Materiały źródłowe

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  The International Childrens Continence Society (ICCS) restricts the term enuresis to wetting that occurs at night. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. It is felt that the pathogenesis of PE is similar to that of SE. […] In PE, psychological problems are almost always the result of the condition and only rarely the cause. In SE, however, psychological problems are a possible cause, albeit not a common one. The comorbidity of behavioral problems is two to four times higher in children with enuresis. […] If no cause can be identified, the important pathophysiologic factors include a disorder of sleep arousal, nocturnal polyuria, and a low nocturnal bladder capacity.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Causes-of-Nocturnal-Enuresis-(Bedwetting).aspx

  Nocturnal enuresis is the most common type of urinary incontinence disorder to arise in children. Despite its frequent occurrence in children, the etiology of nocturnal enuresis is complex and therefore not clearly understood. […] Primary nocturnal enuresis occurs as a result of the failure of a child to awake from sleep, despite receiving stimuli that indicate the need to urinate. In addition to the presence of a stimulus, excessive urine production, the small capacity of the bladder, and/or detrusor overactivity also contribute to primary nocturnal enuresis. […] A positive family history of nocturnal enuresis in which one parent previously suffered from this condition can increase the likelihood that their child will also experience bedwetting by 44%. […] Physiologically, cortisol, which is also known as the hormone that is released during times of high stress, causes a negative feedback effect on the pituitary gland, which can alter the synthesis and/or secretion of the antidiuretic hormone (ADH). […] Low levels of ADH, which regulates and balances the amount of water present within the blood, has been associated with causing the bladder to produce more urine than which it can store, thereby increasing the likelihood of experiencing nocturnal enuresis.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20210119/Study-finds-genetic-variants-that-increase-the-risk-of-bedwetting.aspx

  In a large-scale study of Danish children and young people, researchers from Aarhus University have for the first time found genetic variants that increase the risk of nocturnal enuresis – commonly known as bedwetting or nighttime incontinence. The findings provide completely new insights into the processes in the body causing this widespread phenomenon. […] We identified two locations in the genome where specific genetic variants increase the risk of bedwetting. The potential causal genes which we point to play roles in relation to ensuring that our brain develops the ability to keep urine production down at night, that the bladder’s activity is regulated and registered, and that we sleep in an appropriate way, among other things. […] The study also shows that commonly occurring genetic variants can explain up to one-third of the genetic risk of bedwetting. This means that genetic variants which all of us have may lead to involuntary nocturnal enuresis, when they occur in a certain combination.

• #1 Enuresis in Children: A Case-Based Approach | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1015/p560.html

  Enuresis is defined as intermittent urinary incontinence during sleep in a child at least five years of age. […] The pathophysiology of primary nocturnal enuresis involves the inability to awaken from sleep in response to a full bladder, coupled with excessive nighttime urine production or a decreased functional capacity of the bladder. […] The pathophysiology of primary enuresis involves the inability to awaken from sleep in response to a voiding stimulus (i.e., a full bladder), coupled with excessive nighttime urine production or decreased functional capacity of the bladder.

• #1

  https://journals.lww.com/aips/fulltext/2022/06010/a_clinical_review_of_enuresis_and_its_associated.2.aspx

  Literature has shown evidence that the use of evoked potentials and electromyographic recordings of startle eye-blink response has reflected delayed maturation of brainstem functions. […] Based on observation, authors conclude that enuresis may be related to maturational deficit of central nervous system. […] A study observed that majority of children with nocturnal enuresis had smaller urinary bladder capacities and also tend to pass more quantity of urine than children without enuresis during daytime, in addition to nocturnal bedwetting. […] Enuresis might be effect of OSA on arousal response, urinary hormone secretion, or urinary bladder pressure. […] Some cases of enuresis may persist into adolescence and adulthood periods are known as refractory enuresis, and they do not respond to desmopressin due to primary pathophysiology at receptor level.

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Sleep studies reveal that children with enuresis do not wake up normally in response to an auditory signal; this finding confirms a problem in arousal. […] Studies reveal nocturnal polyuria in some but not all children with enuresis. Although nocturnal polyuria is important in the pathophysiology of enuresis, overproduction of urine per se cannot be the sole causal factor. […] Small functional bladder capacity (FBC) is now known to play a role in the pathogenesis of enuresis. […] Overactive bladder or dysfunctional voiding is more common among girls in preschool or elementary school, usually presenting with urinary frequency, urgency, squatting behavior, daytime wetting, and enuresis. […] Cystitis is a common cause of enuresis and an aggravating factor associated with other causes; cystitis associated with enuresis may present at any age.

