• primary

  • never control

• secondary

  • wetting after normal continence of at least 3mo

Diurnal

daytime wetting >4yo

Management

• urinary containment exercises

  • visit toilet upon urge

  • sit and hold urine for 1 min

  • then stop and start on 3 occasions before emptying

• structural toilet

  • sits on toilet and urinates at scheduled intervasl regardless of urge

  • start @ 1hr intervals

Nocturnal

night time >6yo

• secondary if at least 6mo of dryness

• absence of physical abnormality in children or adults

• normal:

  • 50% 3yo

  • 20% 4yo

  • 15% 5yo

  • problem if regular bedwetting >6yo

  • many boys not dry until 8yo

  • 2% of 15yo

• abnormal

  • 5-6yo with ≥2 episodes / month

  • over 6yo with ≥ episode/month

history - key points

• distinguish nocturnal vs diurnal

• primary/secondary

• pattern of voiding

  • dry nights in past week or month

  • fluid intake at bedtime

  • intake of caffeine

    • remember cocoa/hot chocolate

• practical issues

  • reach the toilet

  • light

  • night time fears

• stressors @ home/school/friends

• discuss what has previously been tried

  • including punishments and rewards

• medical history

Causes

• usually no obvious cause- likely multifactoral

  • sleep polyuria

    • deranged circadian rhythm of antidiuretic hormone

      • 70% of children

  • reduced night-time bladder capacity

  • lack of arousal from sleep

  • psychosocial factors

    • teasing

    • bullying

    • punishment

  • genetics

    • autosomal dominant

• underlying disorders to exclude: ** - urinary tract infection

  • diabetes mellitus

  • diabetes insipidus

  • neurogenic bladder

  • urinary tract abnormality

    • consider uss to exclude after 6yo

• USS only recommended in children who are wet during day or when nocturnal enuresis unresponsive to treatment

Management

• advice

  • reassure

  • eventually go away

    • 15% spont. resolution per year

  • don’t scold or punish child

  • praise child often

    • consider star chart for dry night

  • do not stop child drinking after evening meal

  • empty bladder well @ bedtime

  • do not wake child at night to visit toilet

    • scheduled wakening preferable to lifting

      • waking child periodically 1-3times @ night

      • walking to toilet to pass urine

      • eventually wakening stretched until child can go full night without wetting the bed

  • use a night light to help child who wakes

  • absobant pads/waterproof duvet/mattress covers > nappies

  • shower/bathe prior to going to school

  • treat constipation

• bed alarm

  • loud noise when urine passed

  • child wake: switches off buzzer and visits toilet

  • use for at least 3 mo

  • once 14 consecutive nights

    • dink extra fluid in hour leading up to bedtime

    • “overlearning”

      • reduces rate of relapse from 50%-25%

  • if relapse - offer alarm system again

• desompressin

  • 6yo >

  • 300-500mcg at night or by nasal spray 20-40mcg

  • useful for school camps

  • spray fully funded on specialist recommendation

  • tablets not fully funded

  • watchf or:

    • water intoxication

    • hyponatramia

      • convulsions

www.kidshealth.org.nz

“bedwetting” = key word

Secondary

• can start at any age

• fully investigate

  • urinary infection

  • neurological disorder