directions of therapy of disorders of an emiction at children at the present stage.

At various stages of the development the mankind tried all possible ways to win implication of disturbances MI, including an uracrasia. The abundance of various theories of a parentage of an incontience of urine has led to occurrence of a considerable quantity of agents and methods of its treatment.

Very many of them (for example, bracing of a brush with a rigid bristle and a towel fastened in knot, on a loin etc.) bordered on common sense, have not stood tests by time and have been withdrawn from practice [159, 236, 322].

For a long time one of the most widespread methods of treatment of an incontience of urine during a dream is compulsory awakening of the patient for performance MI, carried out, usually at certain o'clock, regularly within many months and even years. However, as long-term practice shows, even punctual performance of these measures usually does not reach the desirable purpose as children shortly before awakening or, falling asleep after it, often appear "wet" [26, 39, 82, 117, 190]. At regular discontinuing of a dream the child gets used to that will wake him, and does not aspire to react to a desire owing to what this method of treatment can promote only to the further development of an uracrasia, strengthening a neurotization of the child, worsening its psychoemotional status and a psychological climate in a family [58, 59, 146, 147, 312].

For the purpose of the prevention consensual MI in a dream among other medical actions various diets (have been recommended G.I.Baradulin, 1914; B.N.Holtsov, 1926; B.L.Ospovat, 1945, etc.), including with liquid restriction, especially for the night (N.I.Krasnogorsky, 1939; G.N.Kulak, 1944; K.S.Makarets, 1961; Schneider, 1958, etc.) . The dietetics with restriction of consumption of a liquid scientifically is not proved, as well compensated MT should be adapted for usual quantities of a liquid during a dream and wakefulness [38, 101, 173, 229]. Restriction of consumption of a liquid within days or in second half of day is a component of many medical complexes applied and now at disorders MI and an uracrasia. For today of opinion of the majority of domestic and foreign scientists on the given question are similar: in a diet used as a part of complex therapy of disturbances MI and an incontience of urine, quite enough usual hygienic prescriptions which do not recommend plentiful drink 2-3 hours prior to a dream at a physiological water load within day [50, 58, 59, 110, 175].

Application of such way of treatment of an incontience of urine as urinary alarm clocks (especially fashionable abroad per 1960-70) departs on the second and third plan because of the low efficiency and high stressogennoj loads on the patient [13, 23, 305] more and more.

Last 10-15 years parents of children with an urine incontience activly use the various adaptations absorbing a liquid (diapers, shorts, diapers etc.) [69, 101, 173, 228, 302]. Till now in medical medium to these hygienic agents there is a dual and ambiguous relation. On the one hand, doctors often in every possible way position them (including under the influence of interested unfair manufacturers) as the blessing for the child with disturbances MI, comfortable existence providing it in the afternoon and-or at night, on the other hand, admits their negative influence on a disease current as the child quickly gets used to that remains dry at consensual MI and absolutely ceases
To supervise this process [101, 108, 114, 197, 204].

It in turn postpones a print on the formed person of the child for late socialisation by means of development of toilet skills and the control of physiological departures, will inevitably lead infantilizatsii the person [35, 40, 42, 245]. Despite introduction in manufacture of diapers of materials, protuskajushchih air and genitals preventing an overheating, domestic and foreign doctors admits their negative influence at long wearing on man's genesial system owing to regular influence on it of the raised temperatures [54, 107, 212, 223, 239].

As show our observations for successful therapy of an incontience of urine at children using absorbing adaptations, at the first stage it is necessary to refuse their application gradually. It is much easier for carrying out, if the child is on stationary, rather than an out-patient treatment that is bound to influence of parents on the child. At detailed studying of the given problem the interesting detail, paradox is taped: the diaper is used by the child, and the psychological comfort from its application in larger degree is tested by parents - the child sleeps (is awake), bed-clothes (clothes) remain "dry", hence, with it everything is all right in spite of the fact that the child continues to be wetted consensually, in any way not supervising this process. Therefore to convince parents to refuse application of absorbing hygienic agents happens much more difficult, rather than than the child not to use them [107, 108, 197, 229, 231].

For today there is a number of the basic directions of treatment of disturbances MI: medicamental, surgical, FZT, psychotherapy, acupuncture and therapy with use of a method of functional biomanagement (FBU) [125, 146, 157, 266, 288, 309].

