Enuresis

Enuresis is the involuntary or intentional discharge of urine after the age at which bladder control is expected, typically beyond 5 years of age.

The pathophysiology of enuresis is multifactorial and not fully understood. However, it is believed to involve a delay in the maturation of the mechanisms controlling urination during sleep. This includes a maturational deficit in motor performance, particularly for repetitive hand and finger movements, and a possible maturational deficit of the motor cortex circuitry and related cortical areas. Disturbances in the circadian rhythm of arginine-vasopressin, leading to excess urine production during sleep, are also common in children with enuresis. Additionally, immaturity of the brainstem may be involved in the pathogenesis of enuresis.

The prevalence of nocturnal enuresis is estimated at 6-10% at age 7, decreasing to 2% by age 15, and further to 0.5-2% in adulthood. Boys are twice as affected as girls.

Risk factors for enuresis include a family history of the condition, constipation, UTIs, and psychological stress. Secondary nocturnal enuresis can develop after traumatic events such as traffic accidents. Additionally, conditions like attention deficit and hyperactivity disorder can be associated with enuresis.

Clinically, enuresis presents with bedwetting that is inappropriate for the child's developmental age, typically occurring at least twice a week for 3 consecutive months. It often occurs early at night, primarily in sleep stage 2 and deep sleep.

The prognosis of enuresis is generally good, as the condition often resolves with time. However, the persistence of enuresis can lead to psychological distress and impaired QoL.