Clinical thinking of pediatric enuresis

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Enuresis (enuresis) commonly known as bedwetting, is an involuntary urination, clinical sleep unconsciously to urinate on the bed. The child

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Enuresis (enuresis) commonly known as bedwetting, is an involuntary urination, clinical sleep unconsciously to urinate on the bed. The children are able to control bladder age is still not what happened in the night sleep unconscious urination behavior called enuresis. At present, the specific definition of enuresis is still not unified. According to Norello, 5 years old girl, 6 years old boy, at least 1 times a week to wet the bed, can be diagnosed as enuresis. Norgard (1996) believes that children over the age of 5 month at least 1 wet the bed at night (bedwetting). Reported incidence rate of 12%--26&. Many children with or without any urinary system diseases of the nervous system, the vast majority of primary enuresis in children before puberty can automatically stop. The infant period due to the high central development is not yet perfect, urinary bladder function controlled by spinal reflex arc simple, senior central nervous system cannot inhibit spinal micturition center, it can occur enuresis, is not sick. But senior central children 3 years development has become more perfect, can control the urethral sphincter at any time, it should not enuresis. China believes that children over 5 years old for bedwetting called enuresis. Enuresis is divided into primary and secondary. [method] (1) the age of onset of disease from the onset age can be understood as the primary or secondary. Primary enuresis from infancy onset, has been continued for more than 6 months do not wet the bed period, accounting for about 80%. Secondary enuresis refers to more than 6 months after again not bedwetting problem. 2 the time at night, daytime or night enuresis occurred and the frequency of occurrence. Primary enuresis commonly occur at night, while the secondary enuresis can appear day and night. 3 sit habit micturition and micturition frequency. Some children because of behavior and mental factors, can lead to increased frequency of urination, or enuresis, often cause. 4 related symptoms and signs of fecal incontinence, excessive drinking and urination are 5 other secondary causes including a history of urinary tract infection, is one of the causes of enuresis. 6 behavior, developmental history, age development level, sitting habits, behavioral problems to understand whether there is a kidney disease and behavioral psychological problems help. Urination training is necessary to understand, because it is helpful for children's urinary control. 7 drugs, especially the drugs have a diuretic effect can cause enuresis. 8 typical liquid intake, understand there is no excessive drinking too much at night, excessive drinking can cause nocturnal enuresis. 9 of children with enuresis influence and attitude of parents in children with enuresis is enuresis ridiculed, whether parents punishment is the impact of important content and psychological illness in children. 10 families of enuresis Shi Yuan enuresis has obvious familial tendency, one of the boys and 50% parents of enuresis of about 75% of the girls have enuresis history of enuresis. There are 11 other family history of diabetes in the differential diagnosis of diseases such as vesicoureteral reflux or reflux nephropathy, diabetes insipidus, etc.. (two) physical examination 1 growth parameters for secondary enuresis can affect the growth and development of children, such as chronic renal insufficiency. Primary enuresis is not affected. 2 abdomen abdominal mass, swelling of the kidney and bladder, cause fecal constipation can touch the tip of enuresis. 3 causes of genital irritation, adhesion, rash or other persistent caused by damp signs, balanitis, stenosis, foreign body, trauma that enuresis. 4 to observe the urine urine fluid syndrome urine dripping, dysuria, urinary hesitation, urgency, that have structural defects, emptying, urinary tract infection, secondary enuresis. 5 spine bone defect inspection and palpation of potential spinal cord defects of skin signs, such as Langerhans cell histiocytosis with enuresis symptoms of skull defect, spinal cord prolapse may be accompanied by neurogenic bladder incontinence. 6 the knee jerk reflex, gait, muscle tension and tension of the nervous system. Such as brain hypoplasia, also with enuresis. (three) analysis of 1 auxiliary examination and urine specific gravity of urine (especially urine) microscopic examination and urine culture, to the exclusion of urinary tract infections, diabetes and diabetes insipidus. In most cases, simply identify these items. 2 if there is a history of urinary tract infection, emptying or emptying of the symptoms, it should be performed in the bladder radiography, kidney, bladder B ultrasound, excluding anatomical abnormalities. Abdominal plain film X-ray examination can be found in constipation and vertebral defects. Some children with spina bifida bifida. 3 if the test results show that there are neurological dysfunction, should be urodynamic. 4 EEG and stool for ova. If the children with epilepsy, urinary incontinence can occur at night instead of epilepsy, enuresis, so EEG has differential significance. Some children may also be because of oxyuriasis caused enuresis phenomenon. [thinking] program can enuresis is a clinical symptom of many diseases, including kidney disease, nervous system disease and some organic diseases. Primary enuresis should be the main and secondary enuresis and bedwetting symptoms of urinary incontinence (such as epilepsy) phase identification. If the secondary enuresis, should find out the primary disease, the necessary examination is very important to clear the cause. 1 first distinguish urinary incontinence or urinary incontinence, enuresis refers to involuntary urine outflow from the urethra, the main causes are: (1) lower urinary tract obstruction or neurogenic bladder urinary retention induced bladder excessive expansion, urine overflow. (2) the detrusor tension continued to increase (or over) urethral sphincter relaxation, so that the urine can not control, such as nocturnal seizures. (3) urethral sphincter relaxation age and voiding time according to differential diagnosis is not difficult, more common in childhood enuresis, nocturnal sleep unconsciously after urination in bed, with the primary see; urinary incontinence in children age is relatively large, the day can also occur secondary to urinary tract infection, urinary calculi or epilepsy. 2 the second distinction is secondary enuresis or primary without any urinary system, nervous system, endocrine system disorders and behavior psychological symptoms of the disease, and from infancy onset enuresis for primary enuresis; otherwise secondary enuresis. 3 if the secondary enuresis, seek the cause (1) trauma and behavioral problems such as: the father or mother death or divorce, such as often intermittent or transient. (2) urinary tract diseases: lower urinary tract malformation or obstruction with urinary tract infection, renal insufficiency and renal tubular disease. (3) systemic diseases: diabetes, diabetes insipidus, sickle cell anemia, constipation, food allergies etc.. (4) nervous system disorders, such as cerebral hypoplasia. [] experience of most pediatric enuresis is functional. The diagnosis of primary enuresis, should carefully understand children's personality, development status, the spirit of the living environment (family and school) and parenting habits, in order to clear the reason, and do a detailed physical examination and examination of nervous system. If it is due to physical defects or other organic diseases, should be found in the original disease. Also check the midstream urine to exclude urinary tract infection. Nocturnal seizures, may have incontinence, should be identified. Children with nocturnal enuresis to a variety of reasons, it is thought that 30% children during the day may have unstable bladder, in some cases the disease caused by the show. Unstable bladder disease is also called persistent infant bladder, is a dysfunctional voiding, due to contraction caused by involuntary detrusor bladder filling period, clinical manifestations of urgency and frequency, urinary incontinence and nocturnal enuresis. At present, more and more research on the relationship between unstable bladder syndrome and enuresis more attention, in the diagnosis of enuresis, should pay attention to this disease and identification.

 

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