Enuresis: Difference between revisions
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**Abnormal bladder function | **Abnormal bladder function | ||
**Excess urine production during sleep | **Excess urine production during sleep | ||
*Nocturnal | *Nocturnal enuresis often occurs early in the night, mainly in sleep stage 2 and deep sleep. Children with nocturnal enuresis and nocturnal polyuria differ in terms of hemodynamics and autonomic activation at night compared to healthy controls.<ref name="PedersenRittig2020">{{cite journal|last1=Pedersen|first1=Malthe J.|last2=Rittig|first2=Søren|last3=Jennum|first3=Poul J.|last4=Kamperis|first4=Konstantinos|title=The role of sleep in the pathophysiology of nocturnal enuresis|journal=Sleep Medicine Reviews|volume=49|year=2020|pages=101228|issn=10870792|doi=10.1016/j.smrv.2019.101228}}</ref> | ||
*Children with NE often have sleep-disordered breathing and disturbed sleep due to awakenings and arousals. Periodic limb movements (PLM) have also been seen in children with refractory enuresis.<ref name="PedersenRittig2020">{{cite journal|last1=Pedersen|first1=Malthe J.|last2=Rittig|first2=Søren|last3=Jennum|first3=Poul J.|last4=Kamperis|first4=Konstantinos|title=The role of sleep in the pathophysiology of nocturnal enuresis|journal=Sleep Medicine Reviews|volume=49|year=2020|pages=101228|issn=10870792|doi=10.1016/j.smrv.2019.101228}}</ref> | *Children with NE often have sleep-disordered breathing and disturbed sleep due to awakenings and arousals. Periodic limb movements (PLM) have also been seen in children with refractory enuresis.<ref name="PedersenRittig2020">{{cite journal|last1=Pedersen|first1=Malthe J.|last2=Rittig|first2=Søren|last3=Jennum|first3=Poul J.|last4=Kamperis|first4=Konstantinos|title=The role of sleep in the pathophysiology of nocturnal enuresis|journal=Sleep Medicine Reviews|volume=49|year=2020|pages=101228|issn=10870792|doi=10.1016/j.smrv.2019.101228}}</ref> | ||
Revision as of 23:12, 4 February 2021
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Angela Botts, M.D., Beth Israel Deaconess Medical Center Geriatric Medicine [2]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [3]
Overview
Enuresis is the involuntary urination beyond the age of anticipated control. The two major forms of enuresis are diurnal enuresis (or daytime wetting), and nocturnal enuresis (bedwetting or nighttime wetting). Enuresis impacts the child and is associated with poor school performance. It also has a major psychosocial burden on the family and results in poorer quality of life in parents.
Historical Perspective
- Enuresis has been a major social problem since ancient times.
- Initially enuresis was considered a manifestation of psychiatric disturbance. It has been followed by the clearer theory of maturational delay with the role of hereditary factors. [1]
- After multiple studies, it has been found that enuresis may be the cause and not the result of a psychiatric disorder.[2]
- As early as 1550 BC, the problem of childhood incontinence was described in the Ebers papyrus.[3]
- Prayers became an important supplemental component of the treatment options in the middle ages.
- Belladonna, camphor, opium, and ergot were administered to enhance the bladder muscle tone in the eighteenth century.[3]
- In 1948, a direct conditioning based treatment modality called the alarm or bell-and-pad system was introduced.[3]
- Initially, psychotherapy was accepted as the only possible method to treat enuresis, and there was a lot of skepticism about the conditioning treatment. [1]
Classification
- Enuresis is broadly divided in two types: daytime wetting and nocturnal enuresis.[4]
- According to International Children’s Continence Society (ICCS), enuresis consists of wetting by a child who has passed his or her fifth birthday.[5]
- Enuresis is considered significant if it occurs more than once per month and at a frequency of at least three times per three months. Enuresis is termed frequent if there are more than three episodes a week.[5]
- If there are concomitant daytime voiding symptoms such as incontinence, frequency, urgency, or low voided volume, the condition is termed nonmonosymptomatic enuresis. If bedwetting and nocturia are the only symptoms, the condition is known as monosymptomatic enuresis.[5]
- Primary enuresis is used for a child that was never “dry” for longer than six consecutive months, whereas the term secondary enuresis is used for new-onset symptoms after a dry period of at least six months.[5]
Pathophysiology
- Some of the underlying pathophysiological mechanisms for enuresis are:[5][6]
- Altered antidiuretic hormone profile
- Arousal failure
- Delayed bladder maturation
- Abnormal bladder function
- Excess urine production during sleep
- Nocturnal enuresis often occurs early in the night, mainly in sleep stage 2 and deep sleep. Children with nocturnal enuresis and nocturnal polyuria differ in terms of hemodynamics and autonomic activation at night compared to healthy controls.[6]
- Children with NE often have sleep-disordered breathing and disturbed sleep due to awakenings and arousals. Periodic limb movements (PLM) have also been seen in children with refractory enuresis.[6]
Differential Diagnosis
- Medication side effects
- Neurogenic bladder[7]
Epidemiology and Demographics
Prevalence
The prevalence of enuresis is:
- 5,000-10,000 per 100,000 (5%-10%) among children 5 years of age
- 3,000-5,000 per 100,000 (3%-5%) among children 10 year of age
- 1,000 per 100,000 (1%) among children 15 years of age or older[7]
Risk Factors
- Delayed or lax toilet training
- Genetic predisposition
- Psychosocial stress[7]
Diagnostic Criteria
DSM-V Diagnostic Criteria for Enuresis[7]
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References
- ↑ 1.0 1.1 Schulpen, TWJ (1997). "The burden of nocturnal enuresis". Acta Paediatrica. 86 (9): 981–984. doi:10.1111/j.1651-2227.1997.tb15183.x. ISSN 0803-5253.
- ↑ Läckgren, G; Hjalmås, K; Gool, J van; Gontard, A von; Gennaro, M de; Lottmann, H; Terho, P (2007). "COMMITTEE REPORT". Acta Paediatrica. 88 (6): 679–690. doi:10.1111/j.1651-2227.1999.tb00023.x. ISSN 0803-5253.
- ↑ 3.0 3.1 3.2 Nørgaard, Jens Peter; Djurhuus, Jens Christian (2016). "The Pathophysiology of Enuresis in Children and Young Adults". Clinical Pediatrics. 32 (1_suppl): 5–9. doi:10.1177/0009922893032001S02. ISSN 0009-9228.
- ↑ Mahony, David T. (1973). "Studies of enuresis". Urology. 1 (4): 315–316. doi:10.1016/0090-4295(73)90278-1. ISSN 0090-4295.
- ↑ 5.0 5.1 5.2 5.3 5.4 Haid, Bernhard; Tekgül, Serdar (2017). "Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment". European Urology Focus. 3 (2–3): 198–206. doi:10.1016/j.euf.2017.08.010. ISSN 2405-4569.
- ↑ 6.0 6.1 6.2 Pedersen, Malthe J.; Rittig, Søren; Jennum, Poul J.; Kamperis, Konstantinos (2020). "The role of sleep in the pathophysiology of nocturnal enuresis". Sleep Medicine Reviews. 49: 101228. doi:10.1016/j.smrv.2019.101228. ISSN 1087-0792.
- ↑ 7.0 7.1 7.2 7.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.