Childhood Enuresis

　　The possibility of childhood enuresis may be related to the following factors:

　　1. Genetic Factors

　　Nocturnal enuresis usually shows dominant inheritance in families. If both parents have been bedwetting patients, their children have a 3/4 chance of developing the condition. If only one parent has been a bedwetting patient, their children have a 1/2 chance of being affected.

　　2, Disease factors

　　Enterobiasis (stimulation of the urethral orifice by the worm body), urinary tract infection, kidney disease, local inflammation of the urethral orifice, spina bifida, spinal cord injury, sacral nerve dysfunction, epilepsy, incomplete brain development, small bladder volume, and other diseases, but enuresis caused by diseases only accounts for a small proportion. The vast majority of children's bedwetting is related to mental factors, hygiene habits, and environmental factors.

　　3, Deep sleep

　　Unable to wake up in time to urinate.

　　4, Delayed development of nocturnal bladder control ability

　　Due to the delayed development of nocturnal bladder control ability, with the increase of age, the symptoms of nocturnal enuresis may improve, and bedwetting may stop; but it may take several years to stop nocturnal enuresis, and even 1% of people may continue to wet the bed after entering adolescence.

　　5, Environmental factors

　　Environmental changes, such as changes in climate like cold, and other factors. In addition, drinking too much water before going to bed, eating fruits with high water content and diuretic effects, and parents not helping their children urinate in time when they have a desire to urinate at night can all cause children to wet the bed.

　　6, Unable to produce enough antidiuretic hormone

　　Antidiuretic hormone is a hormone naturally produced by the human body that can reduce urine volume. About 20% to 30% of children with nocturnal enuresis cannot produce enough antidiuretic hormone while sleeping.

　　7, Other

　　Some children have not received urinary training, such as long-term use of diapers, parents not waking the child up at night, or even some parents helping their children urinate while they are sleeping on the bed, causing the child to develop a habit of urinating while sleeping, which can easily lead to nocturnal enuresis over time.

　　Enuresis in children generally does not have complications, but can cause nervousness, inferiority, and anxiety.

　　Children with enuresis often have personalities such as shyness, depression, and inferiority. When major changes occur in life, such as entering school, they are very uncomfortable, and with the strict requirements of teachers, they are burdened with heavy thoughts all day, which can cause enuresis. Some parents, when they find their child has wet the bed, often scold and beat them, which can further increase the child's emotional tension and produce feelings of shame and guilt, making it easy for enuresis to occur again and form a vicious cycle.

　　Most enuresis in children is primary enuresis, among which nocturnal enuresis is the most common, and boys are more common; about half of the nocturnal enuresis children wet the bed every night, even 2-3 times a night. After excessive activity, excitement, fatigue, or physical illness during the day, the frequency of enuresis often increases, and enuresis during the day is less common. Enuresis children often have symptoms such as night terrors, somnambulism, hyperactivity, or other behavioral disorders.

　　The prevention of enuresis in children should establish a good rest and hygiene habits from a young age, master the nocturnal urination routine, and wake the child up at regular intervals or use an alarm clock to gradually form a conditional reflex of timing, and cultivate the child's ability to take care of themselves. In addition, a good living environment should be provided to avoid enuresis caused by adverse environmental stimuli. When children face setbacks and accidents, parents should be good at guiding them, helping children to relieve psychological tension, and when children have enuresis, they should not scold or punish them, but should find the cause and treat it accordingly.

　　When training children to urinate, they should first understand the 'urination intention' and have the willingness to urinate. They should feel unpleasant after urinating. The training of children's urination should be coordinated with their level of development. Guide parents to pay attention to the child's response to urination training, such as if the child refuses, parents should not force intervention and should appropriately delay the training time.

　　The examination of bedwetting in children includes physical examination and laboratory examination. The specific examination methods are described as follows.

　　1, Physical examination

　　The focus of physical examination is abdominal palpation, examination of reproductive organs, and examination of the nervous system. Additionally, observe the appearance of the lower end of the spine for small凹 and skin abnormalities. If there are abnormal urination symptoms in the medical history, observe the child's urination. Most bedwetting children do not show any abnormalities in physical examination.

