an aetiology and a pathogenesis of disorders of an emiction.

For last two decades steady growth of number of diseases of organs MVS bound to disturbance urodinamiki of distal departments of urinary ways becomes perceptible. The leading place on frequency among emiction disturbances (MI) is occupied with neurogenic dysfunctions of a bladder (NDMP) [77, 121, 171, 241, 297, 325].

NDMP are the most widespread and various disturbances under the form rezervuarnoj and evakuatornoj functions of a bladder (MT). They develop at lesions of nervous system at various levels: from a cortex of a brain to intramuralnyh MT ganglions [29, 57, 110, 156, 212, 216].

Disturbances MI are formed under the influence of many factors among which the leading place is taken away to stressful influences, to innervation disturbances, neurosises, the neurosis-like conditions, sharply changing conditions of psychosocial space of the person, to a genetic predisposition etc. the attention Recently is focused on psychosomatic aspects of pathology MI [16, 133, 146, 220, 326].

Conscious control MI appears at children by 2-3 years in the afternoon and at the majority is fixed at the age of 3-4 years that is bound to age features of maturing of the centres of regulation in head and a spinal cord, myelination of peripheric nervous fibers. By 4-5 years the control over a bladder is reached at night, thus at boys it is formed later, than at girls. Control MI allows the child to control day and night functions of the body, and also provides its adequate socialisation. However it is possible to speak about mature type of an emiction, when at the child strong-willed management sfinkternym was generated by MT apparatus: thus it completely keeps urine in MT day and night, is able to detain and interrupt if necessary certificate MI [74, 145, 246, 250].

In age aspect formation of "mature type of an emiction coincides with proctal (1,5-3,5 years) and fallicheskoj stages (3,5-6 years) (on Z.Freud) psychosex development of the person [129, 198, 199]. During this period of time parents activly develop at the child skills of cleanliness, neatness, ability to use a pot, and then and a toilet bowl. In the course of education parents encourage skills of neatness or show the discontent at their non-observance. As a result the child starts to understand what behaviour in society is preferable. Only correctly generated and motivatsionno skill MI supported with parents and defecations in a pot, quickly accustoms the child. In this process important everything, including a choice parents of capacity for realisation of physiological departures of the child - a pot. According to domestic and foreign references to start to accustom the child to a pot follows on the average from 18 months. It is important, that the pot had simple, but convenient for planting of the child the form, has been made of the certificated and easily washing materials, was monophonic. It is necessary to exclude from use the pots carrying double function (a pot-toy, a pot-stool etc.), painted in
Numerous bright colours. Thus, since the very first days of use the pot at the child should be bound only to certificates MI and defecations, instead of to associate with a place of game, a dream or food intake [23, 38, 107, 209]. Within several years the child, learning itself, studies to supervise MI and a defecation, testing thus satisfaction from control of functions of the body.

During this period parents should be tactful and patient, to provide psychological comfort in a family. It is established, what even insignificant stresses and furthermore punishment of the child for non-observance of skills of neatness, in 70-75 % of cases can lead to development of an incontience of urine (in the afternoon and-or at night), kalomazanija and-or a chronic constipation of functional character [167, 197, 277, 281, 290]. On this background pathological forms of the person, for example, in the form of so-called enuresticheskogo character which are shown by pathological greed, by an extreme pedantry and perfektsionizmom can be generated. At problem passage proctal and the more so fallicheskoj stages of psychosex development, in the child can arise various psychological complexes, that in an adult life can lead to disturbance of sexual identification, to problems in mutual relations with persons of the or an opposite sex, to inclination pathologies. Thus, correct development of strong-willed control MI directly depends on efforts of parents and is one of key stages of mental development of the child [8, 9, 106, 129, 171, 187, 222].

For today it is considered to be various stressful situations one of key releasers in development of pathology MI of a functional genesis. Influence of the stressful factors causing anxiety, pavor or alarm, at children at the age from two till four years has been in the late sixties of the XX-th century established, that, conducts to failure of processes of formation of control MI during a dream, to development further NDMP and urine incontiences. A physiological substantiation of the given process are domestic and foreign concepts of functioning of open nonlinear biological systems which the human body concerns: the theory of functional systems (the Item To Anokhin), the theory avtopoeza (N. Luhmann) and the theory of fractals (JU.V.Tchaikovsky, A. MacKenzie). Important value at pathology formation in nonlinear biological systems is taken away to the bound among themselves and supplementing processes bound among themselves each other dissipativnosti (tendencies to simplification of the organisation of system) and hierarchies (subordination of the lowest elements of system by the higher) [11, 60, 139, 156, 193, 196, 202].

