Central nervous regulatory mechanisms in nocturnal enuresis

Dysfunctions: Three factors can be considered as basis of the neurobiology of nocturnal enuresis: (1) dysfunction of mesopontine reticular neuronal systems with the consequence of inadequate inhibitory mechanisms for functional subcortical bladder control (developmental delay of afferent pathways or subcortical control mechanisms); (2) arousal-dysfunction, i.e, an absent or inadequate arousal response to bladder distention with the consequence that the child does not awake despite of its full bladder (developmental delay of the arousal system); and (3) dysfunction of the normal circadian rhythm of vasopressin secretion, i.e. an inadequate nocturnal increase of the level of this hormone hormone's level with following excessive nocturnal urine production. Regulation: Three therapeutical approches can be matched to these neurobiological dysfunctions to improve the central nervous regulation of nocturnal enuresis: (1) "the wait-and-see approach," i.e. waiting for the maturation of normal bladder function [while simultaneously reassuring the parents] ("developmental delay"), (2) "alarm therapy" to improve the child's awareness and signal perception of a full bladder, and (3) desmopressin administration to compensate for the nocturnal vasopressin deficit. Parents information: Providing parents of these enuretic children with detailed information about the neurobiology and the possible central nervous regulatory mechanisms of nocturnal enuresis is particularly important to prevent them from unduly blaming their bedwedding child and equally to lessen their inappropriate feelings of insufficiency in training their child to central his/her bladder.