Nocturnal enuresis

Nocturnal enuresis is a treatable condition. It is defined as functional urinary incontinence during sleep beyond the age (arbitrarily taken to be) of 6 years old at which control should be established. Although it is a physically benign condition, it is unfortunately associated with emotional-behavioural disturbances and developmental delays. Diagnosis is usually straight-forward, and based mainly on history and physical examination. Often, only a microscopic examination of urine is required to exclude urinary tract infection. Treatment begins with a baseline recording of the frequency of enuresis. This is incorporated into motivational therapy which consists of counselling, enhancement of self-responsibility and self-efficacy with positive reinforcement for success. Failing which, enuretic alarm provides the single most effective mode of treatment. However, it suffers from poor compliance. Medication is usually used on an as-needed basis because most relapse after cessation of treatment. Imipramine is the most well-studied and commonly used medication but suffers from potential toxicity. Desmopressin, on the other hand, has few adverse side-effects and is just as effective as imipramine. Its main drawback is its cost.