GU - Nocturnal Enuresis

Question 1

Defintion

Answer 1

Enuresis = involuntary bladder

Nocturnal enuresis = Bed wetting = common occurrence of middle childhood

Inability to control bladder function during the day = diurnal enuresis

Question 2

Epidemiology

Answer 2

Boys
Strong family history in 2/3 of cases

Question 3

Aetiology

Answer 3

Primary causes
- overactive bladder
- fluid intake
- failure to wake
- psychological distress
Secondary causes
- UTIs
- Constipation
- Type 1 diabetes
- New psychological problems
- Maltreatemnt
Diurnal Enuresis:
Occurs more commonly in females
- Stress incontinency
- Urge incontenance
- Recurrent UTIs
- Constipation

Question 4

Pathophysiology

Answer 4

There is a genetically determined delay in acquiring sphincter competence and emotional stress can cause secondary enuresis however underlying disorders should always be considered:
1. UTI
2. Faecal retention which is severe enough to reduce bladder volume and cause
bladder dysfunction
3. Polyuria from osmotic diuresis

Question 5

Symptoms

Answer 5

Involuntary urination

Question 6

Investigations

Answer 6

FIRST LINE =
- Clinical examination
- Urinalysis - exclude infection

Question 7

Treatment

Answer 7

1. Reassurance for children age <7 years
   2.Give general advice
   = Fluid intake
   = Toileting patterns: encourage to empty bladder regularly during the day and
   before sleep
   = Lifting and waking
2. Reward systems (e.g. Star charts)
   = NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
3. • Look for possible underlying causes/triggers
     = Constipation
     = Diabetes mellitus
     = UTI if recent onset
4. Enuresis alarm (1st line in children)
   - Have sensor pads that sense wetness = High success rate
5. Medications
   = Desmopressin: Particularly if short-term control is needed (e.g. For sleepovers) or an
   enuresis alarm has been ineffective/is not acceptable to the family
   = Oxybutynin: Anticholinergic used for overactive bladder causing urge incontinence
   = Imipramine: TCA, may relax bladder and lighten sleep