{"id":1602,"date":"2022-02-16T18:42:35","date_gmt":"2022-02-16T18:42:35","guid":{"rendered":"https:\/\/uygarmicoogullari.com.tr\/?page_id=1602"},"modified":"2022-02-16T18:47:33","modified_gmt":"2022-02-16T18:47:33","slug":"altini-islatma-ve-iseme-bozukluklari","status":"publish","type":"page","link":"https:\/\/uygarmicoogullari.com.tr\/en\/altini-islatma-ve-iseme-bozukluklari\/","title":{"rendered":"Bedwetting and Urination Disorders"},"content":{"rendered":"
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Heart Care<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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GECE ALTINI ISLATMA (EN\u00dcREZ\u0130S NOKTURNA)<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\tBe\u015f ya\u015f\u0131n\u0131 bitirmi\u015f bir \u00e7ocuk gece uykusunda idrar ka\u00e7\u0131rmaya devam ediyorsa buna alt \u0131slatma (en\u00fcrezis nokturna) denilmektedir. Be\u015f ya\u015f\u0131ndan \u00f6nce \u00e7ocuklar\u0131n gece alt\u0131n\u0131 \u0131slatmas\u0131 anormal bir durum olarak kabul edilmemektedir. Alt \u0131slatma sorunu erkek \u00e7ocuklarda daha s\u0131k izlenmekte ve g\u00f6r\u00fclme oran\u0131 ya\u015fla birlikte azalmaktad\u0131r. Be\u015f ya\u015f\u0131ndaki \u00e7ocuklar\u0131n yakla\u015f\u0131k %15\u2019inde gece alt\u0131n\u0131 \u0131slatma problemi mevcuttur. G\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 her y\u0131l %15 oran\u0131nda azalarak ergenlik d\u00f6neminde yakla\u015f\u0131k %1\u2019e d\u00fc\u015fmektedir. Bu bilgi bize gece alt\u0131n\u0131 \u0131slatman\u0131n \u00e7ocu\u011fun normal geli\u015fim s\u00fcrecinin gecikmesinden kaynakland\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnd\u00fcrtmektedir. \n\nGECE ALT ISLATMA NEDENLER\u0130\n\nBu sorunun k\u00f6keninde b\u00fcy\u00fck oranda genetik yatk\u0131nl\u0131k vard\u0131r. Anne ya da babada alt \u0131slatma \u00f6yk\u00fcs\u00fc varsa \u00e7ocukta %44, her ikisinde birden bu sorun varsa %77 oran\u0131nda alt \u0131slatma sorunu g\u00f6r\u00fclmektedir.\n\nGece idrar \u00fcretiminin artmas\u0131: Geceleri sal\u0131nan ve v\u00fccutta su tutulmas\u0131n\u0131 sa\u011flayarak idrar \u00fcretimini azaltan ADH hormonunun sal\u0131n\u0131m ritminde problem varsa gece idrar \u00fcretimi artmakta ve idrar ka\u00e7\u0131rma ile sonu\u00e7lanmaktad\u0131r.\n\nDerin uyku ve uyanma sorunlar\u0131: Bu \u00e7ocuklarda mesane dolulu\u011funu alg\u0131layamama veya alg\u0131land\u0131\u011f\u0131 halde uyanamama problemi vard\u0131r.\n\nMesanenin istemsiz kas\u0131lmalar\u0131: Genellikle g\u00fcnd\u00fcz i\u015feme semptomlar\u0131na da yol a\u00e7an bu durum geceleri idrar ka\u00e7\u0131rma sorununa da yol a\u00e7abilmektedir.\n\nPsikolojik sebepler: Gece idrar ka\u00e7\u0131ran \u00e7ocuklar\u0131n %5-10\u2019da altta yatan psikolojik nedenler oldu\u011fu tespit edilmektedir.\n\nOrganik sorunlar: Olgular\u0131n %2-3 gibi k\u00fc\u00e7\u00fck bir k\u0131sm\u0131nda alt \u0131slatmya yola a\u00e7an \u00fcriner enfeksiyon, hipertiroidizm, diabetes mellitus, i\u015feme disfonksiyonu, \u00fcretral valv, uyku apnesi gibi sorunlar yatmaktad\u0131r.\n\nBazen gece idrar ka\u00e7\u0131rma sorunu ya\u015famayan \u00e7ocuklar karde\u015f olmas\u0131, anne baba bo\u015fanmas\u0131, aile bireylerinde kay\u0131p ya da k\u00f6t\u00fc muamele gibi psikolojik nedenlere ba\u011fl\u0131 olarak sonradan geli\u015fen idrar ka\u00e7\u0131rma sorunu ya\u015fayabilmektedir.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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GECE ALT ISLATMA TEDAV\u0130S\u0130<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Davran\u0131\u015f Tedavisi:<\/b> \u00c7ocu\u011fa ve aileye problemin anlat\u0131lmas\u0131 ve detayl\u0131 bilgi verilmesi tedavinin ba\u015far\u0131s\u0131nda \u00e7ok \u00f6nemlidir.<\/p>\n

