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Nocturnal Enuresis

	IMPORTANT POINTS

 

1. Teaching a child to self-awaken to the sensation of a full bladder and independently go to the bathroom is the primary goal in treating enuresis.
   
2. Enuresis alarms are associated with the highest cure rate and the lowest relapse rate of any single treatment.
   
3. Enuresis alarms are cost-effective.
   
4. Combined therapy (enuresis alarms and drugs) can increase the cure rate.
   
5. The best person to evaluate and manage primary enuresis is the primary care physician.
   

	Definition

 
Nocturnal enuresis refers to the involuntary passage of urine during sleep. Diurnal enuresis refers to the involuntary or intentional voiding of urine into clothing while awake. There are two types of nocturnal enuresis: primary is lifelong bed-wetting and secondary is acquired enuresis after being dry for a minimum of 6 months. Another classification of nocturnal enuresis from the recent urology literature is based on the presence or absence of other bladder symptoms. Polysymptomatic nocturnal enuresis is bed-wetting associated with severe urgency, severe frequency, or other signs of an unstable bladder. Monosymptomatic nocturnal enuresis is bed-wetting associated with normal daytime urination. Children who have polysymptomatic enuresis are far more difficult to treat.

	Prevalence/Epidemiology

 
Because most bed-wetting is due to a maturational delay, it becomes less frequent with each passing year of life. Most parents become concerned about its presence after age 5 or 6 years; most children do not become concerned until age 7 or 8 years. At age 5, approximately 20% of children wet the bed at least monthly, with approximately 5% of boys and fewer than 1% of girls wetting the bed nightly. By age 6, only 10% of children wet the bed. Thereafter, approximately 15% of bed-wetters become dry each year. Overall, 60% of bed-wetters and more than 90% of nightly bed-wetters are male.

	Etiology

 
     PHYSIOLOGIC ENURESIS
Most children who have primary nocturnal enuresis have no disease mechanism to explain . . . [Full Text of this Article]

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This article has been cited by other articles:

				T. J. Silber and M. Pao Somatization Disorders in Children and Adolescents Pediatr. Rev., August 1, 2003; 24(8): 255 - 264. [Full Text] [PDF]

				M. R. Lawless and D. H. McElderry Nocturnal Enuresis: Current Concepts Pediatr. Rev., December 1, 2001; 22(12): 399 - 407. [Full Text] [PDF]