For hundreds of years
people have been aware of the problem of enuresis. Throughout the centuries
attempts to find cause and cure have been guided by fact and fable. It
is unfortunate that fable still distorts understanding of enuresis –
and stands in the way of successful treatment.
This statement from the 1897 volume, Holt’s Textbook in Paediatrics,
may be a milestone in the history of understanding the aspects of
enuresis, although the text recommends circumcision, adenoid removal
and other drastic measures to cure the condition. Holt was also far off
track in pinpointing the cause of enuresis.
Enuresis was once a mystery, one that has taken a long time to
solve. Through the years state-of-the-art doctoring has been applied to
enuresis.
- Lubricate the sick body part with oil. Keltham’s Fasciculus Medicinae 1491
- Cure patients with a cockscomb and a crocus, taken with raw egg each morning. Dr. John Hall 1657
- Place a chamber pot beneath the penis and scrotum, and keep them in position all night. William H. Heberden 1802
The nostrums above may be amusing to us, but remember; children had to pay the price.
Old wives’ tales and household wisdom have also been used to relieve enuresis.
- Bite the head off a frog
- Chrysanthemum flowers
- Hot wine and oil
- Hare testicles shaved down and drunk with wine
- Burn a cocks comb and give it as a drink in tepid water
As chemistry was increasingly applied to medicine, new attacks on
enuresis were developed. Pharmaceutical preparations such as opium,
camphor, strychnine, belladonna and chloral hydrate are just a few
previous preparations used to treat enuresis.
It was not before the 20th century was well underway, that real progress was made.
Burns made this observation in 1937 and it has been a key point in
the development of treatment to date. Science has made considerable
advances since then and progress will continue. What remains important
is the need to spread knowledge and understanding of enuresis to
optimise the efficacy of treatment available.
The four factors involved in the basic pathophysiology of enuresis.
- Bladder function
- Sleep
- Urine production
- Genetics
Not all of the processes are fully understood, most notably
genetics, although science has established that enuresis can be
inherited. Most bedwetters have normally functioning bladders and
demonstrate normal sleeping patterns. The question as to why enuretic
youngsters do not wake up, when bedwetting occurs, still remains open.
They apparently have a lack of arousal normally provoked by a full
bladder. As findings were being reported, the relevance of urine
production came into sharper focus.
It was demonstrated in 1989 (S Rittig (1)) that the cause of
enuresis may be from a mismatch between nocturnal urine production and
nocturnal functional bladder capacity, that is, if the kidneys produce
more urine than the bladder can contain, enuresis will occur.
Desmopressin, an antidiuretic treatment, enters the picture when taken at bedtime it reduces the volume of urine produced overnight.
References:
1. Rittig et al, Am. J. Physiol 1989; 256: F664-F671
