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おねしょの治療について

子供

おねしょ(夜尿症)は、睡眠中に本人の意識がない無意識の状態で、排尿をしてしまうことを言います。「おねしょ」と「夜尿症」は症状としては同じなのですが、一般的に、幼児の睡眠中の排尿を「おねしょ」と言い、小学校入学以後の子供の場合「夜尿症」と言うことがあるようですが、実際はあまり区別されていません。子供のおねしょがある程度の年齢まで続くと心配になりますが、対処法、治療法にはどのようなものがあるのでしょうか。本記事では、他の重い病気が原因ではない場合の「おねしょ」の対処法や治療について、整理してみます。

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おねしょの原因は何なのでしょうか

考える

おねしょの多くは病気が原因ではありません。子供のおねしょの場合、尿を抑制するホルモン(抗利尿ホルモン)と自律神経とのバランスが悪いために起こります。睡眠のリズムや精神的な要素も原因の一部となっている場合があります。

一方、他の病気が原因でおねしょになる場合は、以下のようなものが考えられます。

  1. 脊髄の病気、てんかん、発達障害、多動症など
  2. 膀胱炎、尿路感染症、腎炎など
  3. 糖尿病、尿崩症(利尿を抑えるホルモンの異常)など
  4. 外陰部の湿疹や、他の異常など

上記のような病気がないか検査を行ないます。しかし、これらの病気がある場合は、おねしょだけでは済まず、昼間でも尿漏れが発生する場合があります。これらの病気の場合は、適切な治療を行なう必要があります。

おねしょの対処法

幼児期における生活指導について

幼児期のおねしょの場合は、まだ発達途上の年齢なので、生活指導については下記のようなことに留意するだけでかまいません。薬による治療は、まだ必要ありません。

  1. 「あせらない、おこらない、起こさない」の基本的な生活指導を守ってください。特に「おこらない」ことは重要です。
  2. 水分は、朝と昼に多めに与え、夕方以降に与えるのを控えめにしましょう。
  3. 日中のおしっこは、もじもじした場合でもすぐにトイレに行かせず、心もち膀胱にたまってから行かせるようにしてください。しかし、無理にがまんさせることはやめましょう。
  4. 水分を取る場合、ゴクゴクと速く飲んでしまうと、つい多量に取ってしまいます。一気飲みをさせないようにしましょう。

学童期における生活指導について

  1. 夜間に起こすのをやめましょう。
  2. 夜間に起こしてトイレで排尿させると、おねしょをしないことがあります。しかし、これは「トイレでのおねしょ」と言ってもいいような現象で、みかけ上はおねしょをしていないようにみえるのですが、実際には睡眠のリズムが乱れて、おねしょのくせを固定してしまうのです。尿をしっかり膀胱にためる習慣が作れず、かえっておねしょを長引かせてしまいます。

  3. 水分の取り方を変えましょう。
  4. おねしょがあると、夕方以降の水分摂取を減らすようにしていることが多いと思いますが、夕方からの水分を制限するだけでは治りません。意識的に朝から昼に水分を多く取り、夕方からの水分を減らすというような、水分摂取のリズムを作ることが大切です。一日のうちの配分としては、朝から午前中に多目(350~400㏄)に取らせ、午後からは若干控え目(100cc前後) にし、夕方から少なめに制限(100cc以下)し、夕食における汁物や果物はやめて朝に与えるようにするのが重要です。寝る時間に水分で胃がだぶつかない状態にさせることが大切です。

  5. 排尿抑制の訓練を行ないましょう。
  6. 膀胱におしっこを十分溜められない、いわゆる「膀胱型のおねしょ」の場合、おしっこをがまんする訓練をして、膀胱に充分にためられるようにします。帰宅後、尿意を感じた際、おしっこをぎりぎりまでがまんさせる訓練をします。がまんする尿の量は、目安として6~7歳で約150㏄、8~9歳で約200㏄、10歳以上で約250㏄以上はためられるように訓練します。

  7. 冷え症への対応について。
  8. 冷え症状はおねしょを悪化させます。秋から冬におねしょが多くなってしまったり、手足が冷えたり、しもやけができやすい場合は、おねしょとの相関性が認められます。冷え症状がある場合には、寝る前に長い時間入浴させ、ふとんを暖めておくと効果的です。入浴剤を用いる場合は、炭酸ガス系が効果的です。夏季にクーラーをつけたまま寝ると、冬季と同様に冷え症状によりおねしょが悪化する場合があります。

薬による治療について

多尿型の場合

  1. 三環系抗うつ剤:多尿型に対する内服薬には、トフラニール、アナフラニール、トリプタノールがあります。これらは、抗利尿ホルモンの分泌を促す作用を持つ成分です。いずれも就眠前に服用します。副反応としては、悪心、食欲不振、嘔吐といった消化器系の症状と不眠等が代表的あり、これらが認められた場合には直ちに服用を中止します。
  2. DDAVP点鼻療法:うすい尿が多量に出るタイプのおねしょの場合に使われます。就眠直前に酢酸デスモプレシン点鼻薬を鼻に処理して、鼻粘膜から吸収させる方法になります。副反応としては、水分の摂取リズムを守らず、夕方以降に水分をがぶ飲みした状態でこのお薬を用いると、水中毒症状といって浮腫(むくみ)、頭痛、極端な場合にはけいれんといった症状が出る場合があります。

膀胱型の場合

膀胱型のお薬としては、ポラキスとバップフォーが代表的な薬剤になります。お年寄りの尿失禁治療薬として開発された薬で、膀胱を大きくすることにより溜められる尿の量を多くするという作用を持ちます。朝食後、または就眠前に服用します。成人に対する副反応
としては、口の乾き、目の乾き、排尿困難等が報告されていますが、小児については、副反応はほとんど認められていません。その他に、ブラダロンとプロバンサインという薬が用いられることもあります。

混合型

多尿型と膀胱型とが合わさった症状(混合型)に対しては、これらの二つのタイプのお薬を併用して治療します。

新 おねしょなんかこわくない―子どもから大人まで最新の治療法
帆足 英一
小学館
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まとめ:おねしょの原因と対処法、治療法について

本記事では、おねしょの原因と対処法、治療法についてまとめました。

  1. 子供のおねしょの場合、尿を抑制するホルモン(抗利尿ホルモン)と自律神経とのバランスが悪いために起こります。
  2. 朝から昼にかけて水分を多目に取り、夕方から夜間に少なくするという水分摂取リズムが重要で、また、膀胱に尿をためる訓練や夜間、起こさないで尿をためられるようにすることが重要です
  3. 治療薬もありますが、小学生未満の幼児では必要ありません。

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