Enuresis refers to involuntary urination at night (with or without daytime) after 5 years old. /kloc-a normal child of about 0/year old can control urination by himself during the day, but bed wetting at night is inevitable. The survey shows that about 10%-20% of the 4.5-year-old people wet the bed, about 5% of the 9.5-year-old people, and 2% of the 0.5-year-old people still wet the bed. The ratio of male to female is 3: 1.

There are two kinds of this disease: primary and secondary. The former refers to the slow development of bladder sphincter control ability in children and the inability to control urination after birth. The latter means that the child has developed the ability to control urination, and later enuresis appeared. According to the etiology, the disease can be divided into functional enuresis and organic enuresis. Children are mostly functional enuresis, accounting for 75%-80% of enuresis, and the prognosis is good.

The cause of disease

1. Genetic factors Some children have a family history. It has been reported abroad that 30%-50% of the children's parents have a history of enuresis, and the incidence of enuresis in identical twins is higher than that in identical twins. There are similar reports in China, suggesting that the disease is related to heredity.

2. The study of nervous system hypoplasia found that children's bladder volume is small (small L/3), and bladder muscles have poor urination control function. Children sleep too deeply, the central nervous system is dominant, and the stimulation of bladder filling can not excite the central nervous system, so it is difficult for children to wake up. Children with enuresis often have abnormal EEG, the most common of which is abnormal slow wave. A small number of children with enuresis have low IQ, which also shows that there are factors of imperfect neural development.

3. Social psychological factors

(1) Serious mental stimulation, such as unexpected disasters, family breakdown, death of relatives, deprivation of maternal love, loss of care of relatives, anxiety and panic caused by changes in living environment, enuresis caused by excessive mental stress, etc. Many children get worse after school exams, strenuous exercise and overwork. Some children enuresis because of parent-child conflict, out of revenge and in order to get parents' concern. According to the survey, more than 1/3 children have psychological factors.

(2) Personality and behavioral characteristics This disease is easy to occur in children who are timid, docile, passive, withdrawn, emotionally unstable, overly sensitive and excitable. In addition, long-term enuresis is ashamed to meet people and live alone, and over time, it has formed an inferiority complex and introverted personality, lacking self-confidence in doing things and shrinking behavior.

(3) Bad parenting attitude In defecation training, parents are too strict (they hate children's defecation and strictly stipulate defecation time) or too accommodating (they ignore defecation training), resulting in children's inability to urinate independently. Or the child loses caress, abuse and punishment, especially the occasional enuresis is reprimanded by his family, and he is warned not to wet the bed before going to bed, which increases the psychological burden and plays a suggestive role in aggravating enuresis.

(4) Other cold winters, insufficient warmth, contraction of skin blood vessels, inconspicuous reduction of water loss, and excessive drinking or eating porridge at dinner lead to increased urination, which are also inducing factors.

clinical picture

Enuresis is characterized by involuntary urination of children after falling asleep, which often occurs at a relatively fixed time at night, mostly in the middle of the night, sometimes several times a night, and even wetting the bed during a nap, which can last for several years.

The prognosis is good, and most of them disappear naturally after sexual maturity at the latest.

Enuresis often has a great influence on children's bad psychology. People usually don't think that enuresis is a disease, but a shameful thing. It can make children feel remorse, shame, fear, retreat and lack of self-confidence; In addition, parents' improper punishment further dampened children's self-esteem, making them more depressed and inferior, ashamed to meet people, unwilling to associate with others and participate in collective life, and forming a withdrawn and introverted character. Although adult enuresis has been cured, its bad personality characteristics may accompany it for life.

diagnostic criteria

The following three items must be met: 1, repeated involuntary urination (day or night) over 5 years old (or over 4 years old); 2. The severity of enuresis: children over 5-6 years old have enuresis at least twice a month, and children over 6 years old have enuresis at least once a month/kloc-0; 3. Enuresis is not caused by nervous system injury, epilepsy, physical illness or drugs.

treat cordially

First, the reasons for treatment

Second, general treatment: limiting water at night, urinating before going to bed, applying propafenone or acupuncture and other drugs and traditional Chinese medicine can reduce or stop enuresis and relieve symptoms.

Third, the commonly used psychotherapy:

1. Cognitive therapy and supportive therapy explain to children and their parents that the essence of the disease is temporary dysfunction, reduce psychological burden and tension, and establish confidence in rehabilitation. Encourage and encourage children, but don't scold and punish them. Praise small progress and enhance children's confidence.

2. Behavior modification therapy

(1) Training to increase bladder capacity urges children to drink more water during the day, and extend the interval of urination as much as possible, so that the bladder capacity is gradually increased, and children can experience the feeling of bladder fullness and the need for urination. At the same time, encourage children to intentionally interrupt urination and drain urine after counting to improve bladder sphincter function.

(2) Establish conditioned reflex culture and urinate regularly. About half an hour before bed wetting, use an alarm clock or other alarm device to wake up the child to urinate in time, so that when the bladder is full, a bell will appear and a conditioned reflex will be established. Later, the sleep time was gradually extended and the ringing time was postponed until the bed wetting was relieved or even disappeared. Urination behavior training should be persistent and uninterrupted, otherwise all previous efforts will be in vain.

Psychological nursing

(1) Care for children, improve the living environment and avoid intense mental stimulation, excessive tension and fatigue. Interpersonal contradictions between family members should not be exposed to children, so as not to cause psychological trauma and induce enuresis.

(2) Establish a reasonable living system and cultivate good urination habits. For the performance of not wetting the bed, you can stick a red star on the table to show encouragement; You can instruct the child who wets the bed to change the sheets by himself, and understand the consequences as punishment, but don't scold.

(3) Pay attention to the education and explanation of children, and reduce the psychological burden and emotional anxiety. Comfort and encourage more, avoid ridicule, reprimand or punishment, and reduce the self-blame and inferiority of children with enuresis.

(4) Drink less water before going to bed and wake up (or wake up with an alarm clock) the child to urinate on time. Keep warm when sleeping.

prevent

(1) Advocate excellent education and teaching, train children to urinate when they are about two years old, change incorrect parenting attitudes, patiently encourage bladder contraction training, urinate independently, and develop good urination habits.

(2) Avoid psychological trauma and mental stimulation, avoid overwork, eliminate mental stress and psychological burden, and establish a reasonable living system. Eliminate the social and psychological factors of enuresis.