In a number of works on neurophysiology and urology authors bind disturbances MI and urodinamiki to a delay of maturing of the higher centres of the vegetative regulation which are carrying out the control of the bottom departments of urinary ways [67, 72, 115, 146, 148, 317]. An important role in formation of disturbances MI researchers take away gipotalamo-gipofizarnoj failures. It changes in work of vegetative nervous system during wakefulness (a hypertonus and hyperactivity of sympathetic and parasympathetic departments) [29, 67, 82, 148, 172] confirm not rasping, obshchemozgovye disturbances of bioelectric activity of a brain at children with pathology MI, taped at an electroencephalography, and also. Development of disturbances MI is affected by deviations in a biological rhythm the "dream-wakefulness", bound to disturbances of processes of regulation in a limbiko-reticular complex, and also pathological changes in
Various departments of endocrine system (gipofizarno-nadpochechnikovom, gipofizarno-sexual, somatotropinoobrazujushchem, etc.) [118, 265, 295].

The direct interrelation between expression of disturbances MI with gravity and character of the pathological changes proceeding in nervous system is established. It is important, that at children's age against correctly picked up and adequate therapy of disorders MI of function of MT are restored together with normalisation of work of the higher centres of vegetative regulation. It is a key link in selection of effective methods of treatment and aftertreatment of children with pathology MI [3, 83, 148, 254].

Because the basic part of disturbances MI has functional character, it allows the doctor to use effectively for their correction not so much medicinal, how many not medicamental therapy, and also a number of psychological and suggestive techniques. During too time rates of retrogress of disturbances of maturing of the centres of regulation MI are always individual. Considering the above-stated, at the present stage for successful treatment and aftertreatment of children with pathology MI working out of schemes of the therapy necessarily considering individual psychological features of an organism of the patient [26, 50, 110, 250, 307] is required.

Clinical implications of disturbances MI are various are various combinations of an incontience of urine during time and a dream and-or wakefulness, change of frequency and volume characteristics MI, and also a desire to miktsii. Are Most extended a clinical syndrome of an imperative emiction (THESE), shown in the form of a pollakiuria, imperative desires, an imperative incontience of urine, and an uracrasia. According to the literature frequency of disturbances MI at children makes about 9-10 %, and among patients nefrourologicheskogo a profile reaches - 50-60 % [39, 51, 178, 223, 229]. As it became perceptible earlier, disturbances MI, are more often shown by an incontience of urine which suffer not only children, but also from 1-2 % to 5-25 % of adults [6, 8, 113, 174, 204, 237]. Such difference in digits is a consequence etikodeontologicheskih and psychosocial problems at carrying out randomizirovannyh of researches as not each person admits (even to the doctor), that misses urine to some extent expressions [145, 246, 220, 320, 321].

The uracrasia is consensual MI during night (thicket) and-or day (less often) than a dream, aged when control MI during a dream and wakefulness should be reached. Domestic researchers consider as such age of 5 years, and foreign - 6 years [39, 101, 308, 318]. According to the literature prevalence of an uracrasia at children at the age from 4 till 15 years makes from 2,3 % to 30 %, among them: in 5 years - 15-20 %, in 6-8 years - 712 % of children, in 15-18 years - 1,5-4 % [38, 114, 149, 264, 294, 310]. Allocate a primary uracrasia when the child did not have a period of control MI, and secondary when such period was [82, 108, 117, 127, 311, 315].

Excitement and various stressful situations are often accompanied speeded up MI which can provoke as occurrence of an incontience of the urine which is unpleasant in ethical and the social plan defect, and to aggravate already available pathology. However, if the uracrasia, arising at night, is is more often latent from extraneous eyes (except for stay of children in the round-the-clock organised collectives, visitors etc.) consensual MI in the afternoon often happens in public places and puts to the child more serious psychological trauma, rather than an uracrasia [25, 40, 136, 239, 326].

For today the problem of disorders MI costs very acutely, that is bound to features of its perception in society, in a family, and also with low level of medical culture of the population. Very often to disturbances MI in a society concern not as the disease demanding all-round inspection and treatment of the child, and as to the shameful phenomenon in the socially-hygienic plan, to absence of elementary education, skills of neatness and even as to a mental retardation element. In a family, owing to the developed public stereotypes, a problem of disturbance MI at times ignore or do not notice at all, concern it as to implication of "features" of the child, punish children, wait while he "will outgrow" it and to the doctor do not address [173, 204, 237, 267, 294].

Disorders MI (an urine incontience, a pollakiuria, change of characteristics of a desire to miktsii etc.) Immediately lives of the patient do not threaten, but are socially significant problem. They lead to the expressed restriction of mental and physical activity of the child, cause feeling of fault, ushcherbnosti, thereby, make negative impact on psychological development of its person, reduce adaptation in a society and quality of a life of all family [25, 42, 87, 99, 268, 210]. As a result there are problems in dialogue with contemporaries, backlog in study, conflict situations in a family. It is necessary to notice, that in 30 % of cases of disorder MI lead to development of a relapsing chronic cystitis, puzyrnoyomochetochnikovogo a reflux, an ureterohydronephrosis, a pyelonephritis, with occurrence further a nephrosclerosis, a renal arterial hypertensia, chronic renal insufficiency. Being formed in the childhood of disorder MI finally lead to an early invalidism of economically active groups of citizens [114, 145, 267, 299, 329].


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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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