Nocturnal Enuresis
(in 10 minutes)
By Mohammad Adnan
Definition(s)
‘The Diagnostic & Statistical Manual of Mental Disorders (DSM- IV)
defines nocturnal enuresis as an involuntary voiding of urine during
sleep, with a severity of at least twice a week, in children aged >5
years in the absence of congenital or acquired defects of the central
nervous system ’*
Primary – Never been dry at night
Secondary – 6m> of bladder control
*There is no minimum age limit to allow consideration of the benefit of interventions in
younger children (under 7 years) previously excluded from treatment.NICE
Epidemiology
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30% aged 4yrs
14% aged 5yrs
10% aged 6yrs
3% aged 12yrs
1% aged 18
Male>Female
1-2% underlying physical abnormality
Can run in families
Pathophysiology
There are a number of different disturbances of physiology that
may be associated with the development of bedwetting.
These disturbances may be categorised as:
• 1. Sleep arousal difficulties – a reduced ability to wake to
noise or to bladder contractions.
• 2. Polyuria – the production of larger than normal volumes of
urine overnight that typically exceed the nocturnal bladder
capacity.
• 3. Bladder dysfunction – most often either a small bladder
capacity or overactive bladder.
History (1)
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When did it start?
Ever been dry at night?
How often?
Wet in the Day?
Bowels opening ok, constipation/soiling?
Fluid intake, fizzy drinks/caffeinated
SHx – school/bullying/stress
PMH/DHx/Developmental Hx
Red Flags
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Polyuria
Polydipsia
Weight Loss
Abdominal mass
History (2)
History (3) Secondary NE
Examination
Should be unremarkable but...
• Urine Dipstick
• Abdo Exam
• Neuro – reflexes??
Do not perform urinalysis routinely, unless the child or young person has:
● started bedwetting recently (in the last few days or weeks)
● daytime symptoms
● any signs of ill health
● a history, symptoms or signs suggestive of urinary tract infection
● a history, symptoms or signs suggestive of diabetes mellitus.
Management
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Enuresis clinic
Refer to nice Enuresis Guidelines
Three main option
Conservative
Alarm
Desmopressin