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The enuretic episode--a complete micturition from a bladder with normal capacity? A critical reappraisal of the
P V Rasmussen1, J Kirk, S Rittig
1International Enuresis Research Center, Skejby Hospital, University Hospital of Aarhus, Denmark.
Insights
Fluid loading before bed can trigger bedwetting episodes in children, even those without a history of enuresis. This suggests nocturnal urine production exceeding bladder capacity is a key factor.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Nocturnal enuresis is common in children.
- Fluid intake before sleep is a known risk factor for enuresis.
Purpose of the Study:
- To investigate the effect of pre-sleep fluid loading on enuretic episodes in normal children.
- To explore the relationship between fluid intake, bladder capacity, and nocturnal enuresis.
Main Methods:
- Fifty-five healthy children (7-12 years) participated.
- Subjects received 25 ml/kg fluid before bedtime on three of four hospital nights.
- Enuretic episodes and urine volumes were monitored.
Main Results:
- Fluid loading provoked 28 enuresis-like episodes in 17 children.
- Episodes occurred mostly in early sleep and decreased with age.
- A correlation was found between total enuresis and nocturia volume; incomplete voiding was common.
Conclusions:
- Nocturnal enuresis can be provoked when urine production exceeds bladder capacity, even in non-enuretic children.
- The definition of nocturnal enuresis may need to consider incomplete bladder emptying.
Abstract:
Fifty-five normal children, aged between 7 and 12 years, were hospitalised for four consecutive nights. On three of these nights, the subjects received 25 ml/kg body weight of fluid prior to bedtime. Such fluid-loading provoked 28 enuresis-like episodes in 17 children, most of which occurred during the first few hours of sleep. The incidence of these enuretic events decreased with increasing age, more boys than girls were affected, there was a statistically significant correlation between total enuresis volume and nocturia volume, and the micturition was frequently incomplete, leaving large volumes of residual urine in the bladder. It was concluded that if nocturnal urine production exceeds bladder capacity, enuresis may be provoked, even in children who do not normally wet the bed. Furthermore, the definition of nocturnal enuresis as a complete emptying of the bladder during sleep may need revision.