Lesson 12: Nocturnal Enuresis

Question 1

Primary Enuresis

Answer 1

bed wetting that persists past age when nighttime continence is established

Question 2

Secondary Enuresis

Answer 2

bed wetting that recurs after nighttime continence has been established

Question 3

Pathology/Etiology

Answer 3

• Developmental delay resulting in
  — Deep sleep with failure to wake to full bladder
• Inadequate nocturnal production of ADH
• Inadequate bladder capacity
• Emotional factors
• Sleep disorders
• Genetic link
• Food allergies

Question 4

Presentation

Answer 4

• Persistent, high-volume bed wetting
• Usually dry during days
• May have daytime issues with urgency + frequency

Question 5

Diagnostics

Answer 5

• History + physical
  — Daytime issues with urgency, frequency, or leakage
  — UTIs or constipation
  — Trauma events preceding bed wetting
• Urinalysis to rule out infection
• PVR to rule out retention
• Bladder cart

Question 6

Management - Education/Counseling

Answer 6

• Most children experience spontaneous resolution by age 12
• Critical child + parent education
• Clear + non-blaming approach to wet linen management
• Active treatment if enuresis is causing social + emotional distress

Question 7

Management - Behavioural

Answer 7

• Teach patient to wake to sensation of full bladder
• Child sleeps on moisture-sensitive pad
• Effectively only if child wakes to alarm

Question 8

Management - Pharmacologic

Answer 8

Nasal or oral desmopressin
- Reduces nocturnal production of urine
- In conjunction with alarm therapy
- PRN so child can participate in social events
not to be used routinely