• #1 Nocturnal enuresis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348193/

  Newer theories point to the role of the central nervous system in bedwetting. Parents of children who wet the bed often claim that they are deep sleepers. Children with nocturnal enuresis may, however, have sleep disruption. […] Sleep disruption may result in a loss of the physiologic inhibitory signals to the bladder seen in animal studies.

• #1 The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study | Scientific Reports

  https://www.nature.com/articles/s41598-021-96519-w

  Primary nocturnal enuresis (PNE) affects childrens physical and mental health with a high rate. […] Up to now, the pathogenesis of PNE is still unknown, but most of the specialists believe it may be related to awakening dysfunction, insufficient secretion of antidiuretic hormone, unstable contraction of detrusor and other factors, among which awakening dysfunction is the prerequisite. […] Therefore, understanding the neural mechanism of awakening dysfunction is very important for the diagnosis and treatment of PNE. […] The paraventricular thalamus (PVT) is a critical thalamic area for wakefulness and is the key brain region of the neural mechanism of PVTs awakening regulating. […] This study showed how sleep/wakefulness could occur through a coordinated shift in thalamic activity. […] Activation of PVT-NAc pathway can induce the transition from sleep to wakefulness.

• #1 Nocturnal enuresis – Wikipedia

  https://en.wikipedia.org/wiki/Nocturnal_enuresis

  Two physical functions prevent bedwetting. The first is a hormone that reduces urine production at night. The second is the ability to wake up when the bladder is full. Children usually achieve nighttime dryness by developing one or both of these abilities. There appear to be some hereditary factors in how and when these develop. […] The first ability is a hormone cycle that reduces the body’s urine production. At about sunset each day, the body releases a minute burst of antidiuretic hormone (also known as arginine vasopressin or AVP). This hormone burst reduces the kidney’s urine output well into the night so that the bladder does not get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six years old, others between six and the end of puberty, and some not at all.

• #1 Nocturnal Enuresis (bed Wetting)

  https://www.pediatriconcall.com/articles/alternative-medicine/nocturnal-enuresis-bed-wetting/nocturnal-enuresis-bed-wetting-patient-education

  Nocturnal enuresis is the inappropriate voiding (emptying) of the bladder at an inappropriate time or place by a child over 5 years old. […] The causes for bedwetting are multiple and basically it is due to a mismatch between the urinary volume produced, the capacity of the bladder to hold urine and the arousal from sleep to voluntarily pass urine. […] Sine this is a basic article I shall not be going into too much detail of the causes and mechanisms, but suffice it to say that urinary volume is dependent on the circadian secretion of the Anti-Diuretic Hormone (ADH) by the body, as suggested by the name the action is to decrease the volume of urine produced at night. […] However, in many enuretics, this ADH has been found to be deficient and therefore the urinary volume is like daytime, a large volume that fills the bladder and hence is passed by the child in sleep.

• #1 Patient education: Bedwetting in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics/print

  BEDWETTING CAUSES […] Bedwetting may be related to one or more of the following: […] Diminished levels of vasopressin (a hormone that reduces urine production) […] Deep sleep that prevents a child from sensing bladder fullness (this theory is controversial) […] Medical problems that may contribute to bedwetting include diabetes, urinary tract infection, fecal soiling (encopresis), pin worms, kidney failure, seizures, and sleep problems (such as sleep apnea). Most of these conditions can be diagnosed with a medical evaluation. […] BEDWETTING TREATMENT […] Initial treatment of bedwetting includes education and motivational therapy. Behavioral alarms or medication may be tried if enuresis does not improve with these interventions. […] Bedwetting alarms — Enuresis alarms are the most effective method for controlling bedwetting. They are typically reserved for children older than six years of age. Alarms work by using a sensor that detects the first drops of urine in the underwear. When the sensor is activated, it sends a signal to an alarm device, which is intended to wake the child with a sound, light, or vibration. […] Desmopressin — Desmopressin, also known as DDAVP, is a medication that decreases urine production. It is used to treat bedwetting in children. In most cases, motivational therapy and/or bedwetting alarms are tried for three to six months before desmopressin is considered.

• #1 Enuresis Medication: Vasopressin-Related, Antispasmodic Agents, Urinary, Antidepressants, TCAs

  https://emedicine.medscape.com/article/1014762-medication

  Pharmacologic management plays an important role in the treatment of bedwetting. Three pharmacologic approaches are currently considered: desmopressin acetate, anticholinergic medications, and imipramine. […] Desmopressin acetate is a synthetic analogue of antidiuretic hormone (ADH). The mechanism of action is presumed to be a reduction in overnight production of urine. […] This finding provided a scientific rationale for desmopressin use; however, not all children with bedwetting have lower levels of ADH at night, overproduce urine at night, or respond to desmopressin. In addition, not all children who respond to desmopressin have lower levels of ADH or overproduce urine at night before being treated with the medication. […] Most children with bedwetting have a small functional bladder capacity at night. Other children with bedwetting also have daytime symptoms of frequency and urgency. These children might benefit from treatment with an anticholinergic medication that allows the bladder to hold more urine.

