what the main function becomes clear: reduction of release of urine kidneys. Antidiureticheskoye (or prot - vomochegonny) needs effect of hormone for maintenance vodno - a salt exchange in an organism.

concentration of a vazopressin in blood Is normal of

depends on time of day: at night it is higher, than in the afternoon. Therefore allocate with night of a kidney the smaller volume of urine, but with higher concentration. That is at healthy people at night small portions of urine come to a bladder, but do not perenapolnyat it, and there are no desires on an urination.

secretion of a vazopressin is reduced by

At primary enuresis at night that leads to the increased formation of not concentrated urine. Its quantity exceeds the physiological capacity of a bladder, it is overflowed, and there is an involuntary urination. Often parents, probably, from desire to justify oneself, connect it with sound sleep of the child. However it became clear that on character of a dream the children having night enuresis do not differ from other peers.

violations of nervous regulation of a bladder with prevalence of the raised tone of smooth muscles can be Other cause of bed wetting, and then frequent urinations or plentiful rare urinations, and also a day incontience of urine join in the small portions enuresis. If the tone of a bladder is lowered, then the child urinates seldom, in the big portions, the bladder is overflowed, and there is an involuntary urination.


noted also such situation when children from - for visits of various occupations and sections almost do not manage to drink normally in the first half of day, and the house, before going to bed, they drink standard daily rate of liquid and do not hold urine at night. Sometimes it is regarded as enuresis too.

Necessary inspections

the opinion that there is no need with a problem of night enuresis to see a doctor - the nephrologist (or to the pediatrician) Occurs: say, the child “will outgrow“, and 1 . Quite often also broader inspection of urethral system is required: tsistografiya 2 , intravenous urography 3 , nefrostsintigrafiya 4 , tsistoskopiya 1 , urofluometriya 6 . By results of inspection the nephrologist if necessary can direct the child to consultation to other experts, for example to the neuropathologist, the psychologist or to additional inspection in nephrological or urological offices. Only after the enuresis reason will be established, the correct treatment can be appointed.

Treatment of enuresis to

Convincing data on violations of a rhythm of secretion of a vazopressin at primary night enuresis formed

a basis for application of synthetic analog of this hormone - of a desmopressin which tableted form is minirin . Preparation doses for treatment of PNE at children from 5 years are selected the doctor individually, it is necessary to give medicine before going to bed.

At treatment of primary night enuresis should observe the particular drinking treatment - the last reception of liquid has to be not less than in 2 hours prior to a dream. At the same time the child has to receive enough liquid throughout the day.

Independently to apply analogs of a vazopressin inadmissibly as night enuresis at the child can be connected with absolutely other pathology, for example with an infection of an urinary system. And it demands purpose of antibacterial therapy after which the phenomena of night enuresis pass.

If violation of nervous regulation of a bladder, with prevalence of the raised tone of its smooth muscles, leading to reduction of volume of a bladder is the reason of enuresis, it is applied by driptan . It increases the volume of a bladder and reduces a spasm, doing spontaneous reductions of a muscle by more rare, and eliminating an urine incontience. In some cases treatment miniriny in combination with driptany is shown .

At the lowered tone of a bladder is recommended to adhere during the day to the mode of compulsory urinations each 2,5 - 3 hours. It is important that the child emptied a bladder and before going to bed. As therapy it is appointed minirin and prozerin . The last raises a tone of smooth muscles.


For improvement of exchange processes in a brain, and also at nevrozopo - dobny states recommend such preparations as nootropit, pikamilon, Persia, novopassit . Besides, vitamin therapy courses are shown (In 6 , In 2 , B 1 , B 2 , A, E).

enters a complex of treatment of enuresis physical therapy, in the form of impacts on a bladder various currents, ultrasound and thermal procedures (paraffin or ozokerite) regulating work of nervous system. Also the all-strengthening massage and the remedial gymnastics directed to strengthening of muscles of a pelvic bottom is applied.

Treatment of night enuresis - long process, on it months, and sometimes and years therefore parents need to stock up with patience leave. it is better for p to train in

for the purpose of prevention of a disease in due time the kid to use a pot and to watch that the child regularly and completely emptied a bladder. Observance of the drinking mode is obligatory. Inadmissibly, that the child got used to drink before going to bed and at night.

Angela Paramonova, the psychologist - the psychoanalyst : The right psychological spirit in fight against any illness is not less important, couples a course of medicines. And in a case with nurseries night, enuresis this moment has special value. The adults to the kid will be more correct and more attentive, the problem for the formed identity of the child will be less painful.

the Illness and character

At many children, regardless of age, enuresis, as well as everyone it is long the proceeding illness, causes feeling of own inferiority. Even the smallest take this problem hard. Hesitating of the healthy peers, they often aspire to a privacy, become reserved to avoid sneers and the fastidious relation of people around. The feeling of uncertainty appears often or aggravated in kindergarten or at school and can lead to development of a low self-assessment, rejection of, up to an utter impossibility to study and be realized in various areas of life.

