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Evaluation and management of primary nocturnal enuresis
Insights
Bedwetting, or enuresis, can impact a child's self-esteem. Treatment, often involving desmopressin for low AVP levels or small bladder capacity, combined with a holistic approach, can improve outcomes.
Area of Science:
- Pediatric Urology
- Child Psychology
Background:
- Enuresis significantly impacts a child's self-esteem and family dynamics.
- Many children with enuresis have small bladder capacities or a polyuric factor, such as decreased arginine vasopressin (AVP).
Purpose of the Study:
- To explore therapeutic strategies for managing enuresis.
- To highlight the role of nurse practitioners in a holistic treatment approach.
Main Methods:
- Review of research on bladder capacity and AVP levels in enuretic children.
- Discussion of pharmacologic treatments like desmopressin.
- Emphasis on a holistic approach involving child education and psychological support.
Main Results:
- Small bladder capacity and polyuria (decreased AVP) are common in enuretic children.
- Desmopressin therapy can address polyuria and accelerate continence.
- A holistic approach empowers children to actively participate in their treatment.
Conclusions:
- Pharmacologic treatment, particularly desmopressin, can be effective for enuresis.
- A comprehensive strategy combining medical and psychological interventions enhances outcomes.
- Empowering children with knowledge fosters self-esteem and competence in managing enuresis.
Abstract:
Enuresis can be a source of family crisis, and can contribute to a lack of self-esteem in the affected child. It must be stressed to both parent and child that improvement is gradual and largely a function of maturation in cases where no organic problem is identified. Research shows that many enuretic children seem to have small bladder capacities (Long, 1991), and that the majority have a polyuric factor such as a decreased level of AVP that is amenable to replacement therapy with desmopressin (Bloom, 1993; Hamburger, 1993; Hjälmås & Bengtsson, 1993; Nørgaard & Djurhuus, 1993). Utilizing pharmacologic treatment can accelerate spontaneous cure or act as a substitute until time provides nocturnal continence (Nørgaard & Djurhuus, 1993). Nurse practitioners can use multiple modalities in a holistic approach to reframe this problem and to involve children in solving their own problem. The child who is given a basic understanding of the physiology involved in the healing process will be able to identify inner healing resources and utilize external resources available to him or her. This approach begins with children's imaging the desired outcome of urinary control and ends with achieving increased self-esreem and the sense of competence they deserve.