尿失禁或遺尿（尿床）
什么是尿失禁（遺尿）？
尿失禁（遺尿）是尿床的醫(yī)學(xué)術(shù)語。尿失禁是指在本來能夠控制自己膀胱的年齡的孩子，有意外或故意的排尿。女生通常早于男孩獲得膀胱控制。年齡超過5歲的女孩和超過6歲的男孩，仍然有排尿控制問題，就可能診斷尿失禁。有不同類型的尿床可能發(fā)生，包括以下內(nèi)容：
·白天遺尿。白天濕褲子。
·夜間遺尿。夜間濕褲子。
·原發(fā)性遺尿。這發(fā)生在當(dāng)孩子從來沒有完全掌握如廁訓(xùn)練時。
·繼發(fā)性遺尿。這發(fā)生當(dāng)孩子確實有一個時期不濕褲子，但隨后又回到失禁期。
預(yù)防和風(fēng)險評估
根據(jù)美國兒科學(xué)會：
·尿床會影響到20％的5歲兒童，10％的6歲兒童，以及3％的12歲兒童。
·夜間遺尿發(fā)生在男孩的機會比女孩多兩倍。
·遺尿的兒童中，大部分在夜晚尿濕褲子。
·原發(fā)性遺尿是兒童尿失禁最常見的形式。
可能涉及許多因素，也有許多理論來解釋為什么兒童尿濕褲子。以下是這個問題可能原因的列表：
·如廁訓(xùn)練差
·保存尿的能力延遲。 （這可能是一個直到約五歲的因素。）
·小膀胱
·睡眠習(xí)慣差或存在睡眠障礙
·有助于調(diào)節(jié)排尿的荷爾蒙正常運作出現(xiàn)了問題
·大多數(shù)尿床的孩子至少有一個父母或近親，在兒童時期也曾遭受過尿床
·影響睡眠的藥物
診斷
尿失禁（遺尿）的診斷通常是基于完整的病史和你孩子的體檢。除了與你和孩子談話，你孩子的醫(yī)生可能進行以下檢查來幫助排除其他原因引起的尿濕褲：
·驗?zāi)颍ㄒ源_保沒有潛在的感染或疾病，如糖尿病）
·測量血壓
·驗血
治療
你孩子的醫(yī)生將根據(jù)以下情況來確定遺尿的具體治療：
·您孩子的年齡，整體健康狀況和病史
·病癥的程度
·您的孩子對特定的藥物、手術(shù)或治療的耐受力
·對這種狀況過程的預(yù)期
·您的意見或偏好
開始治療前，重要須知：
·孩子是完全沒有責(zé)任的，絕不應(yīng)該受到懲罰。孩子是無法控制尿濕褲子的。
·根據(jù)美國糖尿病、消化道和腎臟疾病研究所的研究，受影響的孩子到5歲以后，遺尿每年的自然消失率大約為15％。
治療可包括：
·兒童的積極強化（比如使用貼紙圖表來記錄沒有濕褲子的夜晚）
·使用夜間報警，有助于當(dāng)尿濕時告訴孩子
·藥物，由您孩子的醫(yī)生開出（以幫助控制尿濕）
·膀胱訓(xùn)練，以幫助提高膀胱容量，也提高孩子對何時他們必須去排尿的認(rèn)知能力（這項是這樣來完成的，在白天讓孩子等待盡可能長的時間去排尿，并讓膀胱得到充盈）
·晚上減少飲水（如果孩子認(rèn)為它有幫助的話，美國兒科學(xué)會建議這個方法），避免咖啡因
此外，孩子及其家庭的咨詢可能有助于確定孩子可能有的一些壓力。
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
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.
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
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
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.