• #1 Bed wetting (nocturnal enuresis) | Healthengine Blog

  https://healthinfo.healthengine.com.au/bed-wetting

  Bed wetting (nocturnal enuresis) is defined as intermittent episodes of wetting the bed while asleep in children who are over 5 years of age. […] The exact mechanism behind bed wetting is not clearly understood, but is thought to result from a combination of three key factors: Difficulty rousing from deep sleep (arousal difficulties); Producing too much urine at night (nocturnal polyuria); and Overactivity of the detrusor muscle, which makes up part of the bladder wall. […] Difficulty waking from deep sleep is thought to be one of the key factors involved in bed wetting. […] Over-production of urine at night is thought to be the result of reduced levels of a hormone known as anti-diuretic hormone (ADH), which is released from the pituitary gland in the brain. […] The third factor thought to contribute to bed wetting is that of an overactive detrusor muscle.

• #1

  https://bpac.org.nz/bpj/2008/june/enuresis.aspx

  Nocturnal enuresis, or bedwetting, is a common condition which children usually grow out of. […] The exact cause of nocturnal enuresis is unknown. It appears to be a neurodevelopmental problem which is probably multifactorial. […] Nocturnal polyuria can result from a deranged circadian rhythm of antidiuretic hormone (ADH) secretion which occurs in approximately 70% of children with bedwetting. […] A recent Chinese study included ultrasound examination of 500 children with nocturnal enuresis and showed a reduced functional bladder capacity in approximately 40% of children with nocturnal enuresis. […] Sleep and arousal is one of the least understood factors in the pathophysiology of enuresis. […] Psychological problems are rarely the cause of primary nocturnal enuresis but teasing, bullying or punishment can be the result of it.

• #1 Nocturnal Enuresis (bed Wetting)

  https://www.pediatriconcall.com/articles/alternative-medicine/nocturnal-enuresis-bed-wetting/nocturnal-enuresis-bed-wetting-patient-education

  In some enuretics this capacity may be less than normal and hence bladder can get filled up and will empty if the capacity is exceeded. […] In 30% of enuretics, this detrusor may be irritable and overactive leading to involuntary contractions during the sleep and this leads to emptying of the bladder and bedwetting. […] Some children are deep sleepers and the parents will tell you that they are very difficult to wake up and hence they do not get the sensation of bladder being full in their sleep and will empty their bladder while asleep. […] This OSA by itself can lead to ineffective secretion of ADH leading to large volume of urine and one again bedwetting.

• #1 Bed-wetting – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685

  Bed-wetting also called nighttime incontinence or nocturnal enuresis means passing urine without intending to while asleep. […] It’s not known for sure what causes bed-wetting. Several issues may play a role, such as: […] A hormone imbalance. During childhood, some kids do not produce enough anti-diuretic hormone, also called ADH. ADH slows down how much urine is made during the night. […] Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea. Sleep apnea is when a child’s breathing is interrupted during sleep. This is often due to swollen and irritated or enlarged tonsils or adenoids. Other symptoms may include snoring and being sleepy during the day. […] A problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a difference in the structure of the urinary tract or nervous system.

• #1 Obstructive sleep-disordered breathing, enuresis and combined disorders in children: chance or related association?

  https://smw.ch/index.php/smw/article/download/2270/3420?inline=1

  Studies have found that children with obstructive sleep apnoea syndrome frequently also have nocturnal enuresis. […] The pathophysiology of enuretic events is seemingly linked to nocturnal obstructive events, causing increased intra-abdominal pressure and altered systemic blood pressure that induces natriuresis and polyuria by altering levels of antidiuretic hormone, and atrial and brain natriuretic peptides. […] Nocturnal enuresis may eventually be triggered by sleep apnoea because an accentuated negative intrathoracic pressure during sleep leads to abnormal secretion of ANP. […] A summary of the putative mechanisms for pathogenesis of enuresis in patients with sleep disordered breathing is shown in figure 3. […] Treatment of obstructive SDB, mainly due to tonsil and adenoid hypertrophy, leads to significant resolution of nocturnal enuresis in most patients, accompanied by normalisation of ADH, ANP and BNP levels, and concomitant improvement of HRQoL.

