ENURESIS

Affects 20% of first-graders
Most commonly associated with urinary symtpoms during the day as well (frequency, urgency, or incontinence).

Etiology:

• Reduced bladder capacity e.g. due to constipation, cystitis, urethral obstruction, or neurogenic bladeder
• Nocturnal polyuria from increased fluid intake
• Impaired nighttime arousal due to sleep-disordered breathing.
  

Workup:

• Urinalysis (to r/o infection and DM)
• Px to r/o neurogenic bladder ande valuate lower spine, including anal wink and LE strength, tone, sensation, and reflexes.
• Pelvic u/s to r/o renal or bladder pathology and evaluate bladder capacity (only in pts with daytime sx as well as nocturnal enuresis).

Treatment:

• Behavior therapy:
  • Frequent urination during day
  • Stooling daily after breakfast
  • Awakening 2h after falling asleep to take child to bathroom.
• Biofeedback for bladder and pelvic floor relaxation
• Alarm therapy

Pharmacologic therapy:

• Desmopressin-Can cause water intoxication and subsequent hyponatremia (more likely with nasal); Doesn't improve bladder capacity.
• Anticholinergics-Increase bladder stability and capacity; can be used along with desmopressin; Sign f/x can be significantly.