Children at whom long time remains an urine incontience under the influence of experiences in certain cases change on character. One become more aggressive, at others the shyness, indecision, isolation, an otgorozhennost amplifies. Is also such who at first sight does not worry concerning the illness in any way, but at them various changes can be shown at teenage age.

of the Form and a cause of illness

the urine Incontience, as a result of the slowed-down formation of control over urination or destruction of already created function from - for organic and infectious diseases or traumatic defeats of nervous system, is called nevrozopodobny. Existence of the nevrozopodobny enuresis caused by organic defeat of nervous system of the child even during pre-natal development does not depend on disorders and other psychological factors, but amplifies at overfatigue, physical indispositions, overcooling.

At destruction of already created function the incontience of urine appears not at early age, and after the postponed trauma (for example, sotrya Senja of a brain) or infections (for example, an encephalomeningitis - an inflammation of covers and substance of a brain). At the same time enuresis carries, as a rule, monotonous, monotonous character. When rate of approach of compensation is slowed down or there are additional negative factors preventing recovery, the nevrozopodobny incontience of urine can last for years and in the teenage period sometimes leads to pathological formation of the personality. In such cases the doctor can recommend against drug treatment long occupations with the psychologist.

function of urination and under the influence of various psychological reasons can Collapse (from - behind sharp a mental trauma). In that case speak about neurotic enuresis. This form of a disease can carry both short-term, and longer character. For example, if the child from a fright had an involuntary incontience of urine. Usually neurotic reaction with enuresis lasts several hours or days and takes place in process of disappearance of mental tension.


When sincere nervousness remains several weeks and months and painful manifestations are fixed, speak about a neurotic state. As its reasons can serve:

In such cases the child takes the internal conflict and the prolonged disease hard.

Accurate dependence on a mental state leads

to the fact that nevrot - cheky course of enuresis, unlike nevrozopodobny frustration, can changeably be shown - to disappear, to amplify depending on an emotional condition of the child. Such enuresis can have flickering character and last from several weeks to several months. But force of experiences of the child at the same time is very intensive. In these cases the qualified psychocorrection of its internal conflict is effective.

That adults

to Parents can important to know that enuresis, as well as any disease, at each child proceeds differently. So far more than 300 independent methods of its treatment are known. The correct recognition of frustration and individual selection of the corresponding methods for each specific kid guarantee an absolute recovery in optimum short terms. And implementation of all recommendations of the expert and the appointed procedures, together with connection of psychological family resources quickly lead to a lasting positive effect.

Main recommendations for parents:

first of all needs to eliminate with
  1. At sharply arisen enuresis the situation injuring mentality of the child. To provide the maximum tranquility in a family, to remove the conflict atmosphere, to normalize psychological climate.
  2. the Chronic conflictness in a family often leads
  3. to aggravation of a problem. The child needs to pay more attention: to read together books, to go for a walk, especially before going to bed.
  4. to the Children having enuresis the uses of liquid set a certain diet also: not less than in 2 hours prior to a dream its quantity decreases or drink is cancelled at all. It is important to follow these rules and to accustom the child to new stereotypes of food, for example to restriction of salty and spicy food which increases thirst. It is possible to replace juice, tea, compote with a segment of orange, apple. If the kid persistently asks to drink, he can be distracted something, to give a small spoon of drink. Gradually such diet becomes habitual for the child and does not cause difficulties in observance.
  5. If the baby refuses flatly to sleep in the afternoon, it is not necessary to do a stressful situation of laying. The kid can spend an afternoon in a chair, listening to the familiar fairy tale or the cartridge.
  6. is important to be reduced throughout treatment or to refuse temporarily long viewing of telecasts and hobby for computer games which strongly influence weak nervous system of the child. The book in this case can replace the TV. it is quite good to li to ritualize
  7. Before a night dream as much as possible forthe nyatiya, that is in the same order to make every evening the same actions together with the child. For example, to clean toys into place, to bathe, tell the fairy tale or spontaneously thought up story with continuations, to implement evening recommendations of the doctor.
  8. the Jealousy of the younger brother or the sister also often is
  9. the reason of enuresis at the senior child. In this situation parents need to analyse the attitude towards the senior, to reconsider if it is necessary, his role in a family. Mother, even if she has on hands a newborn, needs to pay to the firstborn a little more attention. Possibly to it difficult to play the part of the elder brother or sister assigned by adults. And maybe, it is emotionally involved by o^íåäîñòàòî÷íî in the relations of parents with the baby, as causes acute jealousy. The child wants to feel small, only and favourite again. Some parents stack the child - an enuretik with themselves in a bed that at night to wake him or to take away in a toilet. It is not recommended to do it as presence of adults does not allow it to develop a habit independently to wake up at night. The kid and parents have to sleep in different beds and in different rooms. It promotes a quiet dream of the child and gradual schooling it to control the desires or to wake up at night at desires in a toilet.
  10. it is better for li to refrain In the evening from active, vigorous games that the child did not overtire. It is before going to bed better to be engaged in board games, such as a lotto, a mosaic, cubes or the designer. They not only develop the kid, but also stabilize his nervous system.
  11. drawing Well influences mentality of the kid. The child is younger, the more interesting to him to draw a gouache paint thick brushes on big sheets of paper of a different form, white and color. Many children like to create pictures finger-tips or all palm. Parents not always welcome such creativity, dooming kids from early age to stamps and templates. But if it is about treatment of enuresis, it is necessary to liberate as much as possible thinking of the child and to relax his body. And paints fingers and all palm children most fully reflect the emotional state in drawing.
suggestion Force to