• #1 What does sleep apnea have to do with bed-wetting in children? – Meghna Dassani – Houston, TX

  https://www.meghnadassani.com/blog/what-does-sleep-apnea-have-to-do-with-bed-wetting-in-children/

  Additionally, the fragmented sleep caused by sleep apnea can contribute to bed-wetting by affecting a child’s arousal response to a full bladder. Normally, the brain receives signals from the bladder indicating the need to wake up and empty it. But in children with sleep apnea, these signals may be dulled or ignored due to ongoing sleep disruptions. Consequently, the child may not wake up when their bladder is full, resulting in bed-wetting episodes. […] Addressing sleep apnea helps reduce the associated symptoms. Plus, it can lead to a significant improvement in bed-wetting. By restoring normal sleep patterns and promoting uninterrupted breathing, treatment for sleep apnea can positively impact bladder control. And it can reduce the occurrence of bed-wetting. […] While bed-wetting is a common childhood issue, it can sometimes be linked to an underlying sleep disorder like sleep apnea. The breathing disruptions and sleep patterns caused by sleep apnea can affect the body’s hormone regulation and bladder control mechanisms. And this can lead to an increased likelihood of bed-wetting. […] Parents and healthcare professionals should recognize the connection between sleep apnea and bed-wetting. That way, they can seek and provide appropriate evaluation and treatment options. And they can improve the quality of life for affected children.

• #1 What does sleep apnea have to do with bed-wetting in children? – Meghna Dassani – Houston, TX

  https://www.meghnadassani.com/blog/what-does-sleep-apnea-have-to-do-with-bed-wetting-in-children/

  Bed-wetting, or nocturnal enuresis, is a common issue that affects many children. It refers to the involuntary release of urine during sleep after the age when bladder control is expected to be established. […] Bed-wetting can sometimes be linked to an underlying medical condition. One such condition is sleep apnea, a disorder characterized by repeated interruptions in breathing during sleep. […] The connection between sleep apnea and bed-wetting lies in the effect that sleep-disordered breathing has on the body’s ability to regulate urine production and bladder control. During sleep, the body produces a hormone called antidiuretic hormone (ADH). This hormone helps reduce urine production. And it allows the bladder to hold urine for longer periods. […] However, in children with sleep apnea, the disrupted sleep pattern can interfere with the release of ADH. And this can lead to increased urine production and reduced bladder control.

• #1 How are Sleep Apnea and Bedwetting Connected?

  https://sleeplessinarizona.com/how-are-sleep-apnea-and-bedwetting-connected/

  Sleep apnea affects around 30% of children and is a well-documented cause of bedwetting. Apnea disrupts sleep and can interfere with the signals between the brain and bladder, leading to nighttime accidents. […] Though less common, enuresis in adults can also be linked to sleep apnea. A study titled Enuresis and Obstructive Sleep Apnea in Adults observed five adults who developed enuresis concurrent with the progression of their OSA symptoms. […] One theory suggests that the negative intrathoracic pressure generated during obstructive events can increase the return of blood to the heart. Triggering a reflex that increases urine production. Various article authors suggest that atrial natriuretic peptide (ANP) plays a role in these changes in renal function. […] The lack of oxygen (hypoxia) during apnea can cause blood vessels in the lungs to constrict, putting extra pressure on the right side of the heart and causing it to stretch and dilate. This stretching of the right atrium triggers the release of ANP. A hormone that helps regulate blood pressure and fluid balance by increasing urine production. Studies have found that higher levels of ANP are linked to lower oxygen levels and greater chest pressure changes during apnea episodes, further supporting this theory.

• #1 Enuresis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1014762-overview

  Various common situations predispose to a psychological cause of enuresis, including birth of a new sibling, parental divorce or separation, death in the family, child abuse, or any other cause of social dysfunction at home or school. […] Constipation can cause both PE and SE and is a common aggravating factor that should be considered when other causes are present. […] Sleep-disordered breathing (SDB) is a disorder associated with both an abnormality in arousal and enuresis. […] A neurogenic bladder can result from a lesion at any level in the nervous system, including the cerebral cortex, the spinal cord, and the peripheral nerves. […] Urethral obstruction can be congenital (as with posterior urethral valves (PUVs), congenital stricture, or urethral diverticula) or acquired (as with a traumatic or infectious stricture or with meatal stenosis after circumcision).

