Enuresis

Definition: involuntary urinary incontinence by day and/or night in child >5 yr.

Primary Nocturnal Enuresis

definition: involuntary loss of urine at night, bladder control has never been attained

incidence: Male > Female; 10% of 6 yr olds, 3% of 12 yr olds, 1% of 18 yr olds

etiology: developmental disorder or maturational lag in bladder control while asleep

management

  • ~20% resolve spontaneously each yr
  • behavior modification (limiting fluids, voiding prior to sleep), bladder retention exercises. (scheduled toileting overnight has limited effectiveness)
  • conditioning: “wet” alarm wakes child upon voiding (70% success rate)
  • medications (considered second line therapy, may be used for sleepovers/camp): Desmopressin (DDAVP) oral tablets (may have high relapse rate), imipramine (rarely used, lethal if overdose,
    cholinergic side effects)

 

Secondary Enuresis

definition: involuntary loss of urine at night, develops after child has sustained period of bladder control (>6 mo)

etiology: inorganic regression due to stress or anxiety (e.g. birth of sibling, significant loss, family discord), focused on other activities, secondary to organic disease (UTI, DM, DI, neurogenic bladder, CP, seizures, pinworms)

management: treatment of underlying cause



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