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Enuresis in Children: Common Questions and Answers
Rebecca A Lauters1, Kara W Garcia1, James J Arnold1
1Eglin Family Medicine Residency, Eglin Air Force Base, Florida.
Insights
Nocturnal enuresis (nighttime bedwetting) affects children over five. Treatment progresses from behavioral changes to alarms or desmopressin, with alarms offering long-term success for primary monosymptomatic nocturnal enuresis.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Nocturnal enuresis, defined as nighttime urinary incontinence twice weekly in children aged five and older, affects a significant pediatric population.
- Spontaneous resolution occurs annually in about 14% of children, but various subtypes and pathophysiological mechanisms necessitate targeted interventions.
- Understanding the subtypes, including nonmonosymptomatic enuresis and primary/secondary monosymptomatic nocturnal enuresis, is crucial for effective management.
Purpose of the Study:
- To outline the diagnostic approach and treatment strategies for various types of nocturnal enuresis in children.
- To differentiate between monosymptomatic and nonmonosymptomatic enuresis and their respective underlying causes.
- To emphasize the importance of a comprehensive evaluation and tailored treatment plans.
Main Methods:
- In-depth patient history taking to identify symptoms and potential contributing factors.
- Comprehensive physical examination and urinalysis to rule out underlying medical conditions.
- Classification of enuresis into subtypes to guide therapeutic decisions.
Main Results:
- Primary monosymptomatic nocturnal enuresis pathophysiology may involve sleep arousal disorders, nocturnal polyuria, small bladder capacity, or detrusor overactivity.
- Nonmonosymptomatic enuresis presents with both daytime and nighttime symptoms, often linked to diverse etiologies.
- Behavioral modification, enuresis alarm therapy, and desmopressin are key treatment modalities, with alarms offering superior long-term efficacy.
Conclusions:
- Effective management of nocturnal enuresis requires a thorough evaluation to determine the specific subtype and underlying causes.
- Treatment should be individualized, starting with behavioral interventions and escalating to alarms or medication as needed.
- Referral to pediatric urology is indicated for refractory cases or suspected genitourinary/neurologic abnormalities.
Abstract:
Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older. Approximately 14% of children have spontaneous resolution each year without treatment. Subtypes of nocturnal enuresis include nonmonosymptomatic enuresis and primary and secondary monosymptomatic nocturnal enuresis. Monosymptomatic enuresis is characterized by nighttime bedwetting without daytime urinary incontinence. Pathophysiology of primary monosymptomatic nocturnal enuresis may be due to sleep arousal disorder, overproduction of urine, small bladder storage capacity, or detrusor overactivity. Children with nonmonosymptomatic enuresis have daytime and nighttime symptoms resulting from a variety of underlying etiologies. An in-depth history is an integral component of the initial evaluation. For all types of enuresis, a comprehensive physical examination and urinalysis should be performed to help identify the cause. It is important to reiterate to the family that bedwetting is not the child's fault. Treatment should begin with behavioral modification, which then progresses to enuresis alarm therapy and oral desmopressin. Enuresis alarm therapy is more likely to produce long-term success; desmopressin yields earlier symptom improvement. Treatment of secondary monosymptomatic nocturnal enuresis and nonmonosymptomatic enuresis should primarily focus on the underlying etiology. Pediatric urology referral should be made for refractory cases in which underlying genitourinary anomalies or neurologic disorders are more likely. .
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