遗尿（尿床）Enuresis (bedwetting)

尿失禁或遗尿（尿床）

什么是尿失禁（遗尿）？

尿失禁（遗尿）是尿床的医学术语。尿失禁是指在本来能够控制自己膀胱的年龄的孩子，有意外或故意的排尿。女生通常早于男孩获得膀胱控制。年龄超过5岁的女孩和超过6岁的男孩，仍然有排尿控制问题，就可能诊断尿失禁。有不同类型的尿床可能发生，包括以下内容：

·白天遗尿。白天湿裤子。

·夜间遗尿。夜间湿裤子。

·原发性遗尿。这发生在当孩子从来没有完全掌握如厕训练时。

·继发性遗尿。这发生当孩子确实有一个时期不湿裤子，但随后又回到失禁期。

预防和风险评估

关于尿失禁有哪些关键性事实吗？

根据美国儿科学会：

·尿床会影响到20％的5岁儿童，10％的6岁儿童，以及3％的12岁儿童。

·夜间遗尿发生在男孩的机会比女孩多两倍。

·遗尿的儿童中，大部分在夜晚尿湿裤子。

·原发性遗尿是儿童尿失禁最常见的形式。

是什么原因引起尿失禁？

可能涉及许多因素，也有许多理论来解释为什么儿童尿湿裤子。以下是这个问题可能原因的列表：

·如厕训练差

·保存尿的能力延迟。 （这可能是一个直到约五岁的因素。）

·小膀胱

·睡眠习惯差或存在睡眠障碍

·有助于调节排尿的荷尔蒙正常运作出现了问题

·大多数尿床的孩子至少有一个父母或近亲，在儿童时期也曾遭受过尿床

·影响睡眠的药物

诊断

如何诊断尿失禁？

尿失禁（遗尿）的诊断通常是基于完整的病史和你孩子的体检。除了与你和孩子谈话，你孩子的医生可能进行以下检查来帮助排除其他原因引起的尿湿裤：

·验尿（以确保没有潜在的感染或疾病，如糖尿病）

·测量血压

·验血

治疗

尿失禁（遗尿）有什么治疗？

你孩子的医生将根据以下情况来确定遗尿的具体治疗：

·您孩子的年龄，整体健康状况和病史

·病症的程度

·您的孩子对特定的药物、手术或治疗的耐受力

·对这种状况过程的预期

·您的意见或偏好

开始治疗前，重要须知：

·孩子是完全没有责任的，绝不应该受到惩罚。孩子是无法控制尿湿裤子的。

·根据美国糖尿病、消化道和肾脏疾病研究所的研究，受影响的孩子到5岁以后，遗尿每年的自然消失率大约为15％。

治疗可包括：

·儿童的积极强化（比如使用贴纸图表来记录没有湿裤子的夜晚）

·使用夜间报警，有助于当尿湿时告诉孩子

·药物，由您孩子的医生开出（以帮助控制尿湿）

·膀胱训练，以帮助提高膀胱容量，也提高孩子对何时他们必须去排尿的认知能力（这项是这样来完成的，在白天让孩子等待尽可能长的时间去排尿，并让膀胱得到充盈）

·晚上减少饮水（如果孩子认为它有帮助的话，美国儿科学会建议这个方法），避免咖啡因

此外，孩子及其家庭的咨询可能有助于确定孩子可能有的一些压力。

Urinary Incontinence or Enuresis (bedwetting)

What is urinary incontinence (enuresis)?

Urinary incontinence (enuresis) is the medical term for bedwetting. Incontinence is accidental or intentional urination in children who are at an age where they should be able to have control of their bladders. Girls usually obtain bladder control before boys. Incontinence may be diagnosed in girls older than age 5 and in boys who are older than age 6 who are still having urinary control problems. There are different types of bedwetting that may occur, including the following:

·Diurnal enuresis.Wetting during the day.

·Nocturnal enuresis. Wetting during the night.

·Primary enuresis. This occurs when the child has never fully mastered toilet training.

·Secondary enuresis.This occurs when the child did have a period of dryness, but then returned to having periods of incontinence.

Prevention & Risk Assessment

What are some key facts about urinary incontinence?

According to the American Academy of Pediatrics:

·Bedwetting affects 20 percent of 5-year-olds, 10 percent of 6-year-olds, and 3 percent of 12-year-olds.

·Nocturnal enuresis occurs two times more frequently in boys than in girls.

·Of the children with enuresis, most have wetting at night.

·Primary enuresis is the most common form of urinary incontinence among children.

What causes urinary incontinence?

There are many factors that may be involved, and many theories that are given for why children wet. The following is a list of some of the possible reasons for the problem:

·Poor toilet training

·Delay of the ability to hold urine. (This may be a factor up to about the age of five.)

·Small bladders

·Poor sleep habits or the presence of a sleep disorder

·A problem with the proper functioning of hormones that help to regulate urination

·Most children who wet the bed have at least one parent or a close relative who also suffered from bedwetting as a child

·Medication that affects sleep

Diagnosis

How is urinary incontinence diagnosed?

Urinary incontinence (enuresis) is usually diagnosed based on a complete medical history and physical examination of your child. In addition to talking with you and the child, your child's doctor may perform the following to help rule out other causes for the wetting:

·Urine tests (to make sure there is not an underlying infection, or condition, such as diabetes)

·Blood pressure measurement

·Blood tests

Treatments

What is the treatment for urinary incontinence (enuresis)?

Specific treatment for enuresis will be determined by your child's doctor based on:

·Your child's age, overall health, and medical history

·Extent of the condition

·Your child's tolerance for specific medications, procedures, or therapies

·Expectations for the course of the condition

·Your opinion or preference

Prior to starting treatment, it is important to know that:

·The child is not at fault and should not be punished. The child cannot control the wetting.

·According to the National Institute of Diabetes and Digestive and Kidney Diseases, after age 5 enuresis disappears naturally at a rate of about 15 percent of affected children each year.

Treatment may include:

·Positive reinforcement of the child (such as the use of sticker charts for dry nights)

·Use of night-time alarms to help tell the child when wetting is occurring

·Medications, as prescribed by your child's doctor (to help control the wetting)

·Bladder training to help increase the bladder size and the child's ability to know when they have to urinate (this is done by having the child wait as long as possible during the day to urinate and let the bladder get full)

·Decrease fluids (AAP suggests this approach if the child believes it helps) and avoid caffeine at night

In addition, counseling of the child and family may help to determine any stress the child may be under.