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Enuresis

Ενότητες

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”. enuresis

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

CAUSE PROTOPATHOUS ENOURISIS CAUSES SECONDARY
ENOURISIS
IDIOPATHIC, NIGHT MULTIURINE,
SMALL BLADDER CAPACITY		 IDIOPATHIC, NIGHT MULTIURINE,
SMALL BLADDER CAPACITY
OAB OAB
CYSTITIS CYSTITIS
CONSTIPATION CONSTIPATION
NEUROGENIC BLADDER PSYCHOGENIC CAUSES
STRICTURE URETHRA NEUROGENIC BLADDER
PSYCHOGENIC CAUSES EPILEPSY
EKTOPIOS URETER SLEEP APNOIA OBSTRUCTIVE CAUSES
INSIPIDUS DIABETES DIABETES
INSIPIDUS DIABETES
STRICTURE URETHRA

Table 3: Causes Nighttime and daytime enuresis

NIGHTTIME ENURESIS   DAYNIGHT ENURESIS
INHERITANCE MYELOMENINGOCELE
SMALL BLADDER CAPACITY SPINAL CORD INJURY
DIABETES INCONTINENCE EFFORT
INSIPIDUS DIABETES ATONIC BLADDER
NIGHT MULTI URINE OAB
INTENSELY HEAVY SLEEP URINARY INFECTIONS

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