Enuresis
Enuresis
Enuresis is bedwetting after the age of 5 years. Primary monosymptomatic enuresis refers to incontinence during sleep only, in children without any other lower urinary tract symptoms and without a history of bladder dysfunction; children who have never achieved a satisfactory period of nighttime dryness have primary enuresis; children who develop enuresis after a dry period of at least six months have secondary enuresis. Non-monosymptomatic enuresis is in children with other lower urinary tract symptoms (eg, increased frequency, daytime incontinence, urgency, genital or lower urinary tract pain). It is of great importance to differentiate between monosymptomatic enuresis and enuresis with associated bladder dysfunction during daytime, because the treatment of these two conditions is totally different.
Clinical evaluation of all children with enuresis should exclude symptoms of underlying systemic disease: Diabetes mellitus, diabetes insipidus, UTIs, neurological abnormalities and structural renal abnormalities.
Investigations
- Urine dipstick test in all patients as a screening test.
- Ultrasound investigation may be necessary to identify structural abnormalities of the kidneys, pelvis and ureters if clinically indicated
Management
Behaviour modification:
- Motivate, counsel and re-assure child and parents. Advise against punishment and scolding.
- Regular fluid intake of water spread throughout the day, but last drink at least > 1 hour before bedtime.
- Regular voiding 5–6 times per day.
- Bell and pad system in children > 7 years and who are well motivated.
Medicine treatment
If general measures have failed after 6 months, for short term treatment only (Endocrinologist initiated).
- Desmopressin, oral, 200–400 mcg at night for 3 months. Adverse effects include fluid retention, hyponatraemia and cerebral oedema.
In children over 5 years with voiding dysfunction and accompanying daytime wetting:
- Oxybutinin, oral, 0.1–0.3 mg/kg/dose 8 hourly.