ENURESIS: TYPES, CAUSES AND TREATMENTS - ECONOMÍA - 2025

The nocturnal enuresis is the act of urinating involuntarily while sleeping at an age in which it is assumed that already must have reached the sphincter control. It usually appears in children, but it can also happen to some teenagers and even adults.

Usually when bedwetting occurs, the situation can cause a great deal of emotional distress to the person suffering from it. Among other things, it can generate low self-esteem, social rejection if other people find out what is happening, and difficulties sleeping; and on a physical level, it is also associated with urinary tract infections.

Most cases of enuresis are not related to any type of mental or emotional disorder, but they occur due to a delay in the normal development of the person. However, a small percentage of the time (around 10%), the underlying cause is a more serious problem.

Fortunately, even though "bed-wetting" is one of the most common childhood problems, most cases end up resolving themselves. In those in whom this does not occur, behavioral therapy interventions are usually extremely effective, so that almost everyone ends up eliminating this situation.

Types

Doctors and psychologists recognize two different forms of enuresis: primary and secondary. Each of them is associated with different causes, in addition to having different diagnoses. In this section we tell you what each one of them consists of.

Primary enuresis

Enuresis is considered to be primary when the person wetting the bed has never previously been able to control his bowels for a period of six months or longer. Usually this is just a delay in normal development times, and it tends to clear up on its own.

The criterion for diagnosing a case of enuresis, as opposed to a normal part of the child's development, is that nocturnal urination occurs after the age when most people learn to control their bowels. It is generally considered that this learning can occur at any time between 4 and 7 years.

Some doctors believe that at least one other condition must be present in order to diagnose a child with bedwetting. The little one has to wet the bed at least twice every month; if the frequency is lower, it is usually not seen as a symptom of this problem.

Secondary enuresis

Secondary enuresis is much less frequent than the previous variant. The main difference between the two is that, in this case, involuntary urination at night occurs after a more or less long period in which the person had already learned to control their sphincters.

In cases where secondary enuresis occurs, the experience is usually much more painful for those who suffer from it. This is especially true if it occurs in adolescents or adults, since the fact of wetting the bed at these ages often leads to negative consequences such as shame or low self-esteem.

When this type of enuresis occurs, there is usually an underlying psychological cause. However, sometimes urination can be caused by other factors, such as the consumption of certain medications or the intake of diets that promote constipation.

Causes

The factors that cause a person to have enuresis are not entirely clear. However, many factors are known that can influence the appearance of this problem. Next we will see which are the most important.

Delayed neurodevelopment

This is the most common cause of bedwetting. Most children who wet the bed simply have not yet developed the ability to control their toilet bowls; and they usually don't show any other kind of problem.

Some studies suggest that nocturnal urination may be due to the individual's nervous system taking longer than normal to "learn" the sensation of having a full bladder. Of course, this cause can only affect primary enuresis.

Genetics

Apparently, bed-wetting could have a strong genetic makeup. Among children whose parents never had this problem, the probability that it appears is only 15%. However, when one of the two parents had it, it increases to 44%; and it reaches 77% in the event that both develop it.

Psychological factors

In the past, it was believed that all cases of enuresis were caused by an extremely traumatic event in the individual's past. Thus, the death of a relative, a case of bullying, or suffering sexual abuse could cause a person to develop this problem throughout her life.

Today, we know that the vast majority of enuresis cases have nothing to do with trauma; however, some of them are caused by this cause.

When this occurs, involuntary urination is considered just a symptom of a more serious underlying disorder.

Physical abnormalities

In a small percentage of cases of enuresis, patients present certain variations in some of their organs.

These modifications can be the main cause of your nighttime urination. For example, they could have a smaller than normal bladder, or a wider urethra.

Somnambulism

Sleepwalkers (that is, who walk while asleep) are more likely to wet the bed. One of the most common reasons for this is that, while dreaming about going to the bathroom, they can perform the physical act of urinating. Thus, they sometimes urinate in bed, in the middle of their room or in any other part of the house.

Stress

Stress can be one of the main causes of secondary enuresis. Several studies have shown that, in the face of difficult events such as the death of a loved one, moving to another city or the divorce of the parents, the chances of a child wetting the bed again after having stopped doing so are greatly increased.

Lifestyle factors

Consumption in large amounts of some substances, such as caffeine or alcohol, can contribute to the appearance of secondary enuresis. However, this factor is almost never the main cause of involuntary nocturnal urination.

