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4. Bedwetting and toileting problems in children
Patrina H Y Caldwell1, Denise Edgar, Elisabeth Hodson
1NHMRC Centre for Clinical Research Excellence in Renal Medicine, The Children's Hospital at Westmead, Sydney, NSW. Patrinac@chw.edu.au
Insights
Bedwetting, or nocturnal enuresis, is common in children and impacts self-esteem. Alarm devices are effective for primary nocturnal enuresis without daytime symptoms.
Area of Science:
- Pediatrics
- Urology
- Child Psychology
Background:
- Nocturnal enuresis affects a significant percentage of children, with varying prevalence rates by age.
- It can negatively impact a child's emotional well-being, social interactions, and academic performance.
- Distinguishing between primary (never dry) and secondary (relapse) enuresis is crucial for diagnosis.
Observation:
- Risk factors for primary nocturnal enuresis include genetics, increased nighttime urine production, poor sleep arousal, and bladder issues.
- Secondary nocturnal enuresis is often linked to infections, diabetes, or psychological stress.
- Daytime wetting often co-occurs with nighttime wetting in children.
Findings:
- Monosymptomatic nocturnal enuresis (bedwetting only) shows effective treatment with alarm devices, using desmopressin as a secondary option.
- Non-monosymptomatic nocturnal enuresis (bedwetting with daytime symptoms) requires initial focus on managing daytime urinary issues.
- Alarm therapy is a primary, effective treatment for bedwetting without associated daytime symptoms.
Implications:
- Effective management of nocturnal enuresis can improve children's quality of life and reduce family stress.
- Understanding risk factors aids in early identification and intervention strategies for bedwetting.
- Tailored treatment approaches based on symptom presentation are essential for successful outcomes in pediatric enuresis.
Abstract:
Bedwetting (nocturnal enuresis) is common. It occurs in up to 20% of 5 year olds and 10% of 10 year olds, with a spontaneous remission rate of 14% per year. Weekly daytime wetting occurs in 5% of children, most of whom (80%) also wet the bed. Bedwetting can have a considerable impact on children and families, affecting a child's self-esteem and interpersonal relationships, and his or her performance at school. Primary nocturnal enuresis (never consistently dry at night) should be distinguished from secondary nocturnal enuresis (previously dry for at least 6 months). Important risk factors for primary nocturnal enuresis include family history, nocturnal polyuria, impaired sleep arousal and bladder dysfunction. Secondary nocturnal enuresis is more likely to be caused by factors such as urinary tract infections, diabetes mellitus and emotional stress. The treatment for monosymptomatic nocturnal enuresis (bedwetting with no daytime symptoms) is an alarm device, with desmopressin as second-line therapy. Treatment for non-monosymptomatic nocturnal enuresis (bedwetting with daytime symptoms--urgency and frequency, with or without incontinence) should initially focus on the daytime symptoms.Bedwetting without daytime symptoms, the most common toileting problem, can be effectively treated with an alarm device.
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