Nocturnal Enuresis

Introduction

Enuresis is urinary incontinence while sleeping (at night or during naps).

  • By definition, it is not considered abnormal until 5 years of age and must occur at least twice weekly for ≥3 consecutive months.

In other words, nocturnal enuresis, or bed-wetting, is a normal part of a child's development and is not generally treated before age 5 years.



Management

Offer reassurance that most enuresis resolves over time.

  • 15% per year among children >6 years old.

Behavioural treatments are used first.

  • Fluid restriction in hours prior to bedtime.
  • Elimination of products that cause diuresis or bladder irritation such as caffeinated beverages.
  • Maintain normal fluid intake during the day.
  • Advise scheduled urinations during the daytime (4-7 times per day) and voiding just prior to bedtime.
  • Enuresis alarm in motivated and compliant family.

For patients beginning at age 6 years, offer desmopressin (0.2-0.4 mg tablet or 0.12-0.24 mg sublingual tablet) orally 1 hour prior to bedtime for enuresis alone or in combination with an alarm in nonresponsive patients.

  • Desmopressin is more rapidly effective than alarms and requires a shorter time commitment and less caregiver supervision, but has a higher relapse rate.
  • When a patient is on desmopressin treatment for nocturnal enuresis and nocturia, fluid intake should be limited during 1 hour before until 8 hours after administration. If fluid intake is unrestricted, water retention with possible hyponatremia may occur.
  • Stop desmopressin treatment for 1 week every 3 months to assess for resolution of enuresis.
  • Medication may be used for up to 6 months.

NOTE: Bladder training exercises (such as attempting to hold the urine during the day for a set time period) are not recommended.



Using An Enuresis Alarm

Enuresis Alarm

Enuresis alarms are activated when a sensor, placed in the undergarments or on a bed pad, detects moisture. The arousal device is usually an auditory alarm and/or a vibrating belt or pager.

Instructions

  • The alarm should be demonstrated to the child and family before use.
  • It must be used every night.
  • The family and child should be instructed that the child is in charge of the alarm.
  • Each night before they go to sleep, the child should test the alarm; with the sound (or vibration) in mind, the child should imagine in detail, for one to two minutes, the sequence of events that occur when the alarm sounds (or vibrates) during sleep.
The sequence is as follows:

  • The child turns off the alarm, gets up, and finishes voiding in the toilet (only the child should turn off the alarm). The child's being fully awake and cognizant of what is happening is critical to the success of alarm therapy. However, at the initiation of alarm therapy, it may be necessary for the caregivers to wake the child when the alarm sounds.
  • The child returns to the bedroom.
  • The child changes the bedding (with caregiver supervision) and clothing. Changes of bedding and clothing should be kept near the bed.
  • The child wipes down the sensor with a wet cloth and then a dry cloth (or replaces the sensor if it is disposable).
  • The child resets the alarm and returns to sleep.

A diary should be kept of wet and dry nights.

  • Positive reinforcement should be provided for successful completion of the above sequence of events, waking and getting out bed to void, and for dry nights.
  • Penalties (e.g., the removal of a reward) for wetting episodes appear to be counterproductive.



External Links

Comments

Post a Comment