Enuresis, commonly known as bedwetting, typically refers to involuntary urination during deep sleep in children. By the age of 4, only 20% of children experience enuresis, and by age 10, this drops to 5%. A small number of patients continue to have enuresis symptoms into adulthood. Cases without obvious urinary tract or neurological organic sexually transmitted disease are referred to as primary enuresis, accounting for about 70–80%. Secondary enuresis occurs due to conditions such as lower urinary tract obstruction (e.g., urethral membrane), bladder inflammation, or neurogenic bladder (urinary dysfunction caused by neurological disorders). In addition to nighttime bedwetting, affected children often exhibit symptoms like frequent urination, urgency, difficulty urinating, or a weak urine stream during the day.

bubble_chart Etiology

The main disease causes of primary enuresis may include the following: ① Delayed development of the cerebral cortex, which fails to inhibit the spinal micturition center, leading to uninhibited contractions of the detrusor muscle during sleep and subsequent urine expulsion; ② Excessive sleep depth: inability to wake up immediately when the bladder becomes distended during sleep; ③ Psychological factors: such as the child feeling unloved by parents or lacking care. These children often exhibit peculiar spleen qi, shyness, loneliness, timidity, and difficulty socializing; ④ Genetic factors: a higher incidence of enuresis among the parents or siblings of the affected child.

bubble_chart Diagnosis

The principles for diagnosing primary enuresis mainly involve excluding various disease causes of secondary enuresis. ① Medical history: Pay attention to whether there is a genetic factor, whether enuresis started in infancy, and whether it appeared later or is accompanied by daytime urinary symptoms, which may indicate secondary enuresis. Concurrent constipation or neurological disorders may suggest secondary neurogenic bladder. ② Physical examination: Conduct a thorough general physical examination, with special attention to whether the anal sphincter tone is normal, the presence of spina bifida, whether perineal sensation is diminished, and whether lower limb activity is normal. ③ Laboratory tests: Urinalysis and urine culture. ④ X-ray examination: Plain films to check for spina bifida, and bladder-urethral imaging to observe for mechanical obstruction. ⑤ Urodynamic studies: Urine flow rate test to check for lower urinary tract obstruction, and bladder pressure measurement to observe for uninhibited contractions.

1. General Treatment Avoid blaming or scolding the child; instead, provide encouragement to help the child develop the determination to overcome enuresis. Parents should offer high levels of care and affection to the child. Restrict water intake after dinner, ensure the child urinates before bedtime, and wake the child 1–2 times during the night to urinate.

2. Medication ① Imipramine: A central nervous system stimulant that reduces sleep depth. Take 25–50 mg orally every night for 3–4 months. If relapse occurs after discontinuation, the medication can be resumed. ② Parasympathetic blockers: Propantheline or Oxybutynin (Ditropan). Taken orally before sleep, these relax the detrusor muscle and inhibit bladder contractions. ③ Ephedrine 25 mg taken orally before bedtime. This increases the contractility of the bladder neck and posterior urethra.

3. Bladder Training During the day, instruct the child to gradually extend the intervals between urination, starting from every 0.5–1 hour and gradually increasing to every 3–4 hours, to expand bladder capacity.

4. Conditional Reflex Training Use an enuresis alarm device to train the child to wake up before bedwetting occurs. Place an electronic pad connected to a bell under the child. When the pad is wet, the circuit is activated, causing the bell to ring and wake the child to urinate. If the effect is insufficient, imipramine can be added to reduce sleep depth. Typically, 1–2 months of training can cure 70–80% of primary enuresis cases.