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Sleep/Arousal and enuresis subtypes
1Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Enuresis, or bedwetting, is linked to maturational delays. The severity of this delay correlates with the clinical presentation of enuresis in children.
Area of Science:
- Pediatric urology
- Developmental biology
Background:
- Enuresis (bedwetting) is a common condition in children with complex underlying mechanisms.
- Understanding these mechanisms is crucial for effective diagnosis and management.
Purpose of the Study:
- To review and compare bladder physiology mechanisms in children with and without enuresis.
- To elucidate the relationship between maturational delays and enuresis severity.
Main Methods:
- A comprehensive literature review was performed.
- Mechanisms of bladder physiology were compared between normal children and those with enuresis.
Main Results:
- Key mechanisms include nocturnal urine volume, functional bladder capacity, bladder contractions, and arousal difficulties.
- Evidence supports detrusor-dependent (contractions) and volume-dependent (polyuria) enuresis subtypes.
- Children with enuresis often have impaired arousal, particularly during the first two-thirds of the night.
Conclusions:
- Enuresis is primarily caused by maturational delays, with lag severity correlating to clinical picture severity.
- The spectrum of enuresis includes diurnal incontinence and secondary enuresis, both linked to maturation.
- Arousal ability is fundamental for achieving nighttime dryness.
Purpose:
The mechanisms responsible for enuresis are maturational delays and the extent of the maturational lag equates with the severity of the clinical picture.
Materials And Methods:
A literature review was conducted comparing the similar mechanisms of bladder physiology in normal and children with enuresis.
Results:
Several mechanisms are associated with enuresis including nocturnal urine volume, nocturnal functional bladder capacity, spontaneous bladder contractions and the inability to arouse to the stimulus of a large and/or contracting bladder. There is adequate evidence for children with enuresis who demonstrate nocturnal spontaneous bladder contractions (detrusor dependent enuresis) and nocturnal polyuria (volume dependent enuresis). A recent study has shown that children with enuresis are difficult to arouse in the first two-thirds of the night, which is also associated with the period of greatest wetting frequency. Night dry children may demonstrate daytime frequency and urgency, others may have nocturia and others are difficult to arouse. Subtyping into volume dependent and detrusor dependent types may only describe specific entities of a larger array of clinical presentations.
Conclusions:
It is proposed that the mechanisms responsible for enuresis are maturational delays and the extent of the maturational lag equates with the severity of the clinical picture. Included in this clinical spectrum are children who demonstrate diurnal incontinence and those with secondary enuresis. The former is a condition of maturational severity and the latter is a maturational change. The ability to arouse is fundamental to those who are continent.