What to do if your child has enuresis

Nowadays, many children suffer from enuresis due to their young age and psychological or kidney diseases. Children with enuresis often have low self-esteem and are easily blamed by their parents. As parents, we first need to build up children's self-confidence, and strengthen their children through bladder training and conditioned reflex training to prevent the enuresis from getting worse.

Medication

1. Motivation and responsibility training treatment Motivation treatment is to cultivate children's initiative to accept enuresis treatment, that is, to gradually cultivate children's initiative to actively request treatment for enuresis through urination diaries and encouragement. Responsibility training therapy is to let children know that enuresis not only brings a lot of trouble to themselves, but also to their parents, and they should try to reduce the frequency of enuresis.

2. Bladder training aims to increase the functional capacity of the bladder and enhance the control ability of the bladder sphincter. The specific method is to encourage children to gradually extend the interval between two urinations. At the beginning, you can urinate once every half hour. After several successful attempts, change to once every hour, and then gradually increase to once every 3-4 hours. Often, improvement in daytime frequent urination can reduce the frequency of nocturnal enuresis. At night, you can wake up the patient every 2 hours after a deep sleep, and gradually extend the time to once every 4 to 5 hours to urinate. Bladder training plays an important role in the treatment of enuresis.

3. Conditioned reflex training is mainly to awaken the brain and establish conditioned reflexes. For children over 7 years old who can cooperate, an alarm for ultrasonic monitoring of bladder capacity is carried with them. When the bladder urine volume approaches the warning value, a buzzing sound will be heard. The child can wake up by himself or by his parents to urinate. After a certain period of time, a conditioned reflex can be established.

4. Actively treat primary diseases such as infection and obstruction.

5. Medication

① Imipramine: It can excite the brain and facilitate awakening. It has anticholine and antispasmodic effects, can expand bladder capacity, it excites the proximal urethral α-receptors to increase urethral pressure, and it can also increase the secretion of neurohypophysial hormones and reduce urine volume. Take 0.9-1.5 mg/(kg·d) 1-2 hours before bedtime. Effectiveness can be seen in 1 week and the course of treatment is 6 months. The mild side effects of this drug are anxiety, insomnia, dry mouth, and nausea. If the drug is overdose, it can cause arrhythmia, hypotension, and convulsions. Therefore, parents should monitor and guide their children when taking the drug. Not suitable for use on children under 6 years old.

② Propantheline: can relax the detrusor muscle and reduce uninhibited contractions. 25-75 mg orally before bedtime or 15 mg, 3 times a day. Adverse reactions are dry mouth and nausea.

③ Ephedrine: Its mechanism of action is to increase the tension of the urethra behind the bladder and reduce the depth of sleep. 25-40 mg, orally before bedtime.

④ Oxybutynin: an anticholine drug with antispasmodic effect. It can relieve the uninhibited contraction of the bladder and expand the functional bladder capacity. It is especially suitable for children with frequent urination, urgency and small functional bladder capacity. For patients over 6 years old, take 5 mg, 2 times/d or 3 times/d. Side effects include dry mouth, flushing, and fever. Overdose may cause blurred vision and hallucinations.

⑤1-deamino-8-D-arginine-vasopressin (DDAVP): also known as desmopressin, is a natural antidiuretic hormone-like drug, available in two forms: spray and tablets.

The general dosage of the spray is 20 μg per nostril before bedtime. The tablets are 200 to 400 μg and are taken orally before bedtime. They are effective for children with excessive nocturnal urine volume and genetic predisposition.

6. Auxiliary treatments such as acupuncture and traditional Chinese medicine have certain effects on some children.

7. Secondary enuresis needs to be treated according to the specific situation.