Nocturnal enuresis in 10 minutes
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Nocturnal Enuresis (in 10 minutes). By Mohammad Adnan. Definition(s).

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Nocturnal Enuresis (in 10 minutes)

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Nocturnal enuresis in 10 minutes

Nocturnal Enuresis (in 10 minutes)

By Mohammad Adnan


Definition s

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

Epidemiology

  • 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

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

History (1)

  • 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

Red Flags

  • Polyuria

  • Polydipsia

  • Weight Loss

  • Abdominal mass


History 2

History (2)


History 3 secondary ne

History (3) Secondary NE


Examination

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

Management

  • Enuresis clinic

  • Refer to nice Enuresis Guidelines

  • Three main option

  • Conservative

  • Alarm

  • Desmopressin


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