In the first months of life, the baby’s bladder is freed from its contents against the will of the little “owner”, by the age of 1.5 the latter can sometimes subdue this process to his will, and only by 3-4 years the child becomes the master of the situation. At the same time, children from 1.5 to 5 years old learn cleanliness, and with varying success, so that night surprises at 3, 4, and even 5 years of age speak only about the uncoordinated work of the nervous system, or rather, about immaturity some reflexes that regulate the process of emptying the bladder.
Hence the conclusion: enuresis as a disease appears in children over 5 years old. Heredity plays a certain role in its occurrence: if one of the parents of the child suffered from enuresis, the probability that the child will follow his “example” is 40–50%, if both are sick, 70–80%.
It is also known that with boys this trouble happens more often than with girls.
The mechanisms of day and night urination differ from each other, and the formation time does not necessarily coincide. First, while the baby’s sleep is still very deep, he learns to control himself while he is awake. First of all, the child will have to learn how to control the sphincters (the so-called door-muscles that close the bladder outlet) —that they command his activity until the baby sleeps.
Little by little, the child’s sleep becomes less deep, which makes it possible for him to wake up day and night, when the bladder gives a signal that it is full. At about the same stage, the small organism begins to produce a special antidiuretic hormone that inhibits the “production” of urine at night. At first, its quantity is still not enough to prevent “leaks”, and they occur frequently, especially considering the small capacity of the child’s bladder.
In anticipation of establishing the work of all these mechanisms, which occurs in most babies in a natural way, you need to be patient and in no case rush the little “sailor”. For example, you should not put him to sleep without a diaper (day and night), knowing that he is not yet ready to hold back.
Having heard the diagnosis of enuresis, parents usually expect that the specialist will look for the baby for any abnormalities in the development of the organs of the urinary system. Fortunately, such “finds” – a rarity. Most often, the main causes of nighttime disturbances are either the modest size of the baby’s bladder, or insufficient production of antidiuretic hormone in his body.
These phenomena are called doctors: “neurogenic bladder” or “neurogenic dysfunction of the bladder.” Both concepts imply that abnormalities in the bladder function are caused by problems in the functioning of the nervous system at different levels.
If your baby is already 5 years old, and he gives you nightly surprises at least 2 times a month, you should immediately go with him to the doctor.
Examination of the baby is carried out with the help of two tests.
1. Measurement of bladder capacity.
First, the urine of the child is collected in one “approach” into a special flask with a scale. This is usually done in the afternoon, as soon as the baby feels the corresponding urge, which will serve as proof that the bladder sends a signal about its filling.
The result obtained is compared with the so-called functional capacity of the bladder, which is calculated by the formula: 2 is added to the child’s age and the result is multiplied by 32.
For a 5-year-old child, these calculations look like this: (5 + 2) x 32 = 224 ml Test results are considered normal if in one “approach” 70% of the calculated capacity is collected, that is, in the case of a 5-year-old child, about 160 ml of urine. Collected less – it is clear that the capacity of the bladder is small.
One third of the examined babies receive exactly this conclusion.
2. Determination of night urination.
In the remaining patients, enuresis is usually attributed to hormonal disturbances – overnight production of urine is too great. You can check whether this is the case: weigh the dry diaper in the evening and wet in the morning. Then subtract the difference between the two measurements and add to it the weight of the first morning urination (1 ml of urine = 1 g).
If the result exceeds the indicator of 160 ml (for a child of 5 years), it will mean that the production of antidiuretic hormone is small.
There are two more areas of examination of babies that the doctor prescribes for children of any age in the event that something bothers them.
– It is necessary to eliminate inflammation in the urinary tract. Unfortunately, it is found in 30–40% of babies.
– Next is the so-called nephrological examination, which allows you to make sure that the child does not have any congenital or acquired defects of the urinary tract. It includes an ultrasound scan of the kidneys, bladder on residual urine and x-rays of both organs.
Finally, the doctor must make sure that the baby with enuresis does not have epilepsy and mental disorders.
Treatment for a child is prescribed depending on the results of the examination and the tests performed.
If a baby has a small bladder capacity, you should try a program called “alarm clock”. Do not water it a lot at night, plant more often on the pot, including at night.
For a month, a child gets used to such a regimen, and in three he usually recovers.
In the case of a lack of nightly release of antidiuretic hormone, the doctor will prescribe the drug Desmopressin (Ferring) to the child. At the heart of the drug is an analogue of a deficient hormone.
For those children who have a urinary infection or another disease that accompanies enuresis, the treatment regimen will depend on the nature of the problem identified.
Do not be surprised if the doctor advises to reduce the child to a psychologist. Usually, his help is needed by hyperactive children who have difficulty concentrating.
Such babies do have psychological problems, manifested in the form of enuresis. Calm, balanced children can also react in this way to various shocks: parents’ divorce, relocation, conflicts in the garden.
In any case, the search for the cause should begin with a visit to the pediatrician, and he will decide where to send the little one to a psychologist or nephrologist.