• #1 Enuresis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK545181/

  The contribution of disturbed and excessively deep sleep to enuresis must be clarified. […] Children with neurodevelopmental disorders, including intellectual disabilities, autism spectrum disorder, and attention-deficit/hyperactivity disorder (ADHD), experience enuresis more frequently. […] The distension of the rectum in a child with constipation puts direct pressure on the bladder wall, causing detrusor overactivity and impairing bladder emptying. […] Enuresis can cause distress and low self-esteem in children and impact the entire family socially and economically. […] Enuresis is most often due to discordance between bladder capacity, nocturnal urine production, and the child not waking to the sensation of a full bladder.

• #1 Understanding Bedwetting in Kids | Lurie Children’s

  https://www.luriechildrens.org/en/blog/bedwetting-in-kids/

  Bedwetting occurs for different reasons. A child may experience: […] Peeing the bed may happen when the connection between a childs brain and bladder hasnt fully matured. It can also happen in kids who are heavy sleepers. […] The bladder isnt giving the brain a good signal to wake, Freedman says. […] Bedwetting may also run in families, according to Ravoori. Kids who wet the bed may have parents who experienced bedwetting at about the same age. […] Constipation plays a role in bedwetting for some kids. This is because the end of the colon primarily the rectum sits against the bladder. […] When stool (poop) collects in the colon, it reduces the bladders size temporarily. Less room to store urine creates a more urgent need to urinate or may cause the bladder to release urine. […] The relationship is so strong that when healthcare providers treat constipation, about half of kids stop wetting the bed, Ravoori says.

• #1 Bed Wetting | Turo Family Chiropractic

  https://turofamilychiropractic.com/conditions/bed-wetting/

  Bed wetting, or nocturnal enuresis, is a phase that many children experience as they grow. […] To understand why this happens, we start with the phrenic reflex. When an infant sleeps, respiration gradually slows down until carbon dioxide in the body gets high enough to trigger a breathing mechanism called the phrenic reflex. This stimulates the diaphragm (breathing muscle) to increased activity and the normal rhythm of breathing returns. If this reflex is not working correctly, carbon dioxide continues to increase causing smooth muscles to relax. […] Smooth muscles are the involuntary muscles of the body. They function without our control. The valve at the bottom of the bladder is a smooth muscle. When that muscle relaxes, the bladder does not retain fluid. […] In some children this reflex is just slow to develop. This can sometimes be a hereditary trait. More often, however, it is due to a spinal misalignment (subluxation).

• #1 Bedwetting and restraint learning – TheraPee

  https://www.bedwettingtherapy.com/blog/bedwetting-and-restraint-learning/?srsltid=AfmBOopH5NVUbdfpKLh1smd0JrPwVhHNP8bk7THRsmx-bN8EcFpGdVU-

  Most children who experience bedwetting (about 80-70%), do not have a medical or psychological problem that causes it. […] Bedwetting, then, is seen in these cases as a deficiency in restraint learning. These children did not learn to operate the restraint mechanism in a state of sleep. The mechanism exists in their brain, but does not recognize the signal sent from the filling bladder. Instead of contracting the sphincter muscles and holding back, they do the opposite by relaxing the sphincter muscles, which eventually causes bedwetting. […] Bedwetting is defined is an idiopathic symptom for them. An idiopathic symptom is a symptom that stands on its own and is not an expression of another problem.

• #1 Nighttime Wetting | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/enuresis-nighttime-wetting/

  Bladder control is learned gradually, only after the child is old enough to understand that such behavior is desirable and can respond to praise and rewards. […] The conscious suppression of automatic emptying is first learned for daytime control. Eventually, the suppression signal to the bladder becomes automatic and does not require a conscious act by the child. Nighttime bladder control requires that the brain, during sleep, suppresses the automatic emptying reflex. […] Enuresis is not a psychological disorder, although secondary psychological problems may develop if there is tension between the child and the parent about the child’s delay in learning bladder control. […] The most successful treatment involves the use of an enuresis alarm. This is a device, designed to sense „wetness,” which is attached to the child’s underwear or pajamas.

• #1 Urinary Incontinence in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/urinary-incontinence-in-children/urinary-incontinence-in-children

  Bladder function has a storage phase and a voiding phase. Abnormalities in either phase can cause primary or secondary incontinence. […] In the storage phase, the bladder acts as a reservoir for urine. Storage capacity is affected by bladder size and compliance. Storage capacity increases as children grow. Compliance can be decreased by repeated infections or by outlet obstruction, with resulting bladder muscle hypertrophy. External compression of the bladder from the colon and/or rectum may also decrease urine storage. […] In the voiding phase, bladder contraction synchronizes with the opening of the bladder neck and the external urinary sphincter. If there is dysfunction in the coordination or sequence of voiding, incontinence can occur. There are multiple reasons for dysfunction. One example is bladder irritation, which can lead to irregular contractions of the bladder and asynchrony of the voiding sequence, resulting in incontinence. Bladder irritation can result from a urinary tract infection (UTI) or from anything that presses on the bladder (eg, a dilated rectum caused by constipation).

