Bedwetting pathophysiology
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Steven C. Campbell, M.D., Ph.D., [2] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic.
Pathophysiology
Usual Developmental Process
Most bedwetting can be described as, "a bothersome alteration in normal development." [3] The usual development process is:
- Infants: Void by reflex
- One- and two-year olds: Bladder grows larger and the brain develops the ability to sense bladder fullness (McLorie & Husmann, 1987)
- Two- and three-year olds: Develop the ability to void or inhibit voiding
- Four- and five-year-olds: Develop an adult pattern of urinary control
Normal Processes of Staying Dry (Regulation in the Organism)
Children usually achieve nighttime dryness by developing one or both of two abilities. There appear to be some hereditary factors in how and when these develop.
- One is a hormone cycle in which a minute burst of antidiuretic hormone happens daily at about sunset reducing kidney output of urine well into the night so the bladder doesn't get full until morning. This hormone cycle is not present at birth. Many children develop it between the ages of two and six years old, others between six and the end of puberty, and some not at all.
- The other is the ability to awaken before wetting. The body normally develops the ability to wake when the bladder is full.