If you look up the word enuresis in the dictionary, you’ll find that it means involuntary urination. Nocturnal enuresis, commonly known as bedwetting, simply means urinary incontinence which occurs at night, when you are sleeping. However, in medical circles, enuresis is used as a synonym for bedwetting, not as a synonym for incontinence. Of course, if you work at night and sleep during the day, and you wet your bed when you are sleeping, it’s the same problem. It’s bedwetting, but it’s not nocturnal enuresis. When you think of enuresis, you undoubtedly think of children and toilet training, but adults can have enuresis too. Enuresis can be categorized into two general types, primary and secondary enuresis. Primary enuresis means that the person was never successfully toilet trained and wet the bed for as long as he or she can remember. In secondary enuresis, the person was successfully toilet trained and confidently dry at night for a period of time, but subsequently developed bedwetting.
The onset of enuresis in adults is most often the result of a more serious underlying problem than when it occurs in children. This means that if a man or women develops enuresis, it demands prompt evaluation and treatment.
In adult men with secondary enuresis, severe prostatic or vesical neck obstruction is by far the most common cause. After urethral obstruction, neurologic conditions are the second most common cause in men. Neurologic conditions can cause enuresis by one of two mechanisms. Firstly, the bladder may cease to work at all and there is a large amount of residual urine in the bladder which simply spills over at night – this is called overflow incontinence. Overflow incontinence is most commonly seen with ruptured discs, spinal cord tumors and spina bifida. It is also seen after operations for cancer of the female cervix and uterus and in both sexes after surgery for rectal cancer. Secondly, there may be involuntary bladder contractions which result in incontinence. This is most often seen with such conditions as multiple sclerosis, cerebrovascular accident, Parkinson’s disease and other degenerative neurologic diseases. A more complete list of the most common causes of enuresis in adults is seen in the table.
Because of the bladder:
1. Involuntary bladder contractions
A. Detrusor instability (involuntary bladder contractions in the absence of an underlying
1. Prostatic urethral obstruction (in men)
2. Bladder neck obstruction (mostly men, some women)
3. Bladder or prostate infection
B. Detrusor Hyperreflexia (involuntary bladder contractions due to an underlying
1. Multiple sclerosis
3. Brain tumor
4. Transverse myelitis
5. Spina bifida (myelodysplasia)
6. Spinal cord tumor
2. Low bladder compliance
1. Transverse myelitis
2. Spina bifida (myelodysplasia)
3. Spinal cord tumor
1. Prostatic urethral obstruction
2. Radiation cystitis
3. Tuberculous cystitis
3. Weak or absent bladder contractions
1. Non-neurogenic (idiopathic)
A. Occult spina bifida (myelodysplasia)
B. spinal cord tumor
C. Transverse myelitis
D. Ruptured disc
Because of the Sphincter:
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A. Intrinsic sphincter deficiency in women
B. After prostate surgery in men
A. Spina Bifida (myelodysplasia)
B. Spinal cord tumor
C. Transverse myelitis
D. Ruptured disc
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