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

• Reassurance for children age <7 years
• Look for possible underlying causes/triggers
  = Constipation
  = Diabetes mellitus
  = UTI if recent onset
• Give general advice
  = Fluid intake
  = Toileting patterns: encourage to empty bladder regularly during the day and
  before sleep
  = Lifting and waking
• 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
  FIRST LINE = Enuresis alarm
• Have sensor pads that sense wetness o High success rate
• 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