Management of primary nocturnal enuresis

Question 1

What is the definition of primary nocturnal enuresis?

Answer 1

Involuntary discharge of urine at night more than twice per week in children >5yo who have never attained bladder control

Question 2

What is the definition of secondary incontinence?

Answer 2

Involuntary discharge of urine at night more than twice per week in children >5yo which reoccurs after at least 6m of continence

Question 3

What percentage of 5yo have nocturnal enuresis?

Answer 3

10-15%

Question 4

What percentage of 8yo have nocturnal enuresis?

Answer 4

6-8%

Question 5

What percentage of 15yo have nocturnal enuresis?

Answer 5

1-2%

Question 6

What are CPS recommendations regarding behavioral recommendations?

Answer 6

1. Clarify the goal of getting up at night and using the toilet.
2. Assure the child’s access to the toilet.
3. Avoid caffeine-containing foods and excessive fluids before bedtime.
4. Have the child empty the bladder at bedtime.
5. Take the child out of diapers (training pants may be acceptable).
6. Include the child in morning cleanup in a non-punitive manner.
7. Preserve the child’s self-esteem.
8. Children for whom primary nocturnal enuresis is not distressing should not receive treatment. Parents should be reassured about their child’s physical and emotional health and should be counselled about eliminating guilt, shame and punishment
9. Treatment of primary nocturnal enuresis should be aimed at minimizing the emotional impact on the child. There is insufficient evidence about the good versus harm that behavioural therapies may exert in this regard. Reward systems and lifting should not be recommended without careful consideration of, and discussion with parents about, potential adverse effects

Question 7

What are the recommendations re: alarm system?

Answer 7

1. Most efficacious therapy
2. Long term success <50% of children
3. Most appropriate initial line of therapy for primary nocturnal enuresis for older children in highly motivated families

Question 8

What are the recommendations re: pharmacological therapy?

Answer 8

1. Special situations i.e. camp or sleepovers
2. DDAVP do not consume fluids for 1h before and 8h after
3. Imipramine hydrochloride maybe used cautiously but requires careful explanation about dangers of OD