Enuresis

Question 1

Definition of enuresis

• Primary
• Secondary

Answer 1

• Primary
  
  • Involuntary micturition (often at night) in a child > 5 years of age who has never achieved consistent night-time dryness
• Secondary
  
  • Involuntary micturition in a child who was previously dry for at least 6 months

Question 2

Aetiology of enuresis

Answer 2

• Primary
  
  • Developmental delay
  • Anatomical abnormality
• Secondary
  
  • Psychosomatic

Question 3

Enuresis history

Answer 3

• Primary vs secondary
• Nocturnal vs daytime
  
  • Daytime urgency or frequency
• Frequency and severity
  
  • Number of times/night
  • Number of times/week
• Developmental delay
• Fluid intake
  
  • Caffeine
• Social history (child abuse)
• Family history of enuresis
• Impact on the family
• What have you tried?

Question 4

Management of enuresis

Answer 4

*Treatment not indicated in under 5s*

• Conservative
  
  • Ensure child is well hydrated throughout the day
    
    • Avoid caffeine
  • Encourage the child to empty their bladder before bed
  • Ensure easy access to toilet/potty at night (nightlight)
  • Avoid nappies, instead use bedding protection
  • Use a star chart incentive scheme
• Intervention
  
  • Enuresis alarms
  • Desmopressin