NOCTURNAL ENURESIS

Question 1

What is the definition of enuresis?

Answer 1

Enuresis may be defined as the ‘involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’.

Question 2

At what age do most children achieve day and night time continence?

Answer 2

By 3 or 4 years of age.

Question 3

What is the difference between primary and secondary nocturnal enuresis?

Answer 3

Primary - the child has never achieved continence

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

Question 4

According to NICE guidelines, what is first line in the management of nocturnal enuresis?

Answer 4

Reward systems - eg 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

Question 5

If a 5 year old child is struggling with nocturnal enuresis despite a trial of a star chart, what is the next step in the management according to NICE?

Answer 5

Enuresis alarm

This is as long as the child in under 7 years old.

Question 6

An 8 year old child is struggling with nocturnal enuresis. What is the first line management according to NICE guidelines?

Answer 6

Desmopressin may be used first-line for children over the ago 7 years, particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family.