Enuresis

Question 1

Enuresis:

What is it and what is normal?

Answer 1

Inability to remain continent in the day or night

Typically girls are expected to develop continence by 5yo and boys by 8yo

Its normal to develop day time continence first

Question 2

Enuresis:

Factors that can impact continence development?

Answer 2

• Genetics (autosomal dominant inheritance of continence)
• Constipation
• psychological distress
• caffeine intake
• noisy breathing/apnoea
• undiagnosed diabetes
• diabetes insipidus
• bladder structural abnormality or overactivity
• urinary tract infection
• excess nocturnal fluid consumption

Question 3

Enuresis:

Types of enuresis?

Answer 3

Diurnal = day time incontinence

• typically try treating by age 4yo
• bladder training (when going to the toilet hold it for 1min prior to voiding, try and increase intervals between voids)

Nocturnal = dry day, nightime incontinence

• typically consider treatment by age 6
  a) Primary - yet to consistently achieve continence
  b) Secondary - was continent for at least 3months then became incontinent at least 2 nights a week for more than 3 months

Question 4

Enuresis:

Nocturnal enuresis management?

Answer 4

Secondary nocturnal enuresis

• address underlying cause
• KUB USS
• urine MCS
• BSL

Primary

• reassure parents that it could still improve by 6yo
• IF motivated child and parents then treat

1) Regularly spaced fluids throughout the day including near bedtime (DO NOT FLUID RESTRICT)
2) Be supportive with reward charts for waking to void
3) Absorptive bed liners over nappies
4) Bed wetting alarm
- ~$200
- 80% improve after 8 weeks
- reward waking with the alarm and voiding (DO NOT REWARD DRY NIGHTS)
- do not continue if no success after 4 weeks
- if dry for more than 2 weeks consider Overlearning = 200ml fluid prior to bed to increase the difficulty of remaining dry

5) Medication (DO NOT USE TCA’s)
Desmopressin
-ADH that increases fluid reabsorption preventing urine production
-high relapse rate of 60 - 70%
-not to be given intranasal as increases the risk of hyponatraemia
-cannot have fluid 1 hour prior and 8hours after evening dose - if this cannot be adhered to then it should not be use due to increase risk of side effects
-120microg sublingual increasing up to 240microg OR
-200microg oral increasing up to 400microg
-aim to withdraw treatment for 7 days every 3 months the assess relapse risk