• #1 Urinary Incontinence in Children – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/urinary-incontinence-in-children/urinary-incontinence-in-children

  The maturation of the voiding pattern from infant to adult involves changing from the infant’s reflex pattern of urination, in which bladder contractions occur unopposed by increased outlet resistance, to the adult pattern, in which bladder contractions are suppressed by the pontine micturition center. During maturation there is a transition phase in which detrusor contractions are opposed by external sphincter contraction.

• #1 Nocturnal enuresis – Wikipedia

  https://en.wikipedia.org/wiki/Nocturnal_enuresis

  The second ability that helps people stay dry is waking when the bladder is full. This ability develops in the same age range as the vasopressin hormone, but is separate from that hormone cycle. […] The typical development process begins with one- and two-year-old children developing larger bladders and beginning to sense bladder fullness. Two- and three-year-old children begin to stay dry during the day. Four- and five-year-olds develop an adult pattern of urinary control and begin to stay dry at night.

• #1 Primary monosymptomatic nocturnal enuresis: an etiological study | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-018-0020-4

  Nocturnal enuresis (NE) is a very common chronic pediatric problem with bad psychological consequences. […] MNE is a heterogeneous disorder with multiple factors interplay in its pathogenesis. So, the management must be tailored patient by patient according to the dominating etiology. […] Primary MNE is a heterogenous disorder results from the interplay of different factors, the predominant one may vary from patient to another which necessitate tailoring of management protocol case by case. The presence of more than one affected family member (history of affected parent or siblings) is common pointing to the role of genetic predisposition in MNE. Another possible etiology of MNE is nocturnal polyuria with decreased arousal from full bladder during sleep due to brainstem enuresis inhibiting reflex maturational delay. Psychological factors are also possible causes which if not properly treated results in resistance of many cases to treatments. […] Primary MNE is a multi-etiological disorder results from the interaction of genetic predisposition, sleep architecture abnormalities, inverted vasopressin secretion rhythm, and psychological disturbances. So, its management is in ultimate need of multidisciplinary treatment protocol.

• #1 Nocturnal Enuresis in Children (Bed Wetting) | Doctor

  https://patient.info/doctor/nocturnal-enuresis-in-children

  Nocturnal enuresis (bedwetting) is defined by the National Institute for Health and Care Excellence (NICE) guidelines as the involuntary wetting during sleep – without any inherent suggestion of frequency of bedwetting or pathophysiology.1 It is considered normal up to the age of 5 years, and is common up to the age of 10 years. […] Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. […] Three aetiological factors are commonly involved:4 A disorder of sleep arousal. The child is not wakened by the sensation of a full bladder. […] Bladder factors. There may be a low nocturnal bladder capacity and/or an overactive bladder. Emptying reflexes are not inhibited during sleep. […] Nocturnal polyuria. Affected children have been found to have low overnight vasopressin levels, and excessive production of dilute urine during the night.

• #1 Understanding Bed Wetting | ParentData by Emily Osterframe_1-svgframe_2-svgframe_3-svg

  https://parentdata.org/understanding-bed-wetting/

  Recently, a 9-year-old boy and his parents came to see me because he continues to wet the bed at night. […] As a pediatric urologist, I see two to three children every day for nocturnal enuresis, also known as bed-wetting. It is a common childhood issue affecting up to 25% of 5-year-olds, 15% of 7-year-olds, and 10% of 10-year-olds. […] While the exact mechanisms behind nocturnal enuresis are not fully understood, it is likely a condition influenced by several risk factors: […] In addition, our bodies produce a hormone called vasopressin that slows down the kidneys’ production of urine at night, and we know that many children who are bed-wetters do not secrete as much vasopressin, but that can change over time and with age. […] Bed-wetting is rarely linked to an underlying medical condition. However, if your child has secondary bed-wetting (i.e. begins bed-wetting after an extended period of dryness at night) or has symptoms of excessive thirst, snoring, chronic back pain, leg pain, recurrent urinary tract infections, or daytime urinary symptoms, your pediatrician may further evaluate and rule out possible underlying medical conditions. […] Addressing nocturnal enuresis involves a comprehensive approach that acknowledges both the physical and emotional aspects of this common childhood issue.

