Enuresis

　　The exact cause of enuresis in children is still not entirely clear, and it is believed to be related to the following factors:
　　1. Genetic factors 30% of the fathers of enuresis children and 20% of the mothers of enuresis children also had enuresis when they were children. Conversely, if both parents have a history of enuresis, 40% of their sons and 25% of their daughters will also have this disease. In addition, the incidence of enuresis in twins and monozygotic twins is twice as high as that in dizygotic twins, indicating that enuresis has a genetic tendency.
　　2. Deep sleep This is a common factor. These children often play tired before going to bed, sleep deeply, are not easy to wake up, and often wet the bed in dreams. If they drink more water before going to bed, it is even more likely to happen.
　　3. Delayed maturation of bladder function Some children with enuresis have bladders that are smaller than normal children, and these children urinate more frequently in daily life, but the urine volume is not large. This is because there is not much urine in the bladder, so it contracts and urinates.
　　4. Mental tension Family discord, parental divorce, losing both parents, suffering abuse, and before college entrance exams, children have a significantly higher chance of bedwetting. However, this enuresis is often temporary, and after a period of time, the mental and emotional state will gradually disappear.
　　5. Factors of the disease Enuresis caused by organic diseases is not very common. Urinary tract infections, deformities, and conditions such as spina bifida, meningocele, etc., can cause enuresis. In addition, asymptomatic bacteriuria and hypercalciuria can also cause enuresis, which should be paid attention to.

　　Most children with enuresis have character traits such as timidity, passivity, oversensitivity, and excitability. Bedwetting can make the child ashamed, anxious, fearful, and shy. If parents do not consider the child's self-esteem and use methods such as beating, threatening, and punishment, it will make the child feel more wronged and depressed, increase the psychological burden, and the symptoms will not only not improve but worsen.

　　Enuresis commonly occurs in children aged 5 to 10, with boys being more prevalent. This condition is usually self-healing, and bedwetting disappears as age increases. It is divided into primary enuresis and secondary enuresis according to the onset time:
　　1. Primary enuresis Refers to children who have been bedwetting since birth, accounting for about 70-80% of children with enuresis. Most enuresis related to sleep disorders belongs to primary enuresis.
　　2. Secondary enuresis Refers to children who have not wet the bed for a period of time (about 3-6 months) within 5 years of age and then develop enuresis, accounting for about 20-30% of children with enuresis.

　　The main preventive measures for enuresis in children are:
　　1. Paying attention to the child's toilet training is a basic measure to prevent enuresis. The best time to start training is after the child is 1.5 years old. Starting the training too early, due to the immature development of the child's nervous system, the control mechanism of the cerebral cortex over the subcortical reflexive micturition is not yet fully perfected, and failure is often the result, which is bound to undermine the child's self-confidence. The main method of toilet training for children is to adopt positive reinforcement, rewarding the child immediately after each successful attempt.
　　2. It is advisable to avoid excessive fatigue during the day, arrange for children to rest on time, and go to bed early in the evening. Because after 3 hours of sleep, the bladder stores a certain amount of urine, which is when the child is sleeping the deepest, and it is difficult for them to wake up themselves. Calling the child to urinate once before going to bed can prevent bedwetting.
　　3. Avoid eating too salty for dinner, and eat less sweet foods and high-protein drinks after dinner to prevent thirst. Try to drink less water and beverages, such as milk, after dinner, and you can eat a small amount of fruit. At the same time, parents should encourage their children and remind them to get up at night to urinate. Do not punish or scold the child because of enuresis.

　　The diagnosis of enuresis in children not only relies on clinical manifestations but also requires essential auxiliary examination methods. The auxiliary examination items include urine routine, electroencephalogram, and CT examination of the urinary system.

　　The dietary注意事项 for children with enuresis mainly include:

　　Suitable diet
　　1. Warming and astringent foods. People with insufficient kidney qi should eat them, such as glutinous rice, gizzard, fish bladder, yam, lotus seeds, chive, black sesame, longan, and umeboshi.
　　2. Clear and nourishing foods. People with hyperactivity of the liver and gallbladder should eat them, such as glutinous rice, Job's tears, yam, lotus seeds, gizzard, tofu, silver ear, mung beans, red beans, and duck meat.
　　3. Dry rice. It is advisable for children to eat dry rice for dinner to reduce water intake.
　　
　　Prohibited diet
　　1. Milk, chocolate, and citrus fruits. Studies indicate that excessive intake of milk, chocolate, and citrus fruits in the diet is a major cause of nocturnal enuresis in children, with up to 60% of enuresis cases attributed to excessive milk intake. Stopping the consumption of these foods can almost immediately eliminate the enuresis. The reason is mainly that these foods can produce allergic reactions in children, causing the bladder wall to swell, reducing its capacity, and promoting the roughening of smooth muscle, leading to spasms. At the same time, this allergic reaction can cause children to sleep very deeply, unable to wake up when they need to urinate, leading to enuresis.
　　2. Spicy and刺激性 foods. Children's nervous system is not fully developed and they are easily excited. If they eat such foods, it can cause dysfunction of the cerebral cortex and increase the risk of enuresis. Therefore, it is advisable to avoid spicy and刺激性 foods in the diet.
　　3. Avoid drinking too much water after dinner. After 4 p.m., urge the child to control the amount of water intake, avoid liquid food, and drink as little water as possible for dinner to reduce the burden on the kidneys and reduce the amount of nighttime urination.
　　4. High-salt, sugar, and cold foods. Both high salt and sugar can cause polydipsia and polyuria, and cold foods can weaken the spleen and stomach function, which is not beneficial to the kidney, so they should be avoided.

　　The following treatment methods can be used for childhood enuresis:

　　Firstly, Behavioral Therapy
　　1. Setting Schedule: Starting from the first day of treatment, require the parents to set up a schedule for the child to record every day (calendar can be used). When bedwetting occurs, try to find out the factors that may lead to bedwetting and record them in the schedule, such as not sleeping on time, being too excited before going to bed, being too excited during the day, too much fluid intake in the evening, etc. When the child does not wet the bed, draw a star on the schedule and give oral praise or material rewards.
　　2. Establishing Conditional Reflex: Starting from the beginning of treatment, require the parents to wake up the child in advance by alarm clock half an hour to one hour before the child usually wet the bed at night, get up and urinate, so that the sound of waking up the child is presented at the same time as the stimulation of bladder filling, and after a period of training, the conditional reflex is established, and the child can be awakened by the stimulation of bladder filling to achieve the purpose of self-control of urination. In addition, encourage the child to urinate independently, the purpose is to make the child urinate clean under a relatively清醒 state.
　　3. Bladder Function Exercise: Encourage the child to drink more water during the day, try to extend the interval between two urinations, increase urine volume, and gradually increase bladder capacity. Encourage the child to interrupt urination during urination, count from 1 to 10, and then urinate completely to improve the control ability of the bladder sphincter.

　　Secondly, Drug Treatment
　　The treatment adopts a low-dose chlorpromazine in combination, and its mechanism of action is that the drug has an anticholinergic effect on the bladder, expanding the bladder capacity, stimulating the cerebral cortex, making the child easily wake up and urinate. During the treatment, it was found that some children may experience sleeplessness, decreased appetite, and excitation at the beginning of treatment, which generally disappear spontaneously after about 1-2 weeks without treatment.