- Enuresis can be defined as daytime wetting (diurnal enuresis) after age 4 years or night-time wetting (nocturnal enuresis) after 6 years. Usually no treatment is required before that.
- Red flags
- Referral > 6 years old or any age with continual dripping to paediatric nephrologist
- Any child with a febrile urinary tract infection with abnormal renal US
- Any child with a congenital anatomic genitourinary concern (posterior urethral valves, vesicoureteral reflux, hydronephrosis, ureteropelvic junction obstruction, bladder or urethral abnormalities or genital malformation)
- It is very common. About 50% of children aged 3 years wet the bed, as do 20% of children aged 4 years and 15% of children aged 5.
- Usually there is no underlying cause found but we tend to blame:
- parents: there is a genetic tendency
- small bladder
- deep sleeper
- kidneys like to produce urine at night
- Constipation (make sure the child is not constipated)
- Some disorders that we like to exclude:
- urinary tract infection
- diabetes mellitus
- diabetes insipidus
- neurogenic bladder
- urinary tract abnormality
- Investigations
- Urine MCS
- Renal ultrasound
- Management for nocturnal diuresis
- it is mainly behavioural
- the most effective way is using a bed alarm
- it takes 6-8 weeks for it to work
- takes some effort and parents will need to be happy to get involved
- first step: get a bed alarm. it sounds obvious but some parents do not want to because financial reasons
- second step: practice using it with the child. Pour salting water on to it and listen to the alarm
- Practice routine when the alarm goes off. The child needs to get up, turn the alarm off, go to the toilet and empty bladder completely, come back and change the sheet/material on top of the alarm and turn the alarm back, go back to sleep
- The child is better only to wear underpants to go to sleep rather with trousers
- for parents handout: go to http://www.rch.org.au/kidsinfo/fact_sheets/bedwetting/
- Medication if alarm fails:
- DDAVP 200-400 mcg tablets
- if that fails, use that with an alarm
References:
- General practice 5th edition by John Murtagh
- RCH
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