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