Diseases

Some physical pathologies, such as urinary tract infections or type I diabetes, can also contribute to the appearance of secondary enuresis. However, the percentage of cases in which these factors are the most important is very low.

Children

Bed-wetting is much more common in childhood than at any other stage of life. Most cases of this problem simply have to do with the fact that the child has not yet fully developed the ability to control her bowels; and as this is the cause, they usually resolve on their own.

However, despite being minor and requiring no intervention to correct, enuresis in children can also have some serious psychological consequences. For some of those who suffer from this problem in childhood, it can lead to difficulties such as low self-esteem, social exclusion or insomnia.

Therefore, sometimes it is necessary to intervene in cases where enuresis occurs in childhood. If it is a primary type, the main objectives of therapy will be to educate the child to show her that what is happening to her is normal, and to help her better control her bowel movements in specific situations such as camping or nights at her friends 'house.

At other times, more focus will be placed on improving the self-esteem of children affected by enuresis. Sometimes it will even be necessary to carry out family therapy to reduce the emotional impact that this problem can have on the child's closest circle.

Adolescents and adults

When enuresis occurs after childhood, in the vast majority of cases it is a secondary type. This means that when an adult or adolescent wet the bed, the cause is not usually a delay in the development of toilet training.

Because of this, the first thing to do in a case of secondary enuresis is to study what may be causing the problem. As we have seen previously, the reasons why a person may wet the bed in their adolescence or adult life are very diverse.

Depending on what the reasons are suspected, the interventions carried out can be extremely different. For example, bed-wetting related to a physical illness cannot be treated the same as bedwetting caused by an underlying psychological disorder.

Emotional impact

Still, there is something that most cases of secondary enuresis in adolescence and adult life have in common. People who suffer from this problem after childhood tend to have more serious emotional consequences, since wetting the bed is often seen as something terrible and something to be ashamed of.

Thus, those who have involuntary nocturnal urination can end up suffering a drastic drop in self-esteem that leads them to develop other more serious psychological problems. For example, cases of depression, anxiety disorders, inability to sleep or avoidance of situations in which someone might discover them may appear.

Due to this, in most cases the therapy to treat enuresis in adulthood or adolescence focuses both on solving the problem and on alleviating the adverse emotional effects suffered by the person.

Treatments

As we have already seen, in most cases enuresis (if it is primary) ends up disappearing by itself. However, some of its variants require the use of certain interventions to end nocturnal urination.

The first thing that a doctor or psychologist will try when treating a bedwetting problem is to find the causes for which it occurs. If it has to do with some underlying disorder, be it physical or mental, ending it is usually the course of action to take.

In cases in which for some reason the causes of night urination cannot be eliminated, there are still many alternatives to follow in order to alleviate most of the most serious consequences of this problem. Next we will see the most common ones.

Use of certain products

Today, there are many accessories that can reduce the impact that enuresis has on the lives of those who suffer from it. For example, you can buy bed bumpers that absorb any type of liquid and protect your sheets and mattress.

Another option is the use of special underwear that prevents urine from seeping through the clothes. However, most people are not comfortable using these methods, preferring to avoid involuntary urination as much as possible.

Changes in behavior

Certain changes in lifestyle or nighttime habits can help prevent bed-wetting from occurring. For example, some people find that limiting their fluids late in the day prevents them from wetting the bed.

Another widely used technique is the use of alarms to wake up in the middle of the night and go to the bathroom before involuntary urination occurs. This particular method tends to work extremely well, causing only minimal discomfort to the person.

Medical treatments

If all else fails, the person may decide to undergo certain pharmacological or surgical treatments that have been shown to be effective in alleviating or eliminating enuresis. However, like all interventions of this type, they may not be totally safe or cause certain side effects.

Among the most commonly used medical options are increasing the capacity of the bladder through surgery, or the use of medications such as desmopressin to remove urine production from the body.

References

1. "Enuresis treatment & management" in: MedScape. Retrieved on: November 01, 2018 from MedScape: emedicine.medscape.com.
2. "What is enuresis?" in: Kids Health. Retrieved on: November 01, 2018 from Kids Health: kidshealth.org.
3. "Nocturnal enuresis in children" in: Up To Date. Retrieved on: November 01, 2018 from Up To Date: uptodate.com.
4. "Adult bedwetting" in: National Association for Continence. Retrieved on: November 01, 2018 from the National Association for Continence: nafc.org.
5. "Nocturnal enuresis" in: Wikipedia. Retrieved on: November 01, 2018 from Wikipedia: en.wikipedia.org.