Newborn infants have no control over urination. Gradually, as a child grows, control is gained, at first while awake and eventually during sleep as well. By puberty almost, but not quite all children will have outgrown the problem.
The underlying cause of bedwetting (enuresis) has remained until recently, a mystery and one sixth of pre-pubertal children and many teenagers suffered the humiliation and embarrassment of this affliction.
Adult men, when asked if they have urinary frequency, will often respond, “Only in the morning” and then ask, “Why is that doctor?” Amazingly enough, the cause of morning frequency in the adult is related to the cause of bedwetting in the child. The connection is the pituitary gland, a small marble sized structure, located at the base of the brain. This little piece of tissue is the master control gland of the body. Under the influence of brain function, it produces varying amounts of a wide variety of hormones, each of which influences other glands to increase or reduce the production of other hormones essential to the proper functioning of the body.
For example, one of the many hormones the pituitary gland produces is thyroid-stimulating hormone, which influences the thyroid gland to produce thyroid hormone. Another hormone the pituitary gland produces is anti-diuretic hormone or (ADH), which directly diminishes urine production by the kidneys. The production of this hormone, ADH is increased during sleep and diminishes upon awakening. Coffee (caffeine) and alcohol also reduce the production of ADH. So when a person awakens from sleep, he usually goes to pass his first urine of the day and then has a cup of coffee. His ADH production drops sharply, urinary production increases rapidly and morning urinary frequency results. Once the kidneys have excreted all the urine the body had stored up overnight, the frequency is relieved.
The pituitary gland of a child with enuresis does not produce enough natural ADH during sleep to diminish the kidney’s production of urine. Fortunately, there is now a medication, a substitute for the insufficiently produced ADH which can be administered by nasal spray to children for the effective treatment of enuresis.
As always, it’s important to have the correct diagnosis before any kind of treatment is administered and to remember that individual symptoms may originate from more than one condition. When a symptom, such as urinary frequency, daytime as well as nighttime (nocturia) has been found to be due to benign enlargement of the prostate, the first line of approach should be medication and there are excellent drugs available for this purpose.
However, if side effects such as interference with sexual activity, painful breast swelling, allergies, or drug interactions occur, the second type of treatment to be considered is Transurethral Microwave Thermotherapy (TUMT). This is a one-time well-tolerated non-surgical office treatment, which avoids hospitalization, anesthesia, bleeding, and transfusions.
Have a Question? Call Dr. Okun at 718-241-6767
