Nocturnal Enuresis

Enuresis denotes normal urinary bladder emptying at a wrong place and time at least twice a month after the age of 5 years.

Nocturnal enuresis refers to bedwetting.

More common in boys.

ETIOLOGY :

  1. Psychologic : family conflicts and maladjustment (strict parents,sibling rivalry)
  2. Physical : Anatomic defects, genitourinary infection, threadworm infection
  3. Too late, too early, improper training in bladder control
  4. Organic pathology may be present in less than 5 % cases

CLINICAL FEATURES :

1. Two types-

Primary (persistent) enuresis: The child has never been dry at night.

Because of erratic control over the bowel.

Because of overanxious parents about bladder control.

Secondary (regressive) enuresis: Initial control of bladder that gets disrupted because of stressful situations.

Example: shifting to a new house.

2. If an organic pathology is present, dysuria, frequency, straining, dribbling, gait disturbances and poor bowel control may be the features

3.Types based on symptoms:

TYPE I- Nocturnal enuresis (N)

TYPE II- Diurnal enuresis (D)

TYPE III- Nocturnal enuresis with daytime Frequency (NF)

TYPE IV- Nocturnal enuresis with daytime Frequency and daytime Voiding (NFV)


DIAGNOSIS :

1. Detailed interview with parents to find out the underlying cause.

2. Clinical examination to rule out intestinal worms or genitourinary infection.

3. Urine analysis, urine culture

4. Voiding cystourethrogram

5. Urodynamic studies

6. X-ray of lumbosacral spine

7. USG


TREATMENT:

(Not required before 6 years of age)

1. Psychotherapy and training :

-Reassurance to the child and parents

-Encouraging the child to have dry nights and to have an independent control

-Rewarding the child for having dry nights

-Avoiding drinking excess water or drinks before sleeping

-Asking to void urine before sleeping

-Waking the child in the middle of the night to void

-Do not humiliate or ridicule the child if he wets the bed

2. Bladder strengthening exercises :

Asking the child to drink more water in the day and trying to hold it as long as possible , practice repeated voiding and stopping the stream in the flush

3. Electric alarm device (buzzer) :

It has a sensor fixed to the child’s underwear , the alarm rings as soon as he is about the wet the bed. It works on condition reflex response.

4. Drugs :

-Imipanem hydrochloride (may be supplemented with diazepam)

-Anticholinergics (oxybutinin) acts by reducing the uninhibited bladder contractions.

-Desmopressin (synthetic anti diuretic)

A combination of these treatments works best.

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