Abstract
The pathophysiological nature of the monosymptomatic primary nocturnal enuresis (PNE) in children is still the unresolved problem. The most hypotheses of pathogenesis of nocturnal enuresis are limited within anatomical, biochemical and physiological regulation of the urinary control. Based on our own observations as well as the data reported in the literature, we have concluded that in addition to described biological causes of this disorder, we should focus on the common clinical and developmental features observed in the majority of cases of the monosymptomatic primary nocturnal enuresis that could be united as “enuretic syndrome”. In attempt to move “outside of the box” of the urinary control we have put forward a hypothesis that enuresis is a specific compensatory syndrome which is self-developed by the child’s organism to “offset” the deviated sleep–wake mechanisms. This concept is based on the general “control system theory” and offers the explanations of the majority of symptoms. From the compensatory “offset” concept the treatment of PNE should be focused not on the suppression of the act of enuresis but on the stabilization of circadian sleep-wake mechanisms. Further investigations are needed to evaluate the validity of this concept.
Highlights
Enuresis, or “bedwetting” – is a disorder which is as old as the whole history of mankind
Because primary nocturnal enuresis (PNE) is happening in sleep we focused on the relationships between PNE and circadian rhythm
We have conducted a review of the relevant literature related to the etiology of enuresis and studies of sleep patterns in enuretic children
Summary
“bedwetting” – is a disorder which is as old as the whole history of mankind. It is very difficult to find another disorder, which on the one hand has so clear clinical picture, has so much written about it, but, on the other hand, we do not have yet clear answers to physiological nature of PNE. Besides the forceful awakening or/and suppressing the symptom we do not have keys to the really control the child’s afflicted sleep and its deviations including PNE. We attempted to review of the literature and offer a new approach to resolve the theoretically intriguing and practically important puzzle of PNE. Because PNE is happening in sleep we focused on the relationships between PNE and circadian rhythm
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More From: American Journal of Clinical and Experimental Medicine
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