From the Guidelines
Nocturnal enuresis in young adults is primarily caused by a combination of nocturnal polyuria, detrusor overactivity, and an increased arousal threshold, as well as underlying conditions such as constipation and neuropsychiatric disorders. The causes of nocturnal enuresis can be multifactorial and may include:
- Nocturnal polyuria, which is characterized by an excessive production of urine at night 1
- Detrusor overactivity, which can lead to a sudden and intense need to urinate 1
- Increased arousal threshold, which can make it difficult for the individual to wake up in response to a full bladder 1
- Constipation, which can put pressure on the bladder and worsen enuresis symptoms 1
- Neuropsychiatric disorders, such as attention deficit hyperactivity disorder, which can increase the risk of enuresis 1
- Hormonal imbalances, such as insufficient antidiuretic hormone (ADH) production, which can affect the body's ability to regulate urine production 1
- Small bladder capacity, overactive bladder muscles, or genetic factors, which can also contribute to enuresis symptoms 1
Treatment for nocturnal enuresis should focus on addressing the underlying causes and may include lifestyle modifications, medications, and behavioral therapies. For example, desmopressin (DDAVP) at 0.2-0.4 mg at bedtime can be used to regulate hormone production and reduce nocturnal polyuria 1. Additionally, anticholinergics such as oxybutynin (5-10 mg daily) can be used to treat overactive bladder muscles 1. Behavioral therapies, such as bladder training and bedwetting alarms, can also help condition the body to wake up in response to a full bladder 1. It is essential for young adults experiencing nocturnal enuresis to seek medical evaluation to determine the underlying cause and develop an effective treatment plan.
From the Research
Causes of Nocturnal Enuresis
The causes of nocturnal enuresis (bedwetting) in young adults are multifaceted and can be attributed to various factors, including:
- Genetic inheritance 2
- Reduced bladder capacity 2, 3
- Sleep disorders 2, 4
- Abnormal secretion of antidiuretic hormone 2
- Psychologic abnormalities 2
- Neurologic dysfunction 2, 5
- Bacteriuria 2
- Diet 2
- Constipation 3, 4
- Sedative use 5
- Overactive bladder (OAB) 5
- Voiding dysfunction 5
- Abnormal urodynamic findings 5
- Obstructive sleep apnea (OSA) 5
Pathogenetic Factors
Nocturnal enuresis can be caused by disturbances in:
- Nocturnal urine production 4
- Nocturnal bladder function 4
- Arousal mechanisms 4 Two main types of enuresis can be discerned:
- Diuresis-dependent enuresis: characterized by excessive nocturnal urine production and impaired arousal mechanisms 4
- Detrusor-dependent enuresis: characterized by nocturnal detrusor hyperactivity and impaired arousal mechanisms 4
Associated Conditions
Nocturnal enuresis is often associated with other conditions, including: