RU2310481C1 - Method for affecting children in case of nocturnal enuresis to elaborate conditioned reflex for wakening up at signals for urination - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: just before going to bed it is necessary to put an elastic band on a boy's penis. The band induces pain effect being sufficient for wakening up at the onset of uncontrolled urination. The band should be tightened without any perceptible pressure. On wakening up at the onset of uncontrolled urination a patient should empty his urinary bladder. The procedure mentioned should be continued for about 1-2 wk till elaborating the conditioned reflex of wakening up. If necessary, the course should be repeated once again. In peculiar case, the band should be put on again after wakening up. The present efficient method enables to avoid the intake of any medicinal preparations by excluding any contraindications. It is cheap and requires no time for curative courses of physiotherapy, hypnosis or curative gymnastics. The most important advantage of the present innovation is the fact that it could be applied under domestic conditions.

EFFECT: higher efficiency.

1 cl, 1 dwg, 2 ex

Description

The invention relates to medicine and is intended for the treatment of pediatric nocturnal enuresis.

Enuresis - bedwetting. It occurs in preschool and school age (more often in boys). There are functional forms of enuresis due to exposure to psychogenic factors, upbringing defects, transmitted infectious diseases, as well as arising reflexively in diseases of the genitourinary system, and organic (a change in the spinal cord with developmental defects).

Nighttime involuntary urination during sleep is regarded as the result of the absence or insufficiency of conditioned reflex connections, which control the act of urination in a dream. Some children have an involuntary urine output during daytime sleep, and sometimes urge to urinate more often. Night incontinence affects up to 10-15% of children aged 5 to 15 years [Alon U.S. Nocturnal enuresis. Pediatr Nephrol 1995; 9: 94-103].

Under bed urinary incontinence (synonyms - enuresis, nocturnal enuresis) should be understood as involuntary urination in a dream, regardless of whether it occurs at night or in the daytime. Urination in a dream in children is recognized as a natural phenomenon. But at the age of 4-5 years, about 20% of children urinate in a dream, 6-7 years old - up to 10%, 15-17 years old - about 1%. Involuntary urination in a dream is more common in boys than in girls. In persons over 25 years of age, bedwetting is extremely rare.

Etiology and pathogenesis.

After birth, children empty the bladder from urine 20-30 or more times a day. Urination is carried out according to the type of unconditioned reflex: filling the bladder causes stretching of its walls and irritation of mechanoreceptors. Afferent impulses are transmitted to the spinal center of urination, located in the sacral region of the spinal cord. The response is urination.

As the child grows and develops, urination in a dream first stops in the daytime, and then at night. If in a dream there is a need for urination, then to complete this act the child wakes up. With age, as the physiological capacity of the bladder increases, the need for nocturnal awakenings for urination disappears, and the establishment of strong nerve connections between the spinal centers of urination, subcortical formations and the cortex relatively easily contributes to awakening.

At 4-5 years of age, most children are able to not only wake up to urinate, if necessary, but also control urination (suppress urges, interrupt urination if desired).

For some children, for a number of reasons, the ability to wake up for urination is not developed or lost, and then they with different frequencies experience involuntary urination in a dream. The reasons for this condition can be disturbances in any link of the complex reflex arc of urination: increased excitability of the interoreceptors of the bladder, redirection of the spinal cord center of urination, inadequate, and in some cases paradoxical reaction of subcortical formations to impulses coming along the reflex arc "bladder - spinal cord - subcortical formations - the cerebral cortex. " An important place in the development of enuresis is given to the inertia of the main nervous processes in the cerebral cortex, as a result of which the transition from diffuse inhibition to awakening is slow. If the need for emptying the bladder occurs during the phase of deep sleep, then the possibility of committing involuntary urination in a dream increases.

The current hypothesis of the occurrence of enuresis claims that it is associated with impaired production of one of the hormones - vasopressin. Among other functions, this hormone regulates the volume of urine produced. The more this hormone in the blood, the less urine is formed. Normally, the level of this hormone rises at night, thereby producing less urine. With enuresis, everything happens the other way around.

In addition to true nocturnal enuresis, there is also secondary enuresis, that is, associated with any diseases: mental illness, trauma, diseases of the central nervous system or previous operations on it, inflammatory diseases of the urinary system, diabetes mellitus, diabetes insipidus, chronic renal failure.

To date, one of the effective methods of treating childhood nocturnal enuresis is pharmacotherapy with desmopressin, which is produced by FERRING under the name ADIURETIN-SD® in the form of drops in the nose.

According to statistics from European clinics, after treatment with this drug, 80-85% of patients achieve a favorable result.

