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

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