Enuresis

According to the American classification system DSM-IV nocturnal enuresis is defined as “involuntary loss of urine during nighttime sleep at least 2 times a week, in children over 5 years when not caused by problems in the central nervous system or consequences resulting from the use of substances such as diuretics”. 

Types of enuresis:

• Night: where urine loss occurs only during the night. It is more common in boys.
• Daily: where urine loss occurs only during the day. It is more common in girls.
• Joint: daily and nocturnal enuresis.
• Primary: called enuresis, where the patient was never fully dry during sleep for at least 3 months
• Secondary: called enuresis, where the patient was previously completely dry for at least six months.
• Monosymptomatic: when bedwetting occurs only at night. Constitutes 80-85 % of cases.
• Polysymptomatiki: enuresis accompanied by urinary frequency, urgency, urge incontinence, constipation, loose stools.

Frequency

Daily: 5.5% at age 5-12 years
Night: 15% at age 5 years
BOYS: GIRLS: 2:1.

Table 1: Percentage of children who stay dry during the day and night in various preschool.

AGE DAY % NIGHT %
2          25            10
2.5      85           48
3        98            78

Table 2: Causes of primary and secondary enuresis

Table 3: Causes Nighttime and daytime enuresis

TREATMENT

• Limitation of fluids consumed before the child reaches the time to fall asleep
• Encouragement for complete emptying of the bladder just before sleep
• Recording habits at night, so as to allow getting up early to go to the toilet
• Avoiding any punishment associated with the problem
• Rewarding those nights bed stays dry
• Waking during the night
• Use enuresis alarm sensor
• Medication
• Surgeries