\u00c7ocuklar\u0131n \u00f6ncelikle gece yatmadan 2 saat \u00f6ncesinden itibaren s\u0131v\u0131 al\u0131m\u0131 k\u0131s\u0131tlanmal\u0131d\u0131r. Mutlaka uyumadan \u00f6nce ve uyuduktan 1-2 saat sonra kald\u0131r\u0131l\u0131p idrar yapmas\u0131 sa\u011flanmal\u0131d\u0131r. Ak\u015fam yeme\u011finde tuzlu g\u0131dalar\u0131n t\u00fcketiminden ka\u00e7\u0131n\u0131lmal\u0131d\u0131r. S\u0131v\u0131 al\u0131m\u0131 g\u00fcn i\u00e7ine e\u015fit olarak da\u011f\u0131t\u0131lmald\u0131r. Kab\u0131zl\u0131k problemi varsa mutlaka \u00e7\u00f6z\u00fclmelidir. Bunun i\u00e7in bol lifli g\u0131dalar ve yeterli miktarda s\u0131v\u0131 al\u0131m\u0131 \u015fartt\u0131r.<\/p>\n

\u0130\u015femenin d\u00fczenlenmesi de olduk\u00e7a \u00f6nemlidir. \u00c7ocu\u011fun evde ve okulda 2-3 saatte bir tuvalete gitmesi ve d\u00fczenli idrar yapmas\u0131 sa\u011flanmal\u0131d\u0131r. \u00c7ocu\u011fun pelvik taban kaslar\u0131n\u0131n gev\u015feyip mesane ve barsaklar\u0131n\u0131n tam olarak bo\u015falmas\u0131 i\u00e7in tuvalette uygun pozisyonda oturmas\u0131, ayaklar\u0131n\u0131n yere basmas\u0131, gerekirse ayaklar\u0131n\u0131n alt\u0131na destek konulmas\u0131 gerekmektedir.<\/p>\n

\u00c7ocu\u011fun \u0131slak ve kuru geceleri not etmesi istenmelidir. Burada uygulanacak bir \u00f6d\u00fcllendirme sistemi \u00e7ocu\u011fu motive edecektir. Ancak ceza vermekten ka\u00e7\u0131n\u0131lmal\u0131d\u0131r.<\/p>\n

\u0130la\u00e7 Tedavisi:<\/b> En s\u0131k kullan\u0131lan tedavi gece idrar miktar\u0131n\u0131 azaltan hormon analoglar\u0131n\u0131n (desmopressin) verilmesidir. Burada ama\u00e7 eksik olan ADH\/desmopressin hormonunun yerine konularak v\u00fccudun uykuda su tutmas\u0131n\u0131n artt\u0131r\u0131lmas\u0131 ve idrar \u00e7\u0131k\u0131\u015f\u0131n\u0131n azalt\u0131lmas\u0131d\u0131r.<\/p>\n

Bu tedavinin en b\u00fcy\u00fck avantaj\u0131 ilk dozdan itibaren etkinli\u011finin ba\u015flamas\u0131 ve kullan\u0131m\u0131n\u0131n kolay olmas\u0131d\u0131r. En \u00f6nemli dezavantaj\u0131 ise ilac\u0131n b\u0131rak\u0131lmas\u0131n\u0131 takiben alt \u0131slatman\u0131n tekrar ba\u015flayabilmesidir. Halk aras\u0131nda bu ilac\u0131n k\u0131s\u0131rl\u0131k yapt\u0131\u011f\u0131 y\u00f6n\u00fcnde yanl\u0131\u015f bir inan\u0131\u015f s\u00f6z konusu olsa da literat\u00fcrde bildirilen b\u00f6yle bir etkisi yoktur.<\/p>\n

Bunun haricinde altta yatan bozuklu\u011fa g\u00f6re gece uyanma problemini d\u00fczenleyen ya da gece mesanenin a\u015f\u0131r\u0131 aktif \u00e7al\u0131\u015fmas\u0131n\u0131 engelleyen ila\u00e7lar da mevcuttur.<\/p>\n

