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Bed wetting-Nocturnal enuresis- It is involuntary urination while asleep after the age at which bladder control usually occurs.

Nocturnal enuresis (bedwetting): involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology.

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Description

Nocturnal enuresis

The word enuresis is derived from a Greek word enourein it means “to void urine.” It can occur either during the day or at night.

Signs and symptoms:

  • Daytime voiding pattern
  • Sleep history
  • Family history of nocturnal enuresis
  • Number and timing of episodes of bedwetting/ Toilet training history
  • Behavior, personality, and emotional status
  • Nutrition history /Hydration history
  • Overactive bladder or dysfunctional voiding/ Ectopic ureter/ Urethral obstruction
  • Diabetes mellitus or diabetes insipidus
  • Constipation
  • Cystitis and urinary tract infections (UTIs)

Diagnosis:

  • Urinalysis
  •  Measurement of blood pressure
  • Palpation in the renal and supra pubic areas
  • Inspection of external genitalia
  • Palpation of the abdomen
  • Inspection and palpation of the lumbosacral spine
  • Uroflowmetry with bladder scanning
  • Ultrasonography of the bladder and kidneys, both before and after voiding
  • Voiding cystourethrography
  • Magnetic resonance imaging (MRI) of the spine
  • Urodynamic studies and cystoscopy

Management:

  • Preliminary management focusing on positive reinforcement and behavioral modification
  • Treatment with desmopressin acetate or imipramine.
  • Keen attention to maintaining and establishing a normal bowel pattern, normal daytime voiding pattern, and normal hydration

Pharmacologic therapies:

  • Desmopressin acetate: Preferred medication for treating children with enuresis
  • Anticholinergic agents such as tolterodine andoxybutynin chloride: Especially in patients with dysfunctional voiding, overactive bladder, or neurogenic bladder

 

 

Tags

Bed wetting, sleep, urination, bladder, to void urine

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