Primary Nocturnal Enuresis: A Review
Ersan Arda1, Basri Cakiroglu1, David T Thomas2
1Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey.
Insights
Nocturnal enuresis, or bedwetting, affects many children and families. While alarm therapy is a first-line treatment, understanding its complex causes is key to managing this common pediatric incontinence.
Area of Science:
- Pediatric Urology
- Child Psychology
Background:
- Nocturnal enuresis (bedwetting) is common pediatric urinary incontinence with significant psychosocial impact.
- Defined as inability to hold urine at night post-toilet training; primary if never achieved continence, secondary if 6+ months dry.
- Review aimed to consolidate pathophysiological background and general information on nocturnal enuresis.
Approach:
- Literature review of nocturnal enuresis (1970-2015).
- Searches conducted via PubMed using keywords: 'nocturnal enuresis,' 'incontinence,' 'pediatric,' 'review,' 'treatment.'
Key Points:
- Children with nocturnal enuresis may have increased nighttime urine production and reduced bladder capacity.
- Associated symptoms can include daytime urgency, frequency, and incontinence.
- Treatments involve addressing constipation/UTIs, behavioral changes, medical therapy, and alarm therapy as first-line for primary enuresis.
Conclusions:
- Nocturnal enuresis is a prevalent issue with diverse effects on children and families.
- Multiple etiologic factors contribute to the condition, complicating a clear definition.
Context:
Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. Enuresis nocturna is defined as the inability to hold urine during the night in children who have completed toilet training. It is termed as being "primary" if no continence has ever been achieved or "secondary if it follows at least 6 months of dry nights. The aim of this review was to assemble the pathophysiological background and general information about nocturnal enuresis.
Evidence Acquisition:
This review was performed by evaluating the literature on nocturnal enuresis published between 1970 and 2015, available via PubMed and using the keywords "nocturnal enuresis," "incontinence," "pediatric," "review," and "treatment."
Results:
Children with nocturnal enuresis produce urine at higher rates during the night, and may have lower bladder capacities. Some children with nocturnal enuresis may also have daytime urgency, frequency, and urinary incontinence. Treatment includes aggressive treatment of accompanying constipation or urinary tract infections, behavioral changes, and medical therapy. Alarm therapy remains the first-line treatment modality for primary nocturnal enuresis. High rates of patient compliance and relapse mean that alternative treatments remain on the agenda.
Conclusions:
Nocturnal enuresis is a common problem that has multifaceted effects on both the child and the family. Due to multiple etiologic factors, nocturnal enuresis is still not clearly defined.
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