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Nocturnal Enuresis

Nocturnal enuresis is defined as the involuntary passage of urine during sleep. Diurnal enuresis refers to the involuntary or intentional voiding of urine into clothing while awake. Primary nocturnal enuresis is bed-wetting that has been present since birth, and secondary nocturnal enuresis is enuresis that occurs after being dry for a minimum of 6 months. Evaluation of nocturnal enuresis is usually not necessary.

Prevalence/Epidemiology

Most bed-wetting is due to a maturational delay, and it becomes less frequent with each passing year of

At age 5, 20% of children wet the bed at least monthly, with 5% of boys and 1% of girls wetting the bed nightly. By age 6, only 10% of children wet the bed. Thereafter, 15% of bed-wetters become dry each year. Overall, 60% of bed-wetters and more than 90% of nightly bed-wetters.

Etiology

Physiologic Enuresis

Most children who have primary nocturnal enuresis have no disease mechanism to explain the enuresis, and they are considered to have physiologic enuresis. Enuresis results from inability to recognize the sensation of a full bladder during sleep and to awaken from sleep to urinate into the toilet. Those children who wet nightly usually also have a small bladder.

Enuresis has a genetic predisposition. If one parent was a bed-wetter, the probability of offspring having enuresis is 45%. If both parents were bed-wetters, the probability of enuresis.

Evaluation of Nocturnal Enuresis

History For Organic Factors

Symptoms of dysuria, intermittent daytime wetness, polydipsia, polyuria, CNS trauma, constipation, and encopresis.

Constant wetness or dampness (ectopic ureter), an abnormal urine stream with dribbling or hesitancy (posterior urethral valves), or a change in gait (spinal tumor).

Nondrug Management of Nocturnal Enuresis

From age 3 or 4 years onward, the parents should be reassured that bed-wetting is due to a maturational delay and that it is not intentional. They should be warned about the inappropriateness of any punishment.

Getting up at night can compensate for a small bladder. The smaller the child's bladder, the more important it is for him to learn to awaken at night. No child can be cured completely until he learns.

Self-awakening or Parent-awakening Programs

Self-awakening. Ask children to rehearse a particular sequence of events every night before going to sleep. The child lies in bed with eyes closed and pretends that it is the middle.

Enuresis Alarms

Small alarms that are worn on the body are available to help teach children to awaken to the sensation of a full bladder. Most of them are audio alarms (eg, Nytone or Wetstop). One alarm (The Potty Pager) is a vibrating alarm.

Drug Therapy

Desmopressin

Desmopressin (DDAVP), the synthetic analog of vasopressin, reduces urine production by increasing water retention. The odorless drug is administered intranasally.

Imipramine

Imipramine combines an anticholinergic effect that increases bladder capacity. Imipramine is taken 1 hour before bedtime. The starting dosage is usually 25 mg per day.

Clinical Use of Drug Therapy

Desmopressin and imipramine have similar efficacy. Imipramine has the advantage of lower cost and ease of administration; desmopressin has the advantage of minimal side effects. Combination of the two may be useful.