However, this drug has contraindications: hypersensitivity, anuria, edematous syndrome of various origins, plasma hypoosmolarity, decompensated heart failure, polydipsia (congenital or psychogenic), the need for diuretic therapy, predisposition to thrombosis. For iv administration - unstable angina, von Willebrand disease type IIb. For intranasal administration - allergic rhinitis, nasal congestion, swelling of the nasal mucosa, upper respiratory tract infections, impaired consciousness, state after surgery.

With caution, this drug should be used for renal failure, bladder fibrosis, childhood (up to 1 year), old age, impaired water-electrolyte balance, with a potential risk of increased intracranial pressure, pregnancy.

The drug also has side effects: intense headache, dizziness, nausea, rhinitis, nosebleeds, increased blood pressure, compensatory tachycardia (with iv administration), spastic abdominal pain, algomenorrhea, conjunctivitis, decreased tearing, skin hyperemia, allergic reactions ( before anaphylactic shock), hyponatremia or water intoxication (confusion, coma, weight gain, edema); swelling, local hyperemia, pain at the injection site.

Herbal sedatives (valerian, motherwort) are also widely used. On the recommendation of the attending physician, diazepam is used (especially with Hinman syndrome), librax, and other drugs.

In the 60s, American pediatricians first used melipramine to treat enuresis. It can be prescribed for both primary and secondary enuresis with neurogenic bladder dysfunctions. The effectiveness of the use of the drug imramine is associated with a high dose and duration of use. The effect is on average between 40 and 70% (Kass et al., 1989; DeCatta M.M.F e.a., 1990). However, positive changes in the clinic of enuresis can be obtained by taking subtherapeutic doses (Jorgensenet. Al., 1980).

M-anticholinergics or anticholinergics (atropine, belladonna) have been used to treat enuresis for more than 100 years. They are effective especially for hypermotor disorders of the bladder. They help improve the adaptive or reservoir function of the bladder (M.D. Javad-Zade, et al., 1989). Decreased tonus and relaxation of the detrusor in a dream increases its reservoir capacity and reduces motor activity (non-inhibited contractions), thereby preventing nighttime urinary incontinence. The most common complications of M-anticholinergics are: dry mouth, constipation, decreased visual acuity, nausea, gastric discomfort, hot flashes (hot flashes are common in children and decrease with decreasing doses), difficulty urinating. With an overdose of the drug, a CNS disorder is possible (from anxiety and agitation to a psychotic state); disorders of the cardiovascular system (hot flashes, drop in blood pressure); respiratory failure, muscle paralysis, coma are possible.

Acupuncture, homeopathic and phytotherapeutic agents, hypnosis are also widely used.

Physiotherapy is carried out in consultation with a specialist, depending on the identified functional disorders of urination. When hyperreflexion, local procedures are recommended (sinusoidal modulated currents - SMT, ozokerite, paraffin, electrophoresis with atropine in a positive test, electrical stimulation of the perineum or anal sphincter, etc.). Hyporeflex bladder is treated with SMT (in another mode), electrophoresis with vitamins, proserin, calcium or bromine. The complex of physical treatment methods also includes balneotherapy (for example, salt-coniferous or herbal baths) and exercise therapy.

Biorehabilitation, or the biofedbak method, involves the active or passive participation of the patient to develop a conditioned reflex to urinate and teach the patient how to manage bladder function.

EMISSION OF THE CONDITIONAL REFLEX FOR URINE

Using hypnotic suggestion and preliminary natural saturation of the body with water, B.Ya. Laskov and A.Ya. Kramer (1975) successfully developed in patients with enuresis a conditioned reflex to urination using hypnosis. Before hypnotic exposure, the patient is given to drink up to 2-3 glasses of sweet tea. He is informed that a “special substance” is dissolved in a glass that cures urinary incontinence. The patient is convinced of the need to wake up when urging to urinate. Then it is introduced into a hypnotic dream. Course number 10.

To develop a conditioned reflex to awakening in patients with bedwetting (in children after 7 years), electric sleep is used (B.I. Laskov, A.Ya. Kramer, 1975). Back in 1908-1919, devices were created based on the closure of the electric network under the action of a drop of involuntarily released urine (cited by M. I. Buyanov, 1985), which moistened the gasket and closed the electric circuit (electric alarm). When the circuit is closed, a signaling device (acoustic, light or electric) is activated that awakens the patient. It is important that the device is triggered at the initial moment of involuntary urination in a dream - by the allocation of the first drop of urine. In this case, the desired reflex is developed: the urge is awakening (G.F. Kolesnikov, 1989).

In the USSR, the first AL-2M apparatus for this purpose was developed by B.I. Laskov, A.Ya. Kramer (1975), who successfully used it in more than 90% of patients (in 206 patients).