• #2 Nocturnal enuresis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348193/

  Nighttime incontinence, otherwise known as nocturnal enuresis, is a common condition that can cause substantial psychological distress in children with the condition. […] Although very little progress has been made recently in the treatment of bedwetting, there is a greater understanding of the pathophysiology of this condition, in particular, the role of the central nervous system. Here we discuss the proposed pathophysiology behind bedwetting, investigations and evidence for current treatments. […] There are three commonly proposed mechanisms to bedwetting. These include excessive nocturnal urine production, bladder overactivity and a failure to awaken in response to bladder sensations. Each mechanism can be supported by various studies, and no one theory is likely to explain bedwetting in all children. Excessive nocturnal urine production in some children is based on abnormal nocturnal plasma vasopressin release.

• #2 Internet Scientific Publications

  https://ispub.com/IJPN/2/1/10962

  A myriad of disorders lead to a wet child and nocturnal enuresis is not at all unusual in pediatric population. […] Increasing attention is now being focussed on the problem but a number of questions regarding the etiology and the management still elude an answer. […] The etiology of primary nocturnal enuresis has been widely debated but is still not completely understood. The final common pathway for all affected children is an inability to recognise the sensation of a full bladder during sleep and to awaken from sleep to go to the toilet. […] The possible mechanisms are discussed in detail below: 1. Genetic Factors: A Family history of nocturnal enuresis is found in most children. […] 2. Maturational Delay: Although the most common accepted cause of primary nocturnal enuresis, it is the most difficult to prove.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20210119/Study-finds-genetic-variants-that-increase-the-risk-of-bedwetting.aspx

  But you can still also have all the variants without wetting the bed at night, because there are other risk factors in play that we haven’t mapped yet – both genetic and environmental. So it’s clear that this is very complex and that it’s not possible to talk about a single gene that causes nocturnal enuresis. […] The study also shows that children with many genetic variants that increase the risk of ADHD are particularly vulnerable to developing bedwetting. […] Our findings don’t mean that ADHD causes bedwetting in a child, or vice versa, but just that the two conditions have common genetic causes. More research in this area will be able to clarify the details in the biological differences and similarities between the two disorders. […] The researchers hope to be able to further clarify the causes of nocturnal enuresis. It is very likely that it will be possible to identify even more genes and thereby gain a deeper understanding of what is required for a child to become dry at night.

• #2 Bedwetting: Causes, Signs, Treatment & Cure

  https://www.emedicinehealth.com/bedwetting/article_em.htm

  Bedwetting, or nocturnal enuresis, refers to the unintentional passage of urine during sleep. Enuresis is the medical term for wetting, whether in the clothing during the day or in bed at night. Another name for enuresis is urinary incontinence. […] In general, primary bedwetting probably indicates immaturity of the nervous system. A bedwetting child does not recognize the sensation of the full bladder during sleep and thus does not awaken during sleep to urinate into the toilet. […] The cause of bedwetting is likely due to one or a combination of factors. The child: Cannot yet hold urine for the entire night. Does not waken when his or her bladder is full. Some children may have a smaller bladder volume than their peers. Produces a large amount of urine during the evening and night hours. Has poor daytime toilet habits.

• #2 Bed-wetting in older children and young adults is common and treatable

  https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248

  Bed-wetting (enuresis) is a sleep problem. It occurs when individuals are unable to wake to urinate when the bladder is full. […] Three main factors affect bed-wetting: a large volume of urine produced at night which depends on the amount and type of drinks consumed (for example, alcohol is a diuretic), as well as the effect of inadequate amounts of the hormone vasopressin. Vasopressin is normally secreted in larger quantities at night causing the kidneys to make less urine. Some people secrete less vasopressin than normal during sleep, resulting in larger volumes of urine being produced. […] a small bladder or a bladder that contracts more than normal during sleep and holds less urine at night. Caffeine and constipation can affect the bladder. […] people who sleep deeply as well as those with sleep problems find it difficult to wake when the bladder is full during sleep. Tiredness, medication with a sedative effect, as well as alcohol can also affect sleep arousal.

• #2 The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study | Scientific Reports

  https://www.nature.com/articles/s41598-021-96519-w

  In this study, ALFF and DC methods were used to compare PNE and TD children at the four coordinates of bilateral PVT and NAc. […] The results of this study showed that the FCs between lPVT and lNAc of PNE were lower than TD children, showing the pathway correlated with awakening were weaker. […] Higher the awakening score is, lower the degree of awakening ability is. […] Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. […] In conclusion, this study was based on the theory of PVT is among the key brain regions implicated with awakening regulation and the regulation effect of PVT on awakening depends on the PVT-NAc pathway.

