Nocturnal Enuresis

Question 1

How do you define enuresis?

Answer 1

An involuntary discharge of urine by day or night in a child aged 5 years or older, in the abscence of congenital or acquired defects of the nervous system or urinary tract.

Question 2

What are the 2 types of eneuresis?

Answer 2

Datime Eneuresis and Noctunrla Eneuresis

Question 3

Describe the difference between primary or secondary enuresis.

Answer 3

Primary - child never achieved continence.

Secondary - the child has been dry for at least 6 months.

Question 4

How do you manage nocturnal enuresis?

Answer 4

1. Give information and advice about practical measures - fluid intake, diet and toileting.
2. Reward systems.
3. Enuresis alarm - First line for children < 7 years. Continue for 2 weeks of dry nights. (2/3 become dry)
4. Desmopressin - first line for short term treatment in children >7 years.
   
   • Desmotabs 200mcg.
   • Effective - 50% become completely dry.
   • S/E uncommon - headaches, abdo pain, emotional disturbance.
   • take at bedtime.
   • Trial cessation every 3 months.
5. If these fail then refer to secondary care. (Imipramine and anichoinergics, psychological therapy)

Question 5

What assessment/investigations should be done?

Answer 5

1. Urinalysis & BM - exclude UTI and Diabetes
2. Early morning urine osmolality to exclude habitual polydipsia & consider DI. Urine should be more concentrated in the morning. Therefore if high urine osmalitiy (more concentrated) that is normal. If low then refer - possible DI.
3. Examine spine (Spina Bifida) and lower limb neurology
4. Bladder diary for fluid in/out over 48hrs and incontinence episodes over 7 days
   
   • Document bedwetting, daytime symptoms and toileting patterns.
   • Ask about possible triggers if secondary nocturnal enuresis
     
     • If you suspect UTI, constipation or DM assess and treat first
     • Other triggers to secondary bedwetting include physical or emotional triggers
5. Consider a post void residual bladder scan - if residual refer to Urology (possible neurogenic bladder)

Question 6

What is the most common cause of daytime eneuresis?

Answer 6

Constipation

Treat the constipation and it will resolve.

Question 7

In datime eneuresis, if a child laughs and urinates what can this show and what can be a good treatment?

Answer 7

This shows detrusor instability.

Consider Oxybutnin sustained release 5mg OD