Adults, adolescents and children over 9 years of age are subject to treatment on devices with skin irritation by electric shock (with a pain stimulus). Since a complication is possible: inadequate pain effect and even skin burns (Valcova Z., 1971), the method requires careful nightly monitoring of the patient.

For the treatment of young children, devices with a sound stimulus can be used - an “alarm clock with a bell”, which is attached to the patient’s collar. Contact electrodes are attached to the patient's underwear. For this purpose, foreign devices AL-2M, Wett-Stop, etc. are used (N. Malemet.al., 1982; S. Discheet.al., 1983). The course of treatment is about 30 days. The cure criterion for the “laying-bell” system is the average level — less than one involuntary urination at night for 1 week (S. Diche et. Al., 1983). Now an effective treatment with an enuresis alarm is considered if the patient is dry for 21 days. If relapse, then treatment is repeated.

50 years of experience using an enuresis alarm showed its high efficiency - up to 81% of patients, if the electrodes are fixed on linen, and if on the bed, then the efficiency decreases to 68%. After 6-12 months, treatment efficiency is observed in 75% of patients, in 10% - improvement, and in 15% - no effect. On average, the effectiveness of treatment with an enuresis alarm clock is 65-79% (Forsythe W.I. E.A., 1989).

However, there is still no single treatment for nocturnal enuresis, which would give good results in all cases.

The closest in terms of exposure is US patent No. US 5043704, which describes a device that is worn on the pubic area under the genitals, and includes a humidity sensor that detects the release of even a small amount of urine and informs about it with an audible signal.

However, at night it is sometimes difficult to wake up from the sound, and even if the signal wakes the person well, a person suffering from nocturnal enuresis does not usually have time to quickly respond to spontaneous urination.

The inventive method eliminates these disadvantages, but has limitations on the gender and age of the child due to the physiology of the body. It is applicable only to boys aged 8-10 years.

The technical result consists in an effective method of influencing the body to develop a conditioned reflex of awakening during urge to urinate in children suffering from nocturnal enuresis. Also, the inventive method allows you to refuse to take any medications, excluding any contraindications. The method is cheap and does not require time, which is usually spent on medical courses of physiotherapy, hypnosis or therapeutic exercises. The most important advantage of the method is the possibility of its use at home.

This result is achieved due to the fact that immediately before going to bed (see drawing) on the base of the penis (1) of a boy suffering from nocturnal enuresis, an elastic girdle (2) is put on, tightened with the lock (3) easily, without noticeable pressure. During sleep, a slight irritation of the penis by the girdle occurs, which causes an erection. The girdle is elastic enough not to disrupt the blood supply to the penis, and at the same time, it significantly presses on the urethra. At the beginning of uncontrolled urination, an obstruction in the form of a belt causes a slight pain effect, which is enough to wake up.

This effect eliminates the inherent disadvantages of using the device of patent No. US 5043704.

After waking up and emptying the bladder, the belt is put on again, however, practice shows that one waking up per night is enough.

The procedure lasts 1-2 weeks, during which the reflex of awakening during the urge to urinate is fixed, and the need for the use of a belt disappears.

If necessary, the course is repeated after some time.

Case studies:

Example No. 1.

Patient A., 11 years old, suffered from nocturnal enuresis from birth. The described method was applied. After a one-time briefing, A. wore a belt on his own. During the first three nights, re-donning of the girdle after the first awakening was recommended. After a week of application of the method, the use of the belt was discontinued. Over the next week, after a one-time fact of enuresis, the method of exposure was repeated for five days, after which the reflex of awakening was fixed and 100% recovery was recorded.

Additional observation. Re-donning the belt had a certain difficulty due to the fact that the child did not wake up completely and lost the belt in half-asleep condition.

Example No. 2.

Patient S., 13 years old, suffered from nocturnal enuresis from birth. The described method was applied. After a one-time briefing, the belt was put on by S. independently. In addition to method C. deliberately limited fluid intake in the evening and used the belt once a night. It took one week to develop and consolidate the awakening reflex. The effect of recovery is 100%.

Claims (2)

1. A method of influencing the body to develop a conditioned reflex of awakening when urinating in children suffering from nocturnal enuresis, characterized in that immediately before going to bed on the base of the penis of a boy suffering from nocturnal enuresis, an elastic girdle is put on, causing uncontrolled urination at the beginning pain effect sufficient to wake up, tighten the girdle without noticeable pressure, after waking up at the beginning of uncontrolled urination empty the bladder, Same operation was continued for 1-2 weeks to produce reflex awakening course repeat if necessary. 2. The method of influencing the body to develop a conditioned reflex of awakening according to claim 1, characterized in that after awakening and emptying of the bladder, the girdle is put on again.