04 Oct, 2024
Study points out strong correlation between vitamin D and number of episodes of enuresis per day,
Nocturnal enuresis is defined as night time bed wetting in children ≥ 2 nights per week) five years of age or older.1 In one large British study conducted it was found that prevalence of bedwetting was 8% at 9.5 years of age.2 There are multiple factors that play role in nocturnal enuresis ranging from gender to age and genetic component. Apart from this recently a study revealed that vitamin deficiencies of D3 and B12 can also lead to nocturnal enuresis. Role of nervous system has also been established in accordance to newer theories. According to parents of children with bedwetting they sleep deeply however children with bedwetting have sleep disruption. One recent study has seen that children with bedwetting have more disrupted sleep leading to excessive daytime sleepiness. This fragmented sleep may cause loss of physiologic inhibitory signals to the bladder seen in animal studies. This could also be the reason of nocturnal enuresis in children with obstructive sleep apnea.
A research done at Cairo University studied 288 children on outpatient basis with enuresis for the prevalence of vitamin D and vitamin B12 deficiencies in them. The results of this study show that vitamin D insufficiency was seen predominantly (48.3%) followed by vitamin D deficiency (31.3%).3 Only 25% of children had vitamin B12 deficiency. A strong inverse correlation was found between vitamin D and number of episodes of enuresis per day than vitamin B12. A lower limit of 13.7 ng/mL was taken as cut off below which the failure of dry nights were predicted. Higher vitamin D levels and behavioural treatment coexistence played a protective role for absence of dry nights.
Many studies have also revealed that vitamin D is involved in sleep regulation and vitamin B12 plays an important role in development and maturation of nervous system in children. All this in toto show that sleep, central nervous system and vitamin deficiencies is intertwined as causal and effect for nocturnal enuresis.
To conclude further research is still required regarding treatment for nocturnal enuresis but vitamin D and B12 can be considered as adjuvant therapies for nocturnal enuresis with proper sleep schedule and behavioural therapy.
References:
1- Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006;176:314–24
2- Cohen-Zrubavel V, Kushnir B, Kushnir J, et al. Sleep and sleepiness in children with nocturnal enuresis. Sleep 2011;34:191–4
3- Atef Abdelsattar Ibrahim, H. et al. (2024) ‘Vitamin D and vitamin B12 profiles in children with primary nocturnal enuresis, an analytical cross-sectional study’, Annals of Medicine, 56(1). doi: 10.1080/07853890.2024.2352030.