Treatment of urinary incontinence in children
In most cases, in the absence of organic disorders, urinary retention is established spontaneously at 6 years of age; treatment is not recommended. The probability of spontaneous disappearance of enuresis in children older than 6 years is 15% per year. The psychological consequences of enuresis, which can develop (eg, shyness), make the need for treatment more pressing after 6 years of age.
Primary counseling is very useful, in order to dispel misconceptions about nocturnal enuresis. The child is told the etiology and prognosis of enuresis, while the goal is to remove the feeling of guilt and shame. The child is given an active role, including talking with a doctor, urinating before going to bed, keeping a diary, which indicates dry and wet nights, independent change of wet clothes and bed linen. The child should not drink liquids for 2-3 hours before bedtime, strictly containing caffeinated beverages. Positive reinforcement is given for dry nights (for example, a star calendar and other age-appropriate rewards).
In addition, it is effective to use special signaling devices, which are often recommended to be used in parallel with behavioral therapy. According to the results of two studies of children aged 5-15 years, it was found that a positive effect was observed in 70%, while the relapse rate was only 10-15%. These devices are easy to use, they are available, and the sound signal is provoked by several drops of urine. The disadvantage is the time needed to achieve total success: during the first few weeks the baby wakes up after a full discharge of the bladder; In the next few weeks, partial retention of urination is achieved; and eventually the baby wakes up with a reaction to bladder contraction before urination occurs. This device should be used for three weeks after the last wet night.
Drug therapy can be effective in patients who do not respond to the above methods. Short courses (4-6 weeks) of desmopressin acetate (a synthetic analogue of ADH) in the form of a nasal spray are usually used in patients 6 years and older with persistent, frequent nocturnal enuresis. The recommended initial dose is one inhalation in each nasal passage (20 μg in total) before going to bed. In the presence of effect, the dose can sometimes be reduced to one inhalation (10 μg); in the absence of effect, the dose can be increased to 2 inhalations in each nostril (only 40 μg). Side effects are rare, especially if the recommendations for dosing are followed, but may include headache, nausea, flushing of the nasal mucosa, nosebleeds, sore throat, cough, sudden flushing of the face, and mild intestinal colic.
Imipramine and other tricyclic antidepressants are no longer recommended as first-line drugs due to side effects (eg, agranulocytosis); potential hazard and threat to life in case of accidental excess admission and a higher frequency of good effect when using signaling devices for the treatment of enuresis. If other methods of treatment are ineffective and the family is strongly interested in treatment, imipramine can be used (10-25 mg orally at bedtime, increasing at intervals of one week by 25 mg to a maximum dose of 50 mg in children 6-12 years of age and 7 mg in children over 12 years). The effect of prescribing imipramine is usually observed in the first week of treatment, which gives him an advantage, especially if a quick effect is important for the family and the child. If a child does not have enuresis within a month, the drug can be gradually canceled within 2-4 weeks. Recurrence of enuresis occurs very often, which reduces the frequency of positive long-term results to 25%. If there is a return of symptoms, you can try to appoint a patient a 3-month course of treatment. Control of the blood test for the detection of agranulocytosis, a rare effect of therapy, should be done every 2-4 weeks of treatment.