Enuresis has been recognized for centuries. In 1472 Paulus Bagellardus of Padua published the first book on diseases of children, including one chapter entitled ‘On incontinence of urine and bedwetting’. Theories as to the aetiology of enuresis are extremely varied, as do the variety of chemical, mechanical and behaviourally oriented treatments methods. In the 20th century, it was thought that bedwetting was primarily a psychological or even psychiatric disorder and that children with incontinence had more emotional and/or behavioural problems than their continent peers.
Nowadays, nocturnal enuresis can be understood as the result of a relative shortage of vasopressin, detrusor overactivity, lack of ability to wake up from sleep to a full bladder, or a combination of the three systems. It is supposed that all three systems remain outside of the child’s control and treatment interventions, appropriately selected to meet the child’s needs, have an excellent chance of enabling the child to achieve dryness at night. Over the years many studies have focused on enuresis and it has contributed to the increased understanding of the interplay between physiological processes in the onset and course of bedwetting.
This article investigates the pathogenesis of enuresis of children, back in 1952 in an era where bedwetting was often considered a psychiatric disorder. It can be seen as a milestone paper, being the first paper recognizing nocturnal polyuria as a cause for bedwetting. Every self-respecting health care professional should have knowledge of this article, which adds to a better understanding of enuresis pathophysiology.
This research shows us that in all children with and without enuresis, the circadian excretory rhythms are comparable. However, all children with enuresis have a higher night-time output. Furthermore, it describes that most of the enuretic children were deep sleepers and most of them had complaints of higher voiding frequency and imperative urge, during the day. Approximately one third had a small bladder volume as one of the possible causes of bedwetting.
The author also discussed the familial or genetic factor. Currently, it is known that in most 70% of the children with incontinence at night, the problem also runs in the family, from childhood into adult life.
Despite the small sample and the lack of discussion on the aetiology of the observed night-time polyuria, this is an important study being the first to associate nocturnal polyuria with bedwetting. A large number of studies have addressed the pathophysiology of nocturnal enuresis since.
However, there is still a number of questions that remain unanswered and we continue to seek new and effective treatment options.
Reference: Relative Nocturnal polyuria as a factor in enuresis, E.Maclean Poulton, 8 November 1952, The LANCET