　　2, Laboratory examination

　　Routine urine tests or urine culture should be performed to rule out urinary tract infections, chronic kidney diseases, etc.; urine specific gravity test to exclude bedwetting caused by deficiency of antidiuretic hormone. Most bedwetting children have simple causes, but a few patients may need detailed examinations, including the laboratory examination process for bedwetting.

　　The types of bedwetting in children are different, and the dietary therapy recipes are also different. The specific dietary therapy recipes are described as follows.

　　1,山药,益智仁(salted fried), and huoxiang each 60 grams, pork bladder 1. Grind the first three into fine powder, wrap them in gauze, and boil with pork bladder until cooked. Eat twice a day, eat the meat and drink the soup.

　　This recipe is suitable for bedwetting due to insufficient kidney yang.

　　2, Mutton 250 grams, garlic 15 grams, spices in appropriate amount. Wash the mutton, boil it, slice it, crush the garlic, and mix it in a plate with appropriate amount of cooked oil (or cooked oil chili), soy sauce, and refined salt. Mix well and eat.

　　This recipe is suitable for bedwetting due to kidney deficiency.

　　3, Dog meat with bones 1500 grams, clear chicken broth 1500 grams, tangerine peel, green onion, chili, spices in appropriate amount. Cut the dog meat into pieces, cut the green onion into segments, and cut the chili into thin strips. Heat the pot, add 30 grams of peanut oil, and stir-fry minced garlic and appropriate amount of bean paste. Add ginger slices and green onion. While stir-frying, add peanut oil to the dog meat, stir-fry for about 5 minutes, add cooking wine, chicken broth, salt, tangerine peel, soy sauce, and brown sugar, bring to a boil, then transfer to a pot and simmer for 90 minutes. Add monosodium glutamate before serving and eat as a side dish.

　　This recipe is suitable for bedwetting due to kidney yang deficiency.

　　4, Mutton 150-250 grams, fish maw 50 grams, Astragalus 30 grams, spices in appropriate amount. Wash the mutton, slice it, and boil it with fish maw and Astragalus. Add cinnamon, ginger, salt in appropriate amount, and cook until done. Drink the soup and eat the meat and fish maw.

　　Applicable: bedwetting caused by kidney yang deficiency.

　　5, White fungus (shell and kernel removed) 10 grams, dried bean skin 50 grams, white rice in appropriate amount. Due to the toxicity of white fungus kernels, boiling for a relatively long time can volatilize and destroy it. It is best to use a cooking pot with a lid with holes for ventilation (or leave a gap in the lid, do not close it tightly), so that the toxicity is more easily volatilized and lost. Boil white fungus, dried bean skin, and white rice together to make a thick porridge, which can be eaten as a meal.

　　Applicable: Enuresis due to spleen and lung Qi deficiency.

　　6. Fresh pig urinary bladder (bladder) 1-3 pieces (depending on age), Astragalus 20 grams, salt to taste. First, clean the pig urinary bladder, put 10 grams of Astragalus and appropriate salt in each bladder, tie the bladder mouth with cotton thread, add a small amount of water, and simmer over low heat until soft. Discard the Astragalus, let the child eat the meat and drink the soup all at once or several times while it is hot. If not cured, another dose can be taken after 1 week, and 3 doses make a course of treatment. 80% of the children can be cured.

　　Applicable: Enuresis in children due to spleen and lung Qi deficiency.

　　7. Plantago asiatica 15 grams, pig bladder 1. Clean both and cook in water, then remove the medicine residue and take the decoction.

　　Applicable: Children with enuresis due to damp-heat in the liver meridian.

　　8. Lysimachia christinae 15 grams, chicken intestines 1-2 pairs. Cut the chicken intestines open, clean them, and cook with Lysimachia christinae in water. Remove the medicine residue and take the decoction.

　　Applicable: Enuresis due to damp-heat in the liver meridian.

　　9. Rosehip 10 grams, Chinese dates, lychee 15 grams, Cynanchum divaricatum 10 grams, pig bladder 1. The ingredients are all added to the pig bladder and steamed until cooked, then eaten.

　　Applicable: Children with enuresis due to weakened physique.

