Patient's question:
Age description: Every time I need to urinate or defecate, it seems like I can't wait. If I take the toilet slowly, it will be on me. What's going on?Doctor's answer:
From a clinical perspective, enuresis includes two conditions: one refers to enuresis, commonly known as bedwetting; the other refers to enuresis, which involves not only urinating in bed but also urinating in clothing or other inappropriate places during non-sleep states or when awake. From a pathological perspective, the former is mostly caused by neurofunctional coordination disorders and is typically simple and persistent, meaning there are no other accompanying symptoms besides bedwetting. The latter is mostly caused by organic lesions, such as damage to the nervous system or occupying lesions in related organs, and is often accompanied and transient, meaning there are other more obvious pathological manifestations besides bedwetting, which can improve with the resolution of other lesions. This article discusses simple bedwetting without organic lesions.1. Physiological and Pathological Mechanisms of Bedwetting
The process of urination in humans involves the gradual storage of urine, which is a mixed liquid containing excess water, electrolytes, waste products, and metabolic byproducts from the body's cells, in the bladder after being excreted by the kidneys. When the bladder reaches a certain capacity, the pressure stimulates mechanoreceptors in the bladder wall. These mechanoreceptors transmit a urination signal through the peripheral nervous system to the central nervous system. After analysis and processing, the central nervous system issues a urination command, which reaches the bladder, causing the urethral sphincter to relax and the detrusor muscle to contract, thus expelling urine from the body. From this physiological process, if there is damage to the nervous system or occupying lesions in the bladder or related organs, abnormal urination, or enuresis, can occur. This type of enuresis can happen at any time—day or night, in bed or out of bed, awake or asleep—and often occurs alongside other conditions. Bedwetting, however, differs in the following ways:
First, bedwetting occurs during sleep when the individual is unconscious.
Second, bedwetting generally does not accompany other typical neurological lesions or signs of occupying lesions.
Third, physical and chemical tests in bedwetting patients are usually normal.
Based on this analysis, bedwetting is primarily caused by underdeveloped neurofunction or neurofunctional coordination disorders. For example, if the pressure threshold of the bladder's mechanoreceptors is low, even a small amount of urine in the bladder can trigger a urination signal, leading to frequent urination and symptoms such as a small bladder capacity. If the excitatory and inhibitory functions of the micturition center are disordered, patients may experience nocturnal enuresis or blurred vision and disorientation upon waking. In normal individuals, the urinary system should be in a low-excitatory state during sleep, but bedwetting patients often have the opposite condition, with the urinary system remaining active.
Some believe that bedwetting may have a genetic component, as many patients have a history of bedwetting in their families. However, we have not found any abnormal changes in the genetic material chromosomes of bedwetting patients. Therefore, while the author agrees that bedwetting has a familial tendency, they do not support the claim that bedwetting is hereditary.
In summary, bedwetting is caused by neurofunctional coordination disorders, has a familial tendency, and lacks evidence of heredity.
2. Current Treatment Status
The treatment of bedwetting includes medication, physical therapy, and device correction. Medication treatment is divided into traditional Chinese medicine (TCM) and Western medicine. TCM treatment is based on syndrome differentiation and can be categorized into patterns such as lower-jiao deficiency with cold, lung and spleen qi deficiency, heart and kidney deficiency, kidney and insufficiency, damp-heat in the lower-jiao, and lower-jiao damp-heat. Treatment is adjusted accordingly using formulas such as Jisheng Tusizi Pills, Buzhong Yiqi Decoction, Kou's Sanglaozha Powder, Shen's Tusizi Pills, Bazheng San, or Daididing Wan. Clinically, about half of the patients show improvement with accurate syndrome differentiation and consistent medication, with some even being cured. The disadvantages are the difficulty of adherence and the challenge of accurate syndrome differentiation for many patients. Western medicine treatment uses central nervous system stimulants, such as chlordiazepoxide or a combination of parasympathetic blockers and sympathomimetic drugs like atropine and ephedrine. Some also use antidiuretic hormones, such as desmopressin or DDAVP. While effective for some patients, the recurrence rate is high, and the use of antidiuretic hormones in simple bedwetting patients carries certain risks due to the difficulty in determining specific indications. In recent years, some hospitals have been developing topical medication treatments and have made encouraging progress. Among these, the Bedwetting Pouch developed by Wuhan Huimin Pharmaceutical Research Institute is representative. It adopts TCM external treatment methods by applying the pouch to the Shenque (CV6) point on the navel. This method is convenient (worn for 12 hours a day), effective (half of the users can stop bedwetting on the same day, with most showing improvement within a week), does not restrict fluid intake, does not require nighttime waking, and has no side effects.
Physical therapy for bedwetting includes acupuncture, acupoint injection, massage, and acupoint therapy. While all have certain effects, they are difficult for children to adapt to. However, for adults or older children, physical therapy can also be an effective method. According to reports from the Bedwetting Group of the Surgery Department at Wuhan New Century Integrated Traditional Chinese and Western Medicine Hospital, acupoint therapy may achieve satisfactory results for adults or children over 12 years old who have not responded to other treatments.
Device correction for bedwetting is rarely used in China but is practiced in the U.S. with nocturnal enuresis alarms. This method aims to treat bedwetting by using a long-term "waking up upon wetting" to form a conditioned reflex. Generally, treatment requires more than six months.