1
Fifth stage
Pediatric
Lec-12
.د
أوس
7/3/2016
Nocturnal enuresis
'enuresis' is synonymous with bedwetting
Enuresis is defined as the repeated voiding of urine into clothes or bed at least twice a
week for at least 3 consecutive months in a child who is at least 5 yr of age
Children can wet themselves by day or night
It is quite common: about 6% of 5-year-olds and 3% of 10-year-olds are not dry at night.
Boys outnumber girls by nearly 2 to 1
There is a genetically determined delay in acquiring sphincter competence, with two-
thirds of children with enuresis having an affected first-degree relative.
Organic causes of enuresis are uncommon but include
urinary tract infection
faecal retention severe enough to reduce bladder volume and cause bladder neck
dysfunction
polyuria from osmotic diuresis, e.g. diabetes mellitus, or renal concentrating disorders,
e.g. chronic renal failure
A urine sample should always be tested for glucose and protein, specific gravity and
checked for infection
bladder ultrasonography
Management of nocturnal enuresis
1. Explanation :The first step is to explain to both child and parent that the problem is
common and beyond conscious control
2. Star chart :child earns praise and a star each morning if his bed is dry. the child should
not be blamed for wet bed
3. Enuresis alarm :effective in most cases
4. Desmopressin : Short-term relief from bedwetting
5- imipramine