As a result, the understanding of enuresis is now a group of disorders rather than a single entity. Researchers suspect several factors to be involved in the pathophysiology of enuresis, with each patient exhibiting different combinations of these, thus explaining why some individuals respond to specific therapies that are unsuccessful in others. Patients with sickle cell disease also show a higher incidence of enuresis. Enuresis tends to be cured, or its frequency drastically diminished, after tonsillectomy and adenoidectomy in these patients. These patients have high levels of atrial natriuretic peptide leading to inhibition of the renin-angiotensin-aldosterone pathway and increased diuresis, but other proposed links between both entities are an inadequate arousal response secondary from sleep fragmentation due to disordered breathing and bladder stimulation from elevated abdominal pressure resulting from an increased respiratory effort to compensate for an obstructed airway. Īlso, there is an association between sleep-disordered breathing and enuresis. Other comorbid conditions in this category include autism spectrum disorder, oppositional defiant disorder, and mood disorders. The most common of these comorbidities is attention deficit and hyperactivity disorder, and the postulate is that a common sleep disturbance could link both conditions. Īdditionally, 20 to 30% of patients with enuresis also suffer from at least one psychological, behavioral, or psychiatric disorder, a rate twice as high as that of the general population. Enuresis is more common in boys when compared to girls, with a ratio of 3 to 1, but this difference tends to decrease after age 10. The prevalence varies with age, with 15% of 7-year-olds, 10% of 10-year-olds, 2% of adolescents, and 0.5 to 1% of adults being affected by the condition. The prevalence of enuresis is similar across cultures. This activity highlights a detailed understanding of this very common yet misdiagnosed condition. Many children become isolated, lack self-esteem, and have poor academic performance. Children are often punished and are at risk for physical and emotional abuse. Nocturnal enuresis is not a benign disorder it has severe repercussions for the child and the family. To avoid confusion, the International Children’s Continence Society has defined enuresis as wetting that occurs at night, whereas they no longer refer to daytime incontinence as diurnal enuresis. Moreover, the enuretic episodes are considered frequent if they occur 4 or more times per week. Also, the enuresis classifies as monosymptomatic or non-monosymptomatic, with the latter correlating with daytime incontinence or other lower urinary tract symptoms like urgency. Primary enuresis is when it occurs in a child who has not been dry for at least 6 months, whereas secondary enuresis is the one that has an onset after a period of nocturnal dryness of at least 6 months. Enuresis refers to the involuntary loss of urine during sleep that occurs at least twice a week in children older than 5 years of age (or the developmental equivalent) for at least 3 months, and it is the most common urologic complaint in pediatric patients.
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