ENURESIS (Bed wetting)

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ENURESIS (Bed wetting)
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ENURESIS (Bed wetting)

• Def Involuntary voiding of urine into cloths or
  bed after developmental age when bladder control
  should be established .
• this should be twice a week for at least three
  consecutive month, or clinically significant
  distress in child life .

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Prevalence
Female Male Total percent. Age/ yr
3 7 10 5
2 3 5 10
- 1 1 18
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15 20 of patient yearly will spontaneously
improve with out treatment .
60 gt boys 50 gt F / H 44
gt one parent 77 gt both
parent
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Classification

• Primary or persistent 90 .
• Secondary or regressive 10 due to stressful
  environmental events .
• Distinction is important as the pathogenesis
  of the tow patterns is different .

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Further classification

• Nocturnal only En.
• Diurnal only En.
• Nocturnal / diurnal En .

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Pathogenesis

• Delayed maturation of the cortical mechanism that
  allow voluntary of the micturition reflex .
• Sleep disorder most of them are described as
  deep sleeper .
• Decrease ADH at night this will increase U.O.P .
• Genetic factor .
• Psychologic factor mainly in secondary En.
• Sleep apnea (snoring) secondary to enlarged
  adenoid .

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Management

• I. General suggestion
• - Reasurance avoid punishment .
• - restrict fluid intake after 7 pm .
• - void before retiring .
• - waking the child few hour, after
  sleep for voiding .
• - reword the child for dry night .
• - secondary En. As a result of
  environmental stressors .
• - refer al to ENT especially if the
  child snoring .
• II. Condition therapy a device alarm that rings
  when the child wet, a special sheet success
  rate 60 .

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• III. Pharmacologic therapy
• Desmopressin synthetic analog of
  vasopressin .
• 0.2 0.6
  mg at night
• 0.10 µg
• 
  Effectiveness 40 60
• Imipramine tah. mild anticholinergic
• mild
  alfa adrenergic
• 
  Effectiveness 30 60
• Oxybutinin anticholinergic , antispasmodic
  limited
• studies
  available . Effectiveness 17
• Active treatment a voided before seven
  years .