Bedwetting: The Origins of Enuresis

BEDWETTING: THE ORIGINS

The origin of bedwetting is often psychological or related to a delay in toilet training. Thus, overly strict parenting or a significant event such as the arrival of a sibling can trigger bedwetting in children.
Bedwetting can also originate from an immaturity of the bladder system with a deficiency in parasympathetic nerve inhibition.

Several predisposing factors are recognized for enuresis.

• The first and most important factor is genetics . Bedwetting is very often a hereditary condition. Discovering during a consultation that one's father or mother has already had this problem has the advantage of putting the child's bedwetting situation into perspective.
• The bladder factor: Nocturnal enuresis appears to be a delay in the maturation of the nerve pathways controlling urine production and nocturnal bladder function. Indeed, nocturnal polyuria (or nocturnal hyperdiuresis), resulting from a deficiency in nocturnal secretion of ADH (antidiuretic hormone), is found in two-thirds of children with enuresis. Furthermore, various studies have shown that the nocturnal bladder capacity of children with enuresis is lower than that of "healthy" children and that bladder overactivity (or urgency) occurs in the first two-thirds of the night, during deep sleep, which explains why the child does not wake up.
• The sleep-wake cycle: there is no doubt that bedwetting and sleep are closely linked. To be convinced of this, one only needs to listen to parents say that their bedwetting child is very difficult to wake or that they sleep very deeply.

Studies have shown that the sleep patterns of children with enuresis are normal, but their arousal mechanisms are immature. This is why a child with enuresis, even with a full bladder, doesn't wake up, while a "healthy" child will wake up to urinate. From these three predisposing factors, we can easily understand the mechanism of enuresis: a reduced nighttime bladder capacity, combined with bladder contractions that would normally require emptying, and an immature arousal system, prevent the child from waking up to urinate.

Other causes can lead to bedwetting:

• Constipation can contribute to enuresis through disinhibited bladder contractions.
• Psychological factors: school anxiety, divorce, any other cause of psychological stress can be triggering factors for enuresis.