Table of Contents
Definition of Enuresis
Enuresis – an inability to hold the urine, particularly at night (nocturnal enuresis). A common term for enuresis is bedwetting. Enuresis is primarily a condition of childhood though may persist into adulthood, depending on the cause and treatment efforts.
About 85 percent of children are developmentally mature enough to master voluntary control of the bladder sphincter between the ages of 3 and 6.
Generally enuresis that persists beyond the age of 12 is either secondary to other physical conditions or psychological in origin. Enuresis is more common among boys.
Conditions commonly associated with enuresis include cystitis, neurogenic bladder, and urethral obstruction such as congenital anomaly or obstructive calcifications. Occasionally the cause is damage to the lower spinal cord or to the spinal nerves that control bladder function. In teens or adults who develop enuresis, the enuresis may be an early sign of diabetes or indicate other health conditions such as obstructive sleep apnea (which disrupts the body’s normal sleep rhythms), seizure disorders, or hyperthyroidism (overactive thyroid gland).
Obstructive sleep apnea may also be a factor in children between the ages of two and five who have enlarged adenoids, which is a common circumstance among this age group, that block the back of the throat when lying down. Research in the late 1990s suggests some people who have enuresis experience dysfunction of the neurologic interactions that regulate the depth of sleep and initiate sleep arousal.
In some children the causes of enuresis are primarily behavioral, such as ignoring the urge to urinate until it becomes overwhelming, not emptying the bladder immediately before going to bed, or drinking large quantities of fluids throughout the day and especially in the three to four hours preceding bedtime.
Generally these behaviors are easy for parents to modify through positive reinforcement and diligent monitoring of the child’s drinking and urination patterns. Psychological enuresis typically occurs due to profound emotional distress and is not the result of conscious behavior.
Enuresis becomes a significant embarrassment to most who have it after they reach about the age of 8 to 10 and especially for teens and adults. Children may refuse to spend the night with friends or have friends spend the night with them and may avoid overnight activities such as camping or vacationing in motels. Their refusal may be overt or they may express unreasonable fears.
Symptoms and Diagnostic Path
The symptom of enuresis is inappropriate urination, often during naps or when sleeping at night, but it may occur any time. The diagnostic path consists of a careful history of eating, drinking, urination, and bowel habits as well as patterns of enuresis (such as all the time or only during sleep).
The urologist may conduct diagnostic procedures such as urinalysis, ultrasound of the bladder, voiding cystourethrogram, or cystoscopy, depending on the suspected underlying cause. In most situations in which the urinalysis is normal, however, the urologist delays extensive diagnostic procedures until after a trial of basic treatment and behavioral interventions.
Treatment Options and Outlook
Treatment may combine medical interventions with behavioral approaches such as limiting fluids in the evening and fully emptying the bladder right before going to bed. Enuresis alarms (moisture sensitive devices) are especially effective for children. Medication therapy may include desmopressin (DDAVP), which decreases urine production, or oxybutynin (Ditropan) or tolterodine (Detrol), medications that slow smooth muscle stimulation.
Risk Factors and Preventive Measures
Nocturnal enuresis appears to run in some families, though researchers are not sure what accounts for this. The key risk factors for enuresis are organic causes such as congenital anomalies or physiologic dysfunctions and severe emotional stress. Health experts stress that neither punishment nor the so-called bladder training method (holding a full bladder for a determined amount of time, ostensibly to strengthen sphincter control) is effective in ending enuresis.
These approaches fail to address the causes of enuresis, result in further embarrassment and discomfort, and may exacerbate the underlying cause of the enuresis. Time, patience, and positive reinforcement (such as praise and small rewards) as well as appropriately addressing any physiologic dysfunctions, result in ending enuresis about 98 percent of people.
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