Medicamental therapy in complex treatment of disturbances MI at children basically use for oppression of pathological influences of parasympathetic nervous system on a wall of MT in the presence of signs of a hyperreflexia and-or its instability. The medical products improving myelination of nervous fibers are activly applied, and is a little bit more rare - preparations!, blocking v-adrenoretseptory at spastic conditions of a neck of MT [30, 63, 74, 103, 158, 215, 258]. The Medical products levelling pathological impulses of parasympathetic nervous system on MT, concern to M-holinoblokatoram (M - to cholinolytics). At hyperreflex and-or astable forms NDMP one of the first began to apply not selective medical products on the basis of atropine, and also preparations krasavki in the form of extracts and candles. These preparations were used is very limited in connection with often developing by-effects in the form of a tachycardia, dryness of mucosas, a mydriasis, insignificant width of their therapeutic action, and also with potential threat of occurrence of an overdosage. Now atropine apply to carrying out farmakoproby on a susceptibility of the patient with NDMP to M - to cholinolytics. Eventually have appeared selective M-holinoblokatory with smaller quantity of by-effects, such as oksibutinina a hydrochloride (the trading name "Driptan"), trospiuma Sodium chloridum ("Spazmeks"), tolterodin ("Detruzitol"), with wider application as in a hospital, and it is out-patient [64, 73, 78, 92, 111, 214, 255]. Observations of last years have shown, that application of selective M -
Cholinolytics at hyperreflex forms NDMP, even at careful observance of the ordered dosages, often leads to a by-effect in the form of formation of the hyporeflex form NDMP which correction is difficult and ineffective. As a result, careful individual selection of doses selective M-holinolitikov at children with regular monitoring urodinamiki is necessary, that considerably complicates treatment, enlarges treatment time.

Last years popularity is typed by rather new technique of intravesical introduction of M - of cholinolytics in a kind instilljatsy their solutions. Thus at a short-term stage the effect and minimisation of side effects of preparations becomes perceptible more expressed urodinamichesky. However the authentic statistical material which will allow to define efficiency of the given medical procedures in long-term prospect is not saved up yet. Besides, at the present stage application to the given technique is interfaced to certain technical difficulties (shortage of the sterile urinary catheters, the trained personnel etc.), absence ready ofitsinalnyh solutions of preparations for intravesical introduction and remaining high risk of complications from MT catheterization [58, 59, 231, 271].

For the purpose of acceleration of myelination of nervous fibers, and also improvement nejromyshechnoj transfers and trophicities of a wall of MT, at disturbances MI most often apply course treatment pikamilonom or Phenibutum, group vitamins In [30, 63, 71, 271, 331].

Application in children's practice of the preparations containing desmopressin ("minirin", "Adiuretin", Adiuretin SD) [98, 119, 120, 219], in our opinion antifiziologichno as these medical products do not render any influence on sfinkternyj the apparatus of organs of a small basin, neither on nejromyshechnuju transfer, nor on a trophicity of walls of MT. They only stop formation of urine after their reception, false representation about their efficiency in therapy of disturbances MI is as a result framed.

However application even the advanced medicines is interfaced to a number of by-effects (for example, intolerance of the preparation, the mediated toxic influence on an organism etc.). It is necessary to notice, that in overwhelming majority of cases the therapeutic effect remains only while the preparation is present at an organism of the patient [78, 134, 271, 258, 233, 313]. Thus, the narrow specific orientation of action, symptomatic character, presence of a considerable quantity of the by-effects, insufficient efficiency, high probability retsidivirovanija diseases, appreciable cost of preparations do not allow to use widely and safely pharmacotherapy in treatment of disturbances MI and NDMP at children [58, 146, 331].

At an urine incontience it is developed and modified more than 200 various surgical operations, but their use in children's practice is extremely limited [41, 151, 152, 211, 309]. Exist and maloinvazivnye methods of surgical treatment of disorders MI and NDMP, one of which is paraurethral injection introduction obemobrazujushchih preparations for the purpose of a compression of an urethra for rising of closing intraurethral pressure [112, 148, 309]. It is necessary to notice, that operative treatment of an incontience of urine actually at an organic pathology tazovyh organs, and at functional disturbances their application is not expedient. Besides even the minimum surgical intervention is interfaced with
A number of contraindications and complications (including infectious character), and also with occurrence or intensifying of stress available for the child that can aggravate a current of disturbances MI only.

