Nocturnal Enuresis

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• Nocturnal Enuresis
• Kirsty Torson
• ITP post in Community Paediatrics

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Definitions

• Enuresis
• Involuntary voiding of urine when old enough to
  be continent (gt5yr)
• Nocturnal - wetting the bed at night
• Primary enuresis
• Never achieved continence
• Secondary enuresis
• At least 6 month dry period

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UTI
Diuretics
Constipation
CAUSES
Organic
Genetic
Behavioural
Stress
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The 3 System Hypothesis
Lack of arousability
Lack of ADH
Bladder instability
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History

• No. of voids/day
• No. of wettings
• size of patch
• Urgency
• Bowel habit / UTI
• Fluids (type, volume,
• timing)
• ?Primary/secondary
• Arousal
• Family Hx
• Sleeping arrangement
• Toilet arrangement

• Psychosocial
• Stress
• Beliefs/Attitudes
• Family support
• Self esteem
• Specific issues
• e.g. teasing / bullying

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Examination Investigation

• Height/weight centile
• Abdo exam
• Genitalia
• Spine
• Lower limbs tone/reflexes
• BP
• Urinalysis/MCS
• Bladder capacity diary

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Referral pathway
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Bromley PCT guidelines
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• ALARMS
• Child to learn to stop urinating when alarm goes
  off
• Used 3-5 months
• Discontinue after 14 consecutive dry nights
• Motivated child

• OXYBUTYNIN
• Theory relaxant effect on urinary smooth muscle
  ? increased bladder capacity
• Avoid in lt7yr
• Used in OAB in adults

Reward systems
Management

• DESMOPRESSIN
• Analogue of ADH - reduces urine volume
• Stop for 1 week re-assess every 3 months
• Monitor for ?Na and fluid overload
• Stop in DV

• TRICYCLICS
• Main imipramine (less sedating)
• Similar efficacy to desmopressin
• More adverse effects
• 3 months then re-assess

Support
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Any Questions?