Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Enuresis is common in young children, and it often resolves on its own as the child matures. Early intervention, including behavioral strategies, reassurance, and medical management when necessary, can help reduce anxiety for both the child and the family. By adopting a supportive, patient approach, most children with enuresis will eventually overcome the condition.

Introduction

• Enuresis is the involuntary passage of urine at night, affecting children who have not yet achieved full bladder control.
• Infrequent bedwetting (less than 2 nights per week) occurs in about 15% of 5-year-olds and 5% of 10-year-olds.
• 1–2% of individuals over the age of 15 still experience bedwetting due to delayed bladder control maturation.
• A family history of enuresis is common in these cases.
• Girls generally achieve bladder control earlier than boys
• Enuresis is bedwetting beyond the age of 5 years, or 6 years for boys.

Causes and Risk Factors

• Delayed maturation of bladder control: This is the most common cause of enuresis and often runs in families.
• Underlying health issues: Diabetes, urinary tract infections (UTIs), or genital urinary abnormalities can occasionally contribute to bedwetting.
• Secondary enuresis: Refers to wetting after a period of dryness for over 6 months and may indicate emotional or behavioral concerns, illness, or abuse.

Clinical Features

• Frequency and patterns: Ask how often the child wets the bed, and whether it happens more than once a night.
• Daytime symptoms: Symptoms such as urgency or frequency may indicate an overactive bladder, which may benefit from treatments like oxybutynin.
• Fluid intake and constipation: Inquire about how much the child drinks during the day and whether they experience constipation, as this can contribute to enuresis.
• Previous dryness: If the child was previously dry and has started bedwetting again, consider potential underlying medical causes, including systemic illness or concerns such as child abuse.

Diagnosis is primarily clinical. However, certain tests may be indicated:

• Causes:Exclude diabetes, UTIs, and urinary tract abnormalities can be considered.
• Secondary enuresis: bedwetting after dryness may signal emotional distress, illness, or abuse.

Management of Enuresis

• Reassurance:The first step in managing enuresis is to reassure parents. Many children continue to wet the bed after achieving daytime dryness, and it is important to provide advice and support during this stage. Some key management strategies include:
• Avoid caffeine: Ensure that the child avoids caffeine-based drinks, which can irritate the bladder.
• Regular toilet use: Encourage the child to use the toilet regularly throughout the day (4–7 times is typical), and before bedtime.
• Reward system: Implement a system of rewards for positive behaviors, such as drinking adequate fluids, using the toilet before bed, and taking medicines, but avoid rewarding for dry nights which the child cannot control.

Advanced Treatments For children with persistent enuresis

• Bedwetting alarms: These alarms, which include vibration or sound when wetness is detected, have been shown to help 56% of children achieve dryness after 1 year. Continued use even after dryness is achieved can prevent relapse. These alarms are often available through Child Guidance Services (e.g., Drinite®).
• Desmopressin: This medication can be helpful for sleepovers and school trips. The recommended dose for children over 5 years old is 120 mcg at bedtime, with a maximum of 240 mcg. It is important to note that relapse is common after stopping the medication. Caution should be exercised in children with cystic fibrosis, uraemia, or low blood pressure.

Key Points for Parents

• Reassurance: Parents should be reassured that enuresis is not an abnormal or dirty behavior.
• Holistic approach: Address emotional factors, and feelings of shame or ridicule that might arise in the family context.
• Patience is key: bedwetting is a common issue, and many children grow out of it over time.