A Simple Treatment for Pediatric Bedwetting
Enuresis, or bedwetting, is described as episodes of urinary incontinence during sleep in children age 5 years and older. Monosymptomatic enuresis is incontinence in children without any other lower urinary tract symptoms and no history of bladder dysfunction.
Children with monosymptomatic enuresis have never achieved an acceptable period of nighttime dryness and are described as having primary enuresis. Another population of children with monosymptomatic enuresis includes those who have developed nocturnal incontinence after a dry period of at least six months. These children are described as having secondary enuresis.
The Physiology of Bladder Control
Children learn bladder control at various ages during the potty-training years. Most children begin to stay dry during the night roughly at age 3 years. Continence and micturition involves a balance between the urethral sphincter closing and the detrusor muscle contracting. The proximal urethra and bladder are both located within the pelvis. Normally, urethral pressure exceeds the bladder pressure, which results in urine remaining in the bladder. As it increases or decreases, intra-abdominal pressure is transmitted to the urethra and bladder equally. This transmission leaves the pressure differentials unchanged, which results in continence maintenance.
Normal voiding and urine elimination is the result of changes in both of these pressure factors signaling the need to void. As the urethral pressure falls, the bladder pressure rises, thus contracting the detrusor muscle and opening the sphincters of the urethra for micturition.
A brief synopsis of the development of continence is as follows:
Infancy: voiding occurs frequently, reflexively, and without voluntary control.
Age 6 months to age 12 months: bladder capacity increases and voiding frequency decreases.
Age 1 year to age 2 years: conscious sensation and ability to feel fullness develops, able to postpone voiding briefly by contracting the sphincter
Age 2 years to age 3 years: volitional voiding develops; able to initiate, relax the pelvic floor, and inhibit voiding through the cerebral cortex
Age 4 years: bladder volume increases, able to remain dry for two to three hours and void five to eight times per day.
Assessing Monosymptomatic Enuresis
The clinician must consider all the potential causes for a child's nocturnal enuresis. Occasionally the fullness sensation association and coordination between the bladder and the brain is not fully developed yet in some children. This lack of coordination tends to result in incontinence.
Bedwetting is not the child's fault. No child consciously and purposely enjoys wetting his or her bed. In fact, nocturnal enuresis is common in families where one or the other parent experienced bedwetting as a child. If the child's parent or parents were bedwetters, there is a strong correlation for inheritance. The pattern and trend of bedwetting typically follows an outgrowth of the nocturnal enuresis at roughly the same age as the afflicted parent.