Enuresis (bed-wetting)

Question 1

Features

Answer 1

This is urinary incontinence in a child after 5 years of age

• when micturition control usually achieved.

It is considered a problem if regular bed-wetting occurs in children 6 yrs and older,

• although many boys do not become dry until 8 yrs.

After the age of 6, investigations including:

• an intravenous urogram or
• US are necessary to exclude urinary tract abnormalities
• and diabetes.

Ensure a normal daily fluid intake and toileting regime.

Question 2

Advice for parents on managing the child

Answer 2

Do not scold or punish the child

Praise the child often, when appropriate

Consider a star-chart diary with a star/dry night

Do not stop the child drinking after the evening meal, but avoid caffeine drinks

Do not wake the child at night to visit the toilet

Use a night-light to help the child who wakes

Some parents use a nappy to keep the bed dry but try using special absorbent pads beneath the bottom sheet rather than a nappy

Make sure the child has a shower or bath before going to kindergarten or school

Reassure the child there is nothing wrong; it is a common problem that will go away

Question 3

Treatment

Answer 3

Urotherapy or improving urination habits is first line.

Many methods have been tried, but the bed-wetting alarm system is generally regarded to be the most effective.

If the child has emotional problems, counselling or hypnotherapy may be desirable.

Desmopression acetate is effective and very useful on school camps.

Question 4

Stepwise management trial

Answer 4

1. Conditioning therapy:

• pad or bell alarm or
• body worn alarm (e.g. Malem night-trainer)

If a trial fails,

• have a 3-mth break and try again with close supervision.
  2. Desmopressin acetate tablets or nasal spray
• each night
• avoid water load before bed:
• the child should not drink for 1 hr before and 8 hours after

3. Desmopressin + alarm
4. Planned waking

The above is preferred to tricyclic antidepressants such as imipramin