Alarm Tedavisi:<\/b> \u00d6zellikle uyanma zorlu\u011fu olan \u00e7ocuklarda \u00f6nerilen bir tedavi y\u00f6ntemidir. Burada temel ama\u00e7 \u00e7ocukta \u015fartl\u0131 bir refleks olu\u015fturmakt\u0131r. Bir damla idrar ka\u00e7\u0131rd\u0131\u011f\u0131nda bile \u00e7alan alarm ile uyanan \u00e7ocuk istemsiz olarak mesane sfinkter kas\u0131n\u0131 kasmakta ve idrar\u0131n\u0131 tutmaktad\u0131r. Ama\u00e7 zaman i\u00e7erisinde mesane doldu\u011funda hen\u00fcz idrar ka\u00e7\u0131rmadan uyanman\u0131n \u00f6\u011frenilmesinin sa\u011flanmas\u0131d\u0131r. Bu uzun s\u00fcreli bir tedavidir ve her alarm \u00e7ald\u0131\u011f\u0131nda \u00e7ocuk mutlaka tuvalete g\u00f6t\u00fcr\u00fclmelidir. Etkinli\u011fini de\u011ferlendirmek i\u00e7in en az 6-8 hafta uygulanmal\u0131, tedaviye yan\u0131t al\u0131n\u0131rsa 3-6 ay devam edilmelidir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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G\u00dcND\u00dcZ \u0130DRAR KA\u00c7IRMA VE \u0130\u015eEME BOZUKLUKLARI<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Be\u015f ya\u015f\u0131n \u00fczerindeki \u00e7ocuklar\u0131n yakla\u015f\u0131k %20\u2019de g\u00fcnd\u00fcz veya gece idrar ka\u00e7\u0131rma, s\u0131k idrara \u00e7\u0131kma, ani s\u0131k\u0131\u015fma, idrar\u0131n\u0131 tutma, idrar\u0131 ba\u015flatma g\u00fc\u00e7l\u00fc\u011f\u00fc gibi i\u015feme bozukluklar\u0131 g\u00f6zlenmektedir. Bu sorunlar s\u0131kl\u0131kla \u00e7ocu\u011fun b\u00fcy\u00fcrken mesane geli\u015fiminin yetersiz kalmas\u0131ndan kaynaklanmaktad\u0131r. Ama \u00f6ncelikle bu duruma sebep olabilecek n\u00f6rolojik (sinirsel) ve anatomik (yap\u0131sal) nedenler ekarte edilmelidir. \u00c7\u00fcnk\u00fc i\u015feme problemlerinin alt\u0131nda tedavi edilmedi\u011fi takdirde b\u00f6brek yetmezli\u011fine yol a\u00e7abilen n\u00f6rolojik ya da anatomik ciddi bozukluklar yatabilmektedir.<\/p>\n

TEDAV\u0130<\/b><\/p>\n

\u00d6ncelikle \u00e7ocu\u011fun i\u015feme problemlerinin kayna\u011f\u0131n\u0131n ne oldu\u011fu ve altta yatan bir bozukluk olup olmad\u0131\u011f\u0131n\u0131 anlamak i\u00e7in detayl\u0131 bir anamnez ve muayene ile birka\u00e7 basit test yap\u0131l\u0131r. \u00c7ocu\u011fa belli bir s\u00fcre i\u015feme g\u00fcnl\u00fc\u011f\u00fc tutturularak sorununun ciddiyeti anla\u015f\u0131lmaya \u00e7al\u0131\u015f\u0131l\u0131r.<\/p>\n

\u00c7ocu\u011fa ve aileye d\u00fczenli ve do\u011fru i\u015femenin nas\u0131l olmas\u0131 gerekti\u011fi, d\u00fczg\u00fcn i\u015feme post\u00fcr\u00fc, idrar tutma manevralar\u0131ndan ka\u00e7\u0131nma, kab\u0131zl\u0131\u011f\u0131n \u00f6nlenmesi, s\u0131v\u0131 al\u0131m\u0131n\u0131n kontrol\u00fc ve ya\u015fam tarz\u0131n\u0131n d\u00fczenlenmesi teknik olarak anlat\u0131l\u0131r.<\/p>\n

\u00c7ocuklarda idrar ka\u00e7\u0131rma i\u015feme e\u011fitiminin yan\u0131s\u0131ra i\u015feme probleminin ciddiyeti ve tipine g\u00f6re ila\u00e7 tedavisi, pelvik taban kaslar\u0131n\u0131n e\u011fitimi, biofeedback y\u00f6ntemi (oyun oynayarak) veya giri\u015fimsel (ameliyat) y\u00f6ntemler ile tedavi edilebilmektedir.<\/p>\n

