Nocturnal Enuresis

Question 1

Nocturnal enuresis

Answer 1

Wetting the bed at night is common in young children as they learn to gain voluntary control of the bladder sphincters. It is considered normal until children are 5 years old.

Question 2

Epidemiology of Nocturnal enuresis

Answer 2

It is more common in boys.
Children are most often otherwise normal, with no underlying psychological or physical trigger.
There is often a strong family history in 2/3 of cases.
Secondary nocturnal enuresis is very common in children who experience psychological distress.

Question 3

Differentiating primary and secondary nocturnal enuresis

Answer 3

Nocturnal enuresis (bedwetting) can be primary or secondary.

Primary nocturnal enuresis is seen in children who have never achieved urinary continence overnight.
Secondary nocturnal enuresis is seen in children who have previously achieved urinary continence overnight.

Question 4

Nocturnal enuresis can have a variety of underlying physical causes, such as:

Answer 4

Diabetes mellitus
Urinary tract infections
Constipation - due to compression of the bladder

Question 5

Management of nocturnal enuresis depends on the underlying cause. Generally, children and parents should be counselled that bedwetting is very common, and that the child should not be blamed in any way.

Answer 5

Star charts are a useful initial conservative approach to reward good habits that reduce the chance of bed wetting.
The first-line is generally a nocturesis alarm, which is a device that detects water in the underwear and activates an alarm. This alerts the child that they need to wake up and go to the bathroom. Alarms are generally very effective in training children.
Children aged over 7 years old can trial DDAVP (synthetic ADH) if the alarm has failed or rapid control is needed. This drug increases water re-absorption and reduces urine production overnight.

Question 6

In children whom conservative measures including a reward system and enuresis alarm fail to control nocturnal enuresis, drug treatment may be trialed in children over 7 years of age. What is the first line choice?

Answer 6

In children whom conservative measures including a reward system and enuresis alarm fail to control nocturnal enuresis, drug treatment may be trialed in children over 7 years of age. The first line choice is Desmopressin, a synthetic replacement for antidiuretic hormone. Treatment should be assessed after one month and continued for three months if there are signs of response