In complex treatment of disturbances MI are worthy methods FZT referred on restoration miktsy, tonus normalisation detruzora, sphincters and detruzorno-sfinkternyh relations, and also on improvement of a circulation and acceleration of maturing of the nervously-muscular apparatus tazovyh organs by means of physical methods of influence on an organism. In therapy of disorders MI currents, an electrical stimulation, svetoterapija, an electrophoresis of medicinal substances are applied diadynamic and sinusmodelirovannye. Diadynamic currents render stimulating and trophic effect on walls of MT and surrounding tissues. Restoration of a normal circulation in MT wall promotes fastening of results of therapy. To perspective techniques in treatment of disturbances MI carry an electrical stimulation of a back tibial nerve a needle electrode. Also in the literature it is underlined a positive effect from a sacral and transrectal electrical stimulation at hyporeflex and areflektornyh forms NDMP. At use of an electrophoresis of medicinal preparations (for example, atropine, a neostigmine methylsulfate, ubretid) appears sochetannoe influence of an electric current and the ionised forms of medicinal substances on a tissue in this connection higher concentration of preparations in a place of influence in the absence of the general influence of a preparation on an organism is reached. Procedures FZT are carried out at obligatory absence of inflammatory changes from MT in a regimen of stimulation or a relaxation taking into account type of neurogenic disturbances, and their performance is often interfaced to an invasiveness of procedures that limits their application in pediatrics [120, 126, 164, 185, 200, 226, 260, 280, 286].

Acupuncture use in treatment of pathology MI at children has a number of the restrictions bound to risk of a becoming infected of patients at use of reusable needles, a disadvantage of highly skilled experts in the given technique, absence more or less a reliable data about efficiency of a method, an invasiveness of this kind of treatment [58, 59, 175].

For children with disturbances MI and their parents the timely and qualified psychological help which also promotes harmonisation of intrafamily relations has great value. The psychotherapy is aimed at correction obshchenevrologicheskih and psychosomatic disorders and should be carried out by the qualified psychotherapist or the clinical psychologist with the assistance of the neuropsychiatrist [37, 66, 87, 160, 203]. For this purpose are often used gipnosuggestivnye (suggestions and self-suggestions) and behavioural (biheviorialnye) techniques [105, 251, 257, 278, 284]. For achievement of a positive effect from therapy at children with disorders MI and an urine incontience special value is given to family psychotherapy (to interaction of parents and the child) which integral part is motivational therapy. Last, forming positive mutual relations of the child with his parents, provides higher results of treatment and rather low frequency of relapses of disease. Thus the child becomes the active participant of therapy, and parents encourage it for the reached successes. The most practical and it is good itself recommended there was a filling technique
The child of a diary of "dry" and "wet" nights. Also independent change by the child (depending on age under the control of adults) natelnogo and bed-clothes after episodes consensual MI is expedient. Adequate motivational therapy helps the child to get rid of feeling of fault, to reach a psychoemotional relaxation, to develop a self-confidence. It is necessary to notice, that the positive effect from the actions set forth above is reached only at children with safe intelligence. It is necessary to consider and a number of restrictions so use of techniques of suggestion and a self-suggestion can be applied only at achievement by the child of 10-11 years that is bound to formation and formation of kognitivno-mental functions TSNS. Motivational therapy reaches a positive take in 70 % of cases, however effect from it unstable with frequent relapses of disease. In this case the effect is reached at a combination of motivational therapy to other kinds of treatment of an incontience of urine [105, 137, 245, 251, 328].

However, medicamental treatment, FZT, neither paliativno-symptomatic operations, nor motivational therapy do not provide proof positive takes at treatment of disturbances MI. It has given the precondition for working out last 25-30 years of new methods of the therapy based on pathogenetic principles of restoration of functions of MT. A variety of forms of pathology MI does not allow to solve successfully all questions of pathogenetic therapy by means of one method, complex treatment therefore is necessary. To begin it follows as soon as possible before there will come secondary complications and a degeneration of local nervously-muscular structures. Now the greatest prospects are bound to non-invasive not medicamental ways of treatment of disturbances MI which can be used as monotherapy, and as a part of complex treatment. The method of functional biological management concerns them - a biological feedback (biofeedback, FBU, it is barefooted) [7, 34, 146, 259, 266, 293].


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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

Other medical related information directions of therapy of disorders of an emiction at children at the present stage.:

  3. an aetiology and a pathogenesis of disorders of an emiction.
  4. directions of therapy of disorders of an emiction at children at the present stage.
  5. Functional biological management and morfo-funkitsonalnoe a substantiation of its application at disorders of an emiction of an inorganic genesis and SNFTO at children.
  6. Clinico-Anamnestichesky and urodinamicheskie research methods.