carrying out the autogenic training directed to removal of a muscular and nervous tension of the child, on creation of the atmosphere of tranquility and slackness and the enuresis problem allowing to adjust it on removal is Quite available to

to parents. Here one of options of carrying out such training for children of preschool age - in a poetic and soft game form. This game does not represent complexity neither for parents, nor for children.

needs to give Classes every evening before going to bed. Duration of training varies from 15 to 30 minutes. Words of auto-training need to be read to the kid the quiet, slowed-down and low voice. Over time, when the child will learn them by heart, he can give every evening classes independently, without participation of the adult.

before training needs to learn with the child the name of all hour ty bodies. Giving evening classes, the adult needs to take care of the internal mental balance. If mother or the father are overstrained or upset, then occupation should be charged to someone from relatives as in the weakened state the induction (transfer of an emotional state) from one person to another is very strong, and the return result as a result can turn out: the kid not only will not calm down, and opposite, will be overexcited.

should Pronounce all words by a soft, quiet voice, slowly, with long pauses, and calling parts of a body of the child, to touch softly them with a palm (to the head, knees, feet and so on). Separate formulas of suggestion repeat 2 - 3 times with change of a logical accent.

At correctly carried out autogenic training the kid relaxes and can even fall asleep.

the Game “Magic Dream“
(autogenic training for children of preschool age poetically)

“Now I will read to

verses, and you will close eyes. The new game “Magic Dream“ begins. You will not fall asleep really, will hear everything, but will not move, and will relax and have a rest. Attentively listen to words and repeat them about yourself, the internal speech. It is not necessary to whisper. Have quietly a rest, having closed eyes. The attention, comes “A magic dream“...
of the Eyelash fall...
Eyes are closed...
We have quietly a rest (2 times)... magic we fill up
with the Dream...
Is breathed easily... exactly... deeply...
our hands have a rest...
of the Leg have a rest too...
Have a rest... fill up... (2 times) the Neck is not strained by
also races - is weak - le - on...
of the Lip are slightly slightly opened...
Everything wonderfully relaxes... (2 times)...
Is breathed easily... exactly... deeply... (The long pause becomes and the words directed to correction of a problem are told):
Ya I sleep dry today...
Tomorrow I will wake up dry,
I dry The day after tomorrow,
Because I is dry... As I will feel
, I will wake up,
I will Surely wake up!
your body is weakened, but you know that you sleep dry... Tomorrow you will wake up dry... If you want
in a toilet at night, then you will feel and will wake up, will surely wake up...
in the Morning you will wake up dry. You are an owner to the organism, and he obeys you.
You are a good fellow, you sleep dry. If you want in a toilet, then you will wake up, you will surely wake up and you will go to a toilet. Your bed dry. You at me the good fellow, at you everything will turn out“.

Adults have to understand

that elimination of enuresis at the child - laborious and sometimes long process, but it is possible to achieve positive result only with active participation of experts and families . From parents the baby needs a special step and respect for the. Eventually enuresis recovers, it is necessary to have patience only.

Wants to pay special attention of parents: you should not try to correct independently a mental condition of the child some psychological games. The enuresis problem at children is rather difficult and in a complex even if it is not noticeable at first sight. Therefore it is better to address experts. Inept actions of parents can lead to complication of a situation - the disease will be aggravated and more time for treatment will demand.