Enuresis - Science topic

Thank you. It is indeed difficult to locate the alternative therapies. The known modalitites of the alarms and training of parents and children are already well documented but the accupuncture , herbal and other modalitites lack concrete head to head evidence.

Actually this observation is very common,.but not very studied, in my knowledge. Generally speacking we can think that when there is a psychological problem affecting the child development, this development can be affected by an arrest. Jaksonn proposed a similar hypotesis in neurology in ninteeenth century ( in a damaged adult brain ) and Freud also, with his "regression " notion in the sexual development ( of the libido ), proposed a similar effect. Translating that in your pediatric question you should think to a mechanism like that in the child development: if growing it s not safe anymore, then, a little step backward will be safer.

Hi, The mechanism of action can be related to the anticholinergic side effect of the drug, which include urinary retention. Also, all three lower urinary tract controls, i.,e, parasympathetic, sympathetic, and somatic are associated with serotonin and norepinephrine-containing receptors, so increased extracellular levels of serotonin (5GT) and norepinephrine (NE) with clomipramine, which is a 5HT and NE reuptake inhibitor, expect to produce the observed effect. Finally, enuresis is classified as a disorder of arousal, and can occur in both REM and NREM sleep. The drug supresses REM duration, and increases N2, and is also known to lower seisure threshold, suggesting it has an impact on the arousal threshold. Kind regards. 

I have been following this type of patient in retrospect for over 20 years. Retrospect because I see them as adults. The daytime incontinence is mainly urge, though there is some urge also. It runs in families and male and female members are affected often going back generations. Most are cured of the nocturnal enuresis at puberty, but many continue with the urgency into adulthood.The tragedy is that many such children are labeled as "psychological". 

Ultrasound studies showed (in adults) that the problem is a loose pubourethral ligament. We have had very good results at the adult stage with a midurethral sling with basically strengthens the ligament.

Prior to surgery we perform a 'simulated operation': gentle digital pressure on testing with a bladder sufficiently full to provoke urge relieves the urge in most cases. This works by restoring the muscle forces which stretch the vagina to support the bladder base stretch receptors and prevent them from prematurely activating the micturition reflex.

Of course surgery is out of the question in a little girl. The "simulated op", gentle pressure say with a little finger is not. It is painless and it may relieve the urge as it does in an adult where this manoeuvre is standard practice in such cases. I suggest you read the "Unlocking the Female Pelvic Floor" (about $9 Amazon .com) where you will find several such cases described. Also described are squatting-based pelvic floor exercises which may help the child. These strengthen the muscles forces directly, and ligaments indirectly.

As you know, One of the most useful asserted symptoms related to LUTS is P.V.R which easily determined by trans abdominal sonography, However its significance in a normal sensation patients ( and not in neurogenic bladder by any etiology ) relies on the severity of irritative bladder symptoms due to decrease in functional capacity, consequently in patients with BPH where the high P.V.R is usually due to BOO this procedure is not indicated unless you suspect the another accompanying factors or disease such as parkinson. I think for a routine surgical management of BPH urodynamic study is not a necessary investigation unless there is evidence of associated neurogenic component contributing to the symptoms.

Thank you for your replies, I have already read the papers you suggested and the references they cited (except one which is a chinese book), hoped there were others..