Nocturnal enuresis

(bedwetting in children)

 

Primary Nocturnal Enuresis

  (Age >5y & never achieved dry nights for >6m)

– Sleep arousal difficulties

– Nocturnal Polyuria

– Bladder dysfunction

– Genetic/ Hereditary

– Congenital anomalies

 

Secondary Nocturnal Enuresis:

– UTI

– Diabetes

– Emotional issues, etc

– Consider child abuse

History:

Enquire about fluid intake:

– What fluids

– When & until how late in evening

– How much each time approx

– Trying to restrict?

Urine Output:

– How many bed-wets / week?

– How many times/ night?

– Ever dry for 6 months continuous?

– Is there +++ urine volume?

– Does child wake up after bed-wetting?

– What has been tried so far?

Other enquiries:

– Any daytime wetting accidents?

– Increased daytime frequency / urgency / dysuria?

– Abnormal urinary stream? Need to strain?

– Able to ‘hold on’ while micturating?

– Constipation?

– Emotional / Behavioural / Learning issues?

– Impact on child / family?

 

Other assessments:

– Examine spine, LL neurology, Abdomen, perineum

– ? Urinalysis

 

– Input / Output chart for 48h

– If possible, estimate nocturnal polyuria

– Bladder capacity during day:

   Average = 30 x (Age in years +1) in mls

   (not to review early morning volume if wet the bed)

 

– ? USS bladder capacity & post-void residue

– ? Urodynamic studies

Management:

– Education (lots of info)

– Fluid advice on adequate quantities

– Fluid timing & type (avoid fizzy & Caffeinated)

– Regular toiletting habits 

 

– PU every 3 – 4 hours during daytime

– Pelvic floor exercises (if indicated)

– Trial off pull-ups, suitable bed protection

– Reward systems to reinforce positive habits 

 

Enuresis Alarm

– Consider as 1st line in <7 years with  frequent bedwetting

– & if above not adequate

– for motivated families

 

Desmopressin:

– If nocturnal polyuria, particularly >7 years age

– Restrict fluids <1hr & > 8 hr after dose

– Explain side effects

– Explain 3month blocks

– Discontinue if no response

– Regular interruptions for a week

 

Oxybutynin:

– For dysfunctional / neurogenic bladder

– Especially if diurnal symptoms

– Can be used in combination