Professional Documents
Culture Documents
DEFINITION
• Repeated voiding of urine into clothes or bed at least
twice a week for at least 3 consecutive months in a
child who is at least 5 year of age.
• Diurnal enuresis-wetting while awake(10-25%)
• Nocturnal enuresis-voiding during sleep(75-90%)
• CLASSIFICATION:
PRIMARY-Children who have never been
consistently dry through the night.
SECONDARY- When bed wetting after at least 6
months of dryness.
• Monosymptomatic enuresis- without any other
symptoms.
• Non-monosymptomatic enuresis(Functional
voiding disorder)-Enuresis along with other LUT
symptoms like altered voiding frequency, daytime
incontinence, urgency, hesitancy, straining, weak
stream, intermittency, holding maneuvers, a
feeling of incomplete emptying, post micturition
dribble and genital or LUT pain.
EPIDEMIOLOGY
• At age 5 year, 7% boys and 3% girls have enuresis.
• At age 10 year, 3% boys and 2% girls have
enuresis.
• At age 18 year, 1% for men and less then 1% for
women.
• Primary enuresis- 85% cases
• More common in lower socioeconomic groups
and larger families.
• Diurnal enuresis is more common in girls and
rarely after 9 years.
• 75% enuresis are nocturnal enuresis alone and
25% enuresis are combined day and night
incontinence.
• Several condition must be present to achieve
conscious bladder control:
-Awareness of bladder filling
-Cortical inhibition of reflex bladder contractions
-Ability to consciously tight the external sphincter
-Normal bladder growth
-motivation by the child to stay dry
ETIOLOGY
• GENETIC-44% risk if one parent had it & 77% if both
parents had it.
YES NO
MONOSYMPTOMATIC
REFER TO PEDIATRICIAN
NOCTURNAL ENURESIS
POOR RESPONSE
GOOD
TREATMENT
• REGULATED ORAL FLUID INTAKE
• MOTIVATIONAL THERAPY
• ALARM THERAPY
• PHARMACOTHERAPY
• REGULATED ORAL FLUID INTAKE-
-withholding fluid in the evening, random
awakening of the child.
-Diuretic drinks like tea, coffee should be avoided
in the evening.
-Adequate intake of fluids should be taken mostly
during first half of the day.
• MOTIVATIONAL THERAPY- The child is reassured,
provided emotional support and every attempt is made
to remove any feeling of guilt.
-Make a dedicated calendar for the child by parents.
-Dry nights should be marked with a star.
-Wet nights should be blank.
-Any negative motivation like black marks or punishments
should be discouraged.
-At the end of the week, the child should be rewarded for
the dry nights.
• ALARM THERAPY- 75-95% success rate.
-40% relapse rate require second alarm course.
-Use of an alarm device to elicit a conditioned response of
awakening to the sensation of voiding with bladder distention.
-The alarm device consists of a small sensor attached to the
child’s underwear or under the bed sheet & alarm attached
to the child’s collar or bedside.