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Nocturnal Enuresis (in 10 minutes)

Nocturnal Enuresis (in 10 minutes). By Mohammad Adnan. Definition(s).

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Nocturnal Enuresis (in 10 minutes)

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  1. Nocturnal Enuresis (in 10 minutes) By Mohammad Adnan

  2. Definition(s) ‘The Diagnostic & Statistical Manual of Mental Disorders (DSM- IV) defines nocturnal enuresis as an involuntary voiding of urine during sleep, with a severity of at least twice a week, in children aged >5 years in the absence of congenital or acquired defects of the central nervous system ’* Primary – Never been dry at night Secondary – 6m> of bladder control *There is no minimum age limit to allow consideration of the benefit of interventions in younger children (under 7 years) previously excluded from treatment.NICE

  3. Epidemiology • 30% aged 4yrs • 14% aged 5yrs • 10% aged 6yrs • 3% aged 12yrs • 1% aged 18 • Male>Female • 1-2% underlying physical abnormality • Can run in families

  4. Pathophysiology There are a number of different disturbances of physiology that may be associated with the development of bedwetting. These disturbances may be categorised as: • 1. Sleep arousal difficulties – a reduced ability to wake to noise or to bladder contractions. • 2. Polyuria – the production of larger than normal volumes of urine overnight that typically exceed the nocturnal bladder capacity. • 3. Bladder dysfunction – most often either a small bladder capacity or overactive bladder.

  5. History (1) • When did it start? • Ever been dry at night? • How often? • Wet in the Day? • Bowels opening ok, constipation/soiling? • Fluid intake, fizzy drinks/caffeinated • SHx – school/bullying/stress • PMH/DHx/Developmental Hx

  6. Red Flags • Polyuria • Polydipsia • Weight Loss • Abdominal mass

  7. History (2)

  8. History (3) Secondary NE

  9. Examination Should be unremarkable but... • Urine Dipstick • Abdo Exam • Neuro– reflexes?? Do not perform urinalysis routinely, unless the child or young person has: ● started bedwetting recently (in the last few days or weeks) ● daytime symptoms ● any signs of ill health ● a history, symptoms or signs suggestive of urinary tract infection ● a history, symptoms or signs suggestive of diabetes mellitus.

  10. Management • Enuresis clinic • Refer to nice Enuresis Guidelines • Three main option • Conservative • Alarm • Desmopressin

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