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Bed wetting - silent suffering: an approach to enuresis and voiding disorders in children
Madhuri Kanitkar1, H Ravi Ramamurthy
1Department of Pediatrics, Base Hospital, Delhi Cantt, New Delhi 110010, India. mkanitkar15@gmail.com
Insights
Bed wetting, or nocturnal enuresis, requires thorough evaluation to identify underlying causes. Alarms show better cure rates than desmopressin for monosymptomatic enuresis.
Area of Science:
- Pediatrics
- Urology
- Child Health
Background:
- Nocturnal enuresis (bed-wetting) is common in children, presenting as either monosymptomatic or with voiding disorders.
- Contributing factors include developmental delay, genetics, antidiuretic hormone issues, and reduced bladder capacity.
- Proper diagnosis is crucial, distinguishing between primary enuresis and secondary causes.
Purpose of the Study:
- To outline a comprehensive evaluation approach for children with nocturnal enuresis.
- To discuss treatment strategies for monosymptomatic enuresis and related voiding disorders.
- To emphasize evidence-based management for optimal therapeutic outcomes.
Main Methods:
- Structured bowel and bladder history taking.
- Detailed clinical examination.
- Utilizing frequency-volume charts and appropriate investigations for diagnosis.
Main Results:
- Frequency-volume diaries are essential for diagnosis and treatment planning.
- Treatment options for monosymptomatic enuresis include psychological support, alarms, and medications (desmopressin, anticholinergics, imipramine).
- Alarm therapy demonstrates superior cure rates compared to desmopressin in monosymptomatic enuresis.
Conclusions:
- A systematic, evidence-based evaluation is vital for children with bed-wetting.
- Prompt referral is necessary for cases involving bladder dysfunction, anatomical anomalies, or neurological disorders.
- Therapeutic outcomes are generally positive, influenced by etiology, patient motivation, compliance, and family support.
Abstract:
Bed wetting or nocturnal enuresis is a common problem among children. It is either monosymptomatic or may be associated with a voiding disorder. Many factors may contribute towards enuresis such as developmental delay, heredity, inappropriate nocturnal anti diuretic hormone secretion and reduced bladder capacity. Any child presenting with bed-wetting should be evaluated for any underlying bladder dysfunction before labeling as monosymptomatic enuresis. The evaluation consists of structured bowel and bladder history, detailed clinical examination, frequency volume record and appropriate investigations. The frequency volume diary is an indispensible component of evaluation and helps in establishing diagnosis and tailoring therapy. The treatment of monosymptomatic enuresis consists of positive psychological support, alarms and medication (desmopressin/ anticholinergics/ imiprammine). Children with features of underlying bladder dysfunction, anatomical anomalies and neurological disorders should be referred to a pediatrician without delay. The outcome of therapy is usually rewarding but varies, depending on the underlying etiology, motivation, compliance and family support. The cure rates with alarms are better than with desmopressin in monosymptomatic enuresis. Timely and appropriate therapy yields better outcomes. Thus, a thorough, scientific and evidence based approach is essential in children presenting with bed-wetting.
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