Nocturnal Enuresis Flashcards
What is nocturnal enuresis commonly known as?
Bedwetting
What is nocturnal enuresis?
Involuntary urination while asleep after the age at which bladder control usually begins
How common is nocturnal enuresis?
It is THE most common childhood complaint
What is primary nocturnal enuresis?
When nocturnal enuresis occurs but the child has not yet had a prolonged period of being dry
What is secondary nocturnal enuresis?
When a child begins wetting again after having stayed dry for a prolonged period
What are the 3 common causes of nocturnal enuresis?
- Excessive urine volume
- Poor sleep arousal
- Bladder contractions
What physiological functions work to prevent bedwetting?
- Hormone to reduce urine production at night
- The ability to wake up when the bladder is full
How do children usually first develop night dryness?
By developing one or both of the normal physiological mechanisms against bedwetting
How does the process of urinary continence begin?
Development of a larger and more sensitive bladder at 1-2 years old
What do children of 2-3 usually develop?
Daytime urinary continence
What do children of 4-5 develop?
Adult urinary control - dry in the day and at night
What is the most common cause of bedwetting?
Mild developmental delay
What are the other potential causes of bedwetting?
- Psychological problem
- Physical illness
What percentage of bedwetting cases are caused by either emotional or physical problems?
5-10%
What are the risk factors for developing nocturnal enuresis?
- Family history
- Constipation
- ADHD
- Infections e.g. UTI
- Psychological issues
- Sleep apnoea
What is the main investigation in nocturnal enuresis?
Urinalysis
Why is urinalysis performed for nocturnal enuresis?
To exclude infection, signs of renal disease or diabetes mellitus
What imaging can be used to asses nocturnal enuresis if needed?
USS
When may USS be indicated?
- If the child is refractory to treatment
- If there are symptoms or signs of voiding dysfunction
What are the differentials of nocturnal enuresis?
- Congenital abnormality
- Diabetes
- Spina bifida
- Neurogenic bladder
What methods can be used to help manage nocturnal enuresis?
- Explanation
- Star chart
- Enuresis alarm
- Desmopressin
- Self help groups
- Management of contributing medical conditions
What should be explained to the parent and child?
- It is common
- Beyond conscious control
- Punitive procedures are counterproductive
- Excessive or insufficient fluid intake and abnormal toileting patterns should be addressed
How should star charts be used when treating nocturnal enuresis?
As praise for helping change bed sheets rather than for dry nights as this may be seen as blaming the child for wet nights
How should an enuresis alarm be used?
Supplement for star chart. The alarm must wake the child when they wet and they must go to pass urine in the toilet, come back and help change the sheets before going back to sleep
How long does an enuresis alarm take to achieve dryness?
Several weeks
How effective is an enuresis alarm?
Around 1/3 relapse after a few months but repeating the alarm treatment usually produces lasting dryness
What is desmopressin?
An analogue of the anti-diuretic hormone
Who can desmopressin be used in?
Children over 7
What can desmopressin be used for specifically?
Short term relief for holidays or sleep overs
What should be restricted if desmopressin is taken?
Fluid intake
How long can desmopressin be taken for?
3-6 months
What are the potential complications of nocturnal enuresis?
- UTI
- Psychological impact
