SLEEP/AROUSAL AND ENURESIS SUBTYPES

Abstract

The mechanisms responsible for enuresis are maturational delays and the extent of the maturational lag equates with the severity of the clinical picture. A literature review was conducted comparing the similar mechanisms of bladder physiology in normal and children with enuresis. Several mechanisms are associated with enuresis including nocturnal urine volume, nocturnal functional bladder capacity, spontaneous bladder contractions and the inability to arouse to the stimulus of a large and/or contracting bladder. There is adequate evidence for children with enuresis who demonstrate nocturnal spontaneous bladder contractions (detrusor dependent enuresis) and nocturnal polyuria (volume dependent enuresis). A recent study has shown that children with enuresis are difficult to arouse in the first two-thirds of the night, which is also associated with the period of greatest wetting frequency. Night dry children may demonstrate daytime frequency and urgency, others may have nocturia and others are difficult to arouse. Subtyping into volume dependent and detrusor dependent types may only describe specific entities of a larger array of clinical presentations. It is proposed that the mechanisms responsible for enuresis are maturational delays and the extent of the maturational lag equates with the severity of the clinical picture. Included in this clinical spectrum are children who demonstrate diurnal incontinence and those with secondary enuresis. The former is a condition of maturational severity and the latter is a maturational change. The ability to arouse is fundamental to those who are continent.