• #2 Enuresis in Children: Common Questions and Answers | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html

  Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older. […] Pathophysiology of primary monosymptomatic nocturnal enuresis may be due to sleep arousal disorder, overproduction of urine, small bladder storage capacity, or detrusor overactivity. […] Primary monosymptomatic nocturnal enuresis may be attributed to sleep arousal disorder, nocturnal polyuria, low bladder storage capacity, or detrusor overactivity. Children with sleep arousal disorders have a harder time waking in response to normal bladder cues. These children have more fragmented and nonrestorative sleep. […] Nocturnal polyuria and large volume voids are present when the kidneys do not concentrate urine appropriately. The formal evaluation of polyuria includes weighing sheets or diapers and measuring the first-morning void volume. Factors contributing to polyuria include drinking large volumes before bedtime; ingestion of large amounts of solute, such as salt or sugar; and decreased vasopressin release from the pituitary at night.

• #2 Enuresis in Children: Common Questions and Answers | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html

  Underlying bladder issues, including low bladder storage capacity and detrusor overactivity, may also cause enuresis. […] Secondary monosymptomatic nocturnal enuresis is more likely to have an underlying pathologic cause and may be the first sign of a new medical issue. […] Nonmonosymptomatic nocturnal enuresis occurs in 15% to 30% of children with enuresis. It is usually attributed to an underlying pathologic cause; common causes are listed in Table 4. Diagnosis and treatment of the underlying pathology causing the daytime symptoms should occur before nocturnal enuresis therapy. […] When first-line therapies are not successful, the physician should evaluate for comorbidities, such as constipation, sleep disorders, or behavioral issues, and address these. Medications such as anticholinergics and tricyclic anti-depressants, especially in combination with first-line therapies, may be effective. Pediatric urology consultation should be considered in refractory cases.

• #2 What does sleep apnea have to do with bed-wetting in children? – Meghna Dassani – Houston, TX

  https://www.meghnadassani.com/blog/what-does-sleep-apnea-have-to-do-with-bed-wetting-in-children/

  Bed-wetting, or nocturnal enuresis, is a common issue that affects many children. It refers to the involuntary release of urine during sleep after the age when bladder control is expected to be established. […] Bed-wetting can sometimes be linked to an underlying medical condition. One such condition is sleep apnea, a disorder characterized by repeated interruptions in breathing during sleep. […] The connection between sleep apnea and bed-wetting lies in the effect that sleep-disordered breathing has on the body’s ability to regulate urine production and bladder control. During sleep, the body produces a hormone called antidiuretic hormone (ADH). This hormone helps reduce urine production. And it allows the bladder to hold urine for longer periods. […] However, in children with sleep apnea, the disrupted sleep pattern can interfere with the release of ADH. And this can lead to increased urine production and reduced bladder control.

• #2 Bedwetting as an Idiopathic symptom – TheraPee

  https://www.bedwettingtherapy.com/blog/bedwetting-as-an-idiopathic-symptom/?srsltid=AfmBOor-WKDIYP4VXKnAJXnq-mrDsU8Uzi82gqmCuvICUTssLCJxJqOX

  Most bedwetting children (about 70-80%) have no medical or psychological problems that cause them to wet. […] In these childrens cases, bedwetting is considered as a restraint learning deficiency. They did not learn to operate the restraint mechanism while they are asleep. Although the mechanism does exist in their brain, it does not recognize the signal sent from the filling bladder. Instead of contracting the sphincter muscles and holding back the urine, they do the opposite, i.e. relax the sphincter muscles and wet the bed. […] Their bedwetting is in fact an Idiopathic symptom, which is a stand-alone symptom, that doesnt indicate another problem. It is different from a symptom that is a manifestation of a particular problem, for example bedwetting as a result of mental stress (Psychological cause), or bedwetting due to urinary issues (medical cause). The common thing for all these children, is their depth of sleep. 97% parents who come to our clinics report that their child is an extremely deep sleeper.

• #3 Enuresis in Children: Common Questions and Answers | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1100/enuresis-children.html

  Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older. […] Pathophysiology of primary monosymptomatic nocturnal enuresis may be due to sleep arousal disorder, overproduction of urine, small bladder storage capacity, or detrusor overactivity. […] Primary monosymptomatic nocturnal enuresis may be attributed to sleep arousal disorder, nocturnal polyuria, low bladder storage capacity, or detrusor overactivity. Children with sleep arousal disorders have a harder time waking in response to normal bladder cues. These children have more fragmented and nonrestorative sleep. […] Nocturnal polyuria and large volume voids are present when the kidneys do not concentrate urine appropriately. The formal evaluation of polyuria includes weighing sheets or diapers and measuring the first-morning void volume. Factors contributing to polyuria include drinking large volumes before bedtime; ingestion of large amounts of solute, such as salt or sugar; and decreased vasopressin release from the pituitary at night.

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