　　10. Chicken kidneys 1 pair (roasted to yellow), Astragalus 18 grams, Aspidistra elatior 1.2 grams (fried), Oyster 18 grams, Cinnamon twig 0.5 grams. The medicine is in powder form, take 4 grams each time, decocted in water.

　　Applicable: Childhood enuresis.

　　11. Astragalus 9 grams, Cinnamomum cassia 6 grams, White peony 6 grams, Eucommia 9 grams, Codonopsis 12 grams, Alisma orientale 5 grams, Psoralea 6 grams, White boshi 9 grams, Aspidistra elatior 10 grams, Osseous coral 9 grams, Morinda officinalis 9 grams, Rubus fruticosus 9 grams, Schisandra chinensis 3 grams, Cassia seed 6 grams, Lycium barbarum 6 grams, Cinnamon twig 6 grams, Jujube 3 pieces, Malt sugar 9 grams. Decoct the medicine, take 1 dose a day, divided into 2 servings.

　　Applicable: Childhood enuresis.

　　The treatment for childhood enuresis includes general treatment, behavioral therapy, and medication, and the specific inspection methods are as follows.

　　1. General Treatment

　　Develop good rest and hygiene habits, avoid overexertion, master the timing and regularity of bedwetting, and wake the child up to urinate 1-2 times at night with an alarm clock. Sleep for 1-2 hours during the day, avoiding excessive excitement or intense exercise to prevent deep sleep at night. Throughout the treatment course, maintain confidence. Gradually correct shyness, anxiety, fear, and timidity, taking into account the patient's self-esteem, offering more comfort and encouragement, and fewer reprimands and punishments to alleviate their psychological burden, which is the key to treatment success. Properly handle the mental factors causing enuresis, understand the mental triggers and possible psychological contradictions leading to enuresis through medical history, and address any solvable mental stimuli as soon as possible. For conflicts and problems that have already occurred or are objectively existing and subjectively unsolvable, focus on educating and explaining with patience to eliminate mental tension and avoid emotional unrest. Avoid drinking water after dinner, and empty the bladder before going to bed to reduce the frequency of bedwetting.

　　Second, behavioral therapy for children with bedwetting

　　1. Urination interruption training Encourage the child to interrupt urination in the middle of each urination, count from 1 to 10 by themselves, and then empty the urine, which can train and improve the bladder sphincter's ability to control urination.

　　2. Urination retention training Let the child drink more water during the day, when they have the urge to urinate, let them hold it, no more than 30 minutes each time, train 1-2 times a day, so that the bladder expands, increases capacity, and thus reduces the frequency of nocturnal urination.

　　3. Timed training At the time when the child often urinates at night in the past, use an alarm clock combined with human call to wake the child up half an hour earlier, let them move back and forth indoors, or wash their face with cold water, so that they can empty their urine in a conscious state, the purpose is also to help establish a conditioned reflex.

　　4. Parents need to timely discover the child's bedwetting Encourage the child to empty the residual urine, dry the local area, change underwear, and handle the dry bed.

　　5. Summarize records Parents should record the reasons and frequency of bedwetting every day, mark the bedwetting and non-bedwetting on the schedule, summarize once a week, find out the reasons, and encourage the child when they make progress.

　　6. Try to drink less water at night

　　Third, drug treatment

　　1. Imipramine A central nervous system stimulant that can reduce sleep depth, taken orally every night, suitable for arousal disorder type.

　　2. Oxybutynin Also known as diuretic, it can reduce intravesical pressure, increase capacity, reduce involuntary bladder contraction, taken orally before bedtime, suitable for diurnal and nocturnal frequency type.

　　3. Ephedrine Taken orally before bedtime, increases the contraction force of the bladder neck and the posterior urethra, and also has a central nervous system stimulatory effect, suitable for mixed type.

　　4. Desmopressin An artificial synthetic antidiuretic hormone, also known as Miacalcin, taken orally before bedtime, suitable for nocturnal polyuria type.

　　The combined application of amitriptyline, desmopressin, and oxybutynin is currently considered the 'golden combination' for treating nocturnal enuresis. With a course of 3 months, the advantages are that it works quickly, but the disadvantages are that there are varying degrees of side effects and it is easy to relapse after discontinuation.