Volume 4 Issue 3 March, 2014
Nocturnal enuresis is a very common condition and has occurred since man’s earliest days and the first references may be found in the Ebers papyri of 1550 BC. “Enuresis” is a term which literally means “to urinate within”. The International Children’s Continence Society states that nocturnal enuresis is the intermittent involuntary loss of urine that occurs only at night in children five years of age or older without an underlying organic disease as the cause. At five years of age, 15 to 25 percent of children still continue to wet the bed. With each year of maturity, the percentage of bed-wetter’s declines.
Classification of Enuresis:
According to time of day: Nocturnal enuresis/ Diurnal enuresis
According to presence of other symptoms: Monosymptomatic nocturnal enuresis / Polysymptomatic nocturnal enuresis.
According to previous periods of dryness: Primary enuresis/ Secondary enuresis
Proposed mechanisms:
Disturbances in sleep arousal to a full bladder, defect in nocturnal release of vasopressin( which causes increased water absorption and reduced urine production during sleep) hence excessive overnight urine production, reduced bladder capacity caused by overactive bladder.
Risk factors for nocturnal enuresis include: genetic influences, delay in attaining bladder control, constipation, faecal incontinence, daytime urinary incontinence, sleep apnoea, psychological factors.
Assessment consists of a thorough history, physical examination, frequency/volume charts, specific questionnaires, sonography, urine analysis and urine culture.
Interventions used for treating nocturnal enuresis include pharmacological and behavioural. Behavioural interventions include fluid restriction( pre-bedtime fluid intake ), lifting (carrying the child, while still asleep, from the bed to allow them to urinate in an appropriate place), scheduled wakening, reward system using positive reinforcement (e.g. star charts) and bladder training (including retention control training), Alarm training. Other nonpharmacologic treatments include hypnosis, biofeedback. Psychotherapy aimed at addressing underlying psychological causative factors and modifying the environment which produced the symptoms. Desmopressin (by decreasing urine volume at night) and imipramine (anticholinergic effect) are the primary drugs used in the treatment of nocturnal enuresis. Pharmacologic treatment is not recommended for children under six years of age.
To conclude nocturnal enuresis is socially and emotionally stigmatizing and can affect self esteem, peer relationships and educational opportunities of sufferers ,hence the need for individualized treatment approach taking into account both the child’s motivation and parent’s perceptions.
“Bedwetting is something children can’t help, and they almost always grow out of it.”
Dr. Sreelatha P Kumar, MBBS, MD; Assistant Professor, MVJ Medical College, Bangalore
