Sleep Enuresis: Causes and Treatments

Sleep Enuresis, more commonly known as Bedwetting, refers to the lack of ability to maintain urinary control during sleep. This recurrent involuntary urination is also called Nocturnal Enuresis, which is characterized by at least two occurrences per month in 3 to 6 years old infants and at least one occurrence per month for older children.

Though it is considered normal for children below 7 years old to have enuretic episodes, 5% of 10 year old and 3% of 12 year old children, and as many as 1-3% of 18-year-old teenagers may continue to experience this disorder.

Primary and Secondary Enuresis:

Primary Enuresis is involuntary urination that occurs from infancy with at least two episodes a week, and comprised of 70-90% of all cases. Secondary Enuresis, on the other hand, refers to a relapse after experiencing an extended period of dryness. Adults are more likely to suffer from the secondary type.

Causes of Sleep Enuresis:

Sleep Enuresis can be caused by many factors including hormonal, dietary, or emotional factors.

One of the most common causes of Sleep Enuresis is the inability to develop the antidiuretic hormone cycle in some people. In this cycle, which is typically developed by individuals by the age of 2 to 6, the pituitary gland releases a hormone at night that promotes water retention in the kidneys, thereby reducing urine output till sunrise. Failure to develop this hormone cycle naturally leads to Sleep Enuresis.

An overactive bladder can also cause Sleep Enuresis in many children. By nature, muscle spasms occur in the bladder during urine retention and removal. When these spasms become too active or uncontrollable, the bladder is incapable of holding the normal amount of urine, which eventually results in accidental urination during sleep.

Another common hereditary factor is failure to develop an awareness that enables a person to awaken before urinating on bed. This awareness is normally developed by children during the natural process of learning how to control the bladder while awake.

Besides these common causes, medical disorders such as diabetes, urinary tract infection, sleep apnea or epilepsy and psychiatric disorders may also cause individuals to develop Sleep Enuresis.

Treatments:

Simple behavior modifications can be very effective treatments for children with enuretic episodes. For example, intake of liquids and dietary bladder irritants such as citrus products should be discouraged before bedtime. Taking note of when the enuresis actually occurs, and waking and taking the child to toilet before that hour, can also be very helpful.

Psychological treatments such as encouragement of self-reliance, participation in management, inculcation of self-respect and responsibility are also recommended by many experts. Physical punishments and coercion, on the other hand, are considered to be the most counterproductive measures and should be avoided at all costs.

Using devices such as bedwetting alarms and moisture alarms, combined with bladder muscle exercises, dietary changes, retention control training etc can also be helpful remedies in treating Sleep Enuresis.

For some of the more severe cases that cannot be treated by behavior modification, alarm devices and other treatment methods, using medications such as Desmopressin, a synthetic substitute for the missing antidiuretic hormone discussed earlier, is found to be very effective. Desmopressins such as DDAVP, Stimate, and Minrin can easily be administered nasally or intravenously.

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