Enuresis

Question 1

What is enuresis and nocturnal enuresis?

Answer 1

Enuresis is involuntary urination. Nocturnal enuresis refers to bed wetting.

Question 2

What is diurnal enuresis?

Answer 2

Diurnal enuresis is the inability to control bladder function during the day.

Question 3

By what age do most children gain control of daytime and nighttime urination?

Answer 3

Most children gain daytime control by 3 years and night time control by 3-4 years.

Question 4

What is primary nocturnal enuresis?

Answer 4

Primary nocturnal enuresis is when the child has never managed to be consistently dry at night.

Question 5

What is the most common cause of primary nocturnal enuresis?

Answer 5

A variation of normal development, especially if the child is under 5 years, and family history of delayed dry nights. Reassurance is often sufficient.

Question 6

What are some other causes of primary nocturnal enuresis?

Answer 6

• OAB - frequent small volume urination, prevents the development of bladder capacity
• fluid intake prior to bedtime, esp fizzy drinks, juice and caffeine - diuretic effect
• failure to wake esp during deep sleep and underdeveloped bladder signals
• psychological distress eg. low self esteem, too much pressure or stress at home or school
• secondary causes - chronic constipation, UTI, learning disability, cerebral palsy

Question 7

What is the initial step in the management of primary nocturnal enuresis?

Answer 7

• establish underlying cause
• keep 2 week diary of toileting, fluid intake and bedwetting episodes
• history and examination

Question 8

What are the management strategies for primary nocturnal enuresis?

Answer 8

• reassure if child <5 that it’ll likely resolve without treatment
• lifestyle changes - reduce fluid in evenings, pass urine before bed, ensure easy access to toilet
• encouragement and positive reinforcement, avoid blame or shame and avoid punishment/reward system eg. star charts
• treat underlying causes or exacerbating factors eg. constipation
• enuresis alarms
• pharmacological treatment eg. desmopressin esp if short term control is needed eg. for sleepovers or if enuresis alarm hasn’t be effective, oxybutynin, imipramine

Question 9

What is secondary nocturnal enuresis?

Answer 9

Secondary nocturnal enuresis is when a child begins wetting the bed after being dry for at least 6 months.
- more indicative of an underlying illness than primary enuresis

Question 10

What are the causes of secondary nocturnal enuresis?

Answer 10

Causes include new psychosocial problems, UTI, constipation, diabetes, and maltreatment.