An introduction to managing enuresis

1
An introduction to managing enuresis

• Contributor
• Dr C M Ni Bhrolchain
• Huntingdon

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Medical aspects of enuresis

• Definition of enuresis
• Persistent and frequent urination during sleep at
  an age when more bladder control would be expected

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Prevalence and prognosis

• 10 of 5-year olds
• 5 of 10-year olds
• Cure rate without treatment occurs in
  approximately 15 per year of those still wet
  during that year
• Treatment with an enuresis alarm will cure
  approximately 75 if used properly. Drugs are
  nowhere near as effective in producing long-term
  cure

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Theories of bedwetting

• Deep sleep
• Problems with ADH secretion
• Decreased bladder capacity
• Immature bladder control
• Emotional disturbance

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Known facts

• Enuresis runs in families
• It is more common in boys
• It is more common in disadvantaged families
• Emotional disturbance can contribute
• Physical causes are rare but important

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Initial assessment

• Find out exactly what the problem e.g. an alarm
  will not help a child who is wet only 1 night per
  week
• Think of physical causes
• i.e. neurological, anatomical,
• infection

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General assessment

• Family information and history
• Can child
• Stay dry during the day
• Tell when they need to go
• Able to dress/undress
• Sit on toilet
• Hold on
• Empty bladder completely

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General assessment

• What is the attitude of the parents?
• What is the attitude of the child?
• What have they tried?
• Why hasnt it worked?

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Medical assessment

• Urinary symptomse.g. polyuria, dysuria, UTI?
• Soiling / constipation
• Examination including neurology
• Have they had a dry night?
• Dribbling?
• Always wet?

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Social assessment

• Sharing a room
• Bunk beds
• Access to toilet
• Transport to clinic

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Management

• Explanation and education about enuresis
• Institute record keeping for at least 2 weeks and
  preferably for 4 weeks
• These may be enough in up to
• 20 of cases

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Alarms

• Important to explain to parent and child
• How it works i.e. helps you to learn when to wake
  up
• Dont restrict drinking
• Warn them the first 2 weeks may show no change
  and the whole learning process may take 3-4/12
• Records help to show progress
• Provide regular support during treatment

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Should always refer if

• Primary enuresis with no dry nights
• Primary enuresis with soiling
• Daytime enuresis
• Personal or family history of
• infection
• Those who may benefit from medication
• Those not responding to treatment despite
  apparent compliance

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Signs of progress

• Smaller wet patches
• More to do in toilet
• Wetting later at night
• Wet fewer times per night
• Waking better (though not waking is OK if not
  wet)
• Self-waking
• MORE DRY NIGHTS!

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Problems with alarms

• Not waking
• False alarms
• Switching alarm off (sabotage)
• Alarm doesnt go off although wet

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Using drugs for enuresis

• Tricyclics
• Desmopressin
• Oxybutinin
• Not as successful as alarms
• High relapse rate
• Side effects
• Safety
• Expensive