That’s exactly what we mean. Of course it is possible to have an occasional episode of enuresis if you’ve had too much alcohol to drink and you pass out in your bed, but that doesn’t happen very often. Further, if you already have incontinence during the day, then the night time incontinence is most likely caused by the same condition. However, if you develop recurrent enuresis, even without any other symptoms at all, you should have a thorough evaluation by a urologist. Let me give you a few examples:
Stanley was a healthy stock broker, married with two children, whose only symptom was that he urinated a little more frequently than he used to, about every two hours during the day. He attributed this to the fact that he drank about 10 cups of coffee a day while at work. For several weeks he had been wetting the bed during the night without waking up. He saw his family doctor who obtained a urinalysis which was normal. He was referred to a urologist who examined him and measured his post void residual urine with an ultrasound. To the astonishment of both patient and doctor, Stanley had a residual urine of over 1500 ml, that’s over 1 liter! And that is after he already urinated 600 ml, so he actually held over two liters in his bladder and didn’t even know it. Blood tests showed that he was in kidney failure (his serum creatinine was 2.5) and renal ultrasound showed that both kidneys were obstructed – he had bilateral hydronephrosis. Hydronephrosis means that there has been damage to the kidney because of a blockage. Videourodynamic study showed severe obstruction by the prostate and, fortunately, after prostatic surgery (transurethral resection of the prostate), his kidneys returned to normal and the enuresis subsided. Further, he now voids in normal amounts and has only a small amount of residual urine.
Stanley was lucky. The enuresis, which in itself was not so terrible a symptom, was a warning sign of a potentially fatal condition which was completely reversed by surgery. Eric, a movie producer was not quite so fortunate. He also developed enuresis and had no other symptoms at all. On evaluation, he was also found to have an enormous bladder, he held over two liters. But in his case the cause was a spinal cord tumor called an ependymoma. As he was being evaluated, before the eyes of his doctors, he became paraplegic, unable to move his legs at all. After spinal surgery to remove the tumor, he was eventually able to walk again, but his bladder never recovered and now he must do intermittent self catheterization four times a day in place of urinating. Aside from that, though, he is doing very well. He works full time, he still produces movies, and, by his own account, “life is pretty good.”
Most of the time they do cause symptoms day and night, but sometimes, particularly in the early stages, they may present with only enuresis. The likely explanation is that during the day there is a heightened sense of awareness compared to sleep. People with these problems may subconsciously begin to urinate more frequently or drink less fluid to prevent daytime incontinence.
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