Biofeedbak Y\u00f6ntemiyle (Oyun Oynayarak) \u00c7\u00f6z\u00fcm<\/b><\/p>\n

\u00c7ocuklara idrar tutma kaslar\u0131n\u0131 kullanmay\u0131 \u00f6\u011fretmeyi ama\u00e7layan \u201c\u00dcroterapi Y\u00f6ntemi\u201d mesanenin dolum ve bo\u015falt\u0131m bozukluklar\u0131n\u0131 d\u00fczeltmeyi ama\u00e7layan bir mesane e\u011fitim ve rehabilitasyon program\u0131 olarak tan\u0131mlanmaktad\u0131r.<\/p>\n

\u0130\u015feme \u00f6nerilerinin sonras\u0131nda ise bilgisayar destekli birtak\u0131m oyunlar e\u015fli\u011finde pelvik taban kaslar\u0131n\u0131 nas\u0131l kullanmas\u0131 gerekti\u011fini \u00f6\u011freten 6 haftal\u0131k pratik uygulamal\u0131 bir e\u011fitim program\u0131 verilir. Haftada bir kez uygulanan ve her seans\u0131 yakla\u015f\u0131k 30 dakika s\u00fcren \u201cbiofeedback\u201d ad\u0131n\u0131 verdi\u011fimiz bu tedavi y\u00f6nteminde \u00e7e\u015fitli bilgisayar animasyonlar\u0131ndan faydalan\u0131lmaktad\u0131r.<\/p>\n

Bu programda \u00e7ocu\u011fa bilgisayar ekran\u0131nda g\u00f6rd\u00fc\u011f\u00fc bal\u0131\u011f\u0131 veya ku\u015fu hareket ettirmesi ve kar\u015f\u0131s\u0131na \u00e7\u0131kan tehlikelerden (kurt, y\u0131lan vs.) ka\u00e7\u0131rmaya \u00e7al\u0131\u015fmas\u0131 istenmektedir. Bunu yapabilmesi i\u00e7in \u00e7ocu\u011fun idrar tutma kaslar\u0131n\u0131 yeterince kasmas\u0131 veya gev\u015fetmesi gerekmektedir. Bu e\u011flenceli program ve evde yapmas\u0131 i\u00e7in verilen k\u0131sa egzersizlerle \u00e7ocu\u011fun idrar tutma kaslar\u0131n\u0131 kendi kendine kontrol etmesini \u00f6\u011fretmek ama\u00e7lanmaktad\u0131r.<\/p>\n

Avrupa ve Amerika\u2019da y\u0131llard\u0131r uygulanan bu tedavi program\u0131 \u00fclkemizde de son y\u0131llarda uygulanmaya ve pop\u00fclarite kazanmaya ba\u015flam\u0131\u015ft\u0131r. Bu tedavi program\u0131n\u0131n sonu\u00e7lar\u0131 ile ilgili yap\u0131lan bilimsel \u00e7al\u0131\u015fmalarda 6 haftal\u0131k tedavi s\u00fcrecinin sonunda ila\u00e7 kullan\u0131m\u0131na gerek kalmadan elde edilen %90\u2019\u0131n \u00fczerinde ba\u015far\u0131 oran\u0131 bildirilmektedir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

Heart Care GECE ALTINI ISLATMA (EN\u00dcREZ\u0130S NOKTURNA) Be\u015f ya\u015f\u0131n\u0131 bitirmi\u015f bir \u00e7ocuk gece uykusunda idrar ka\u00e7\u0131rmaya devam ediyorsa buna alt \u0131slatma (en\u00fcrezis nokturna) denilmektedir. Be\u015f ya\u015f\u0131ndan \u00f6nce \u00e7ocuklar\u0131n gece alt\u0131n\u0131 \u0131slatmas\u0131 anormal bir durum olarak kabul edilmemektedir. Alt \u0131slatma sorunu erkek \u00e7ocuklarda daha s\u0131k izlenmekte ve g\u00f6r\u00fclme oran\u0131 ya\u015fla birlikte azalmaktad\u0131r. Be\u015f ya\u015f\u0131ndaki \u00e7ocuklar\u0131n yakla\u015f\u0131k […]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1602","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/pages\/1602","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/comments?post=1602"}],"version-history":[{"count":0,"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/pages\/1602\/revisions"}],"wp:attachment":[{"href":"https:\/\/uygarmicoogullari.com.tr\/en\/wp-json\/wp\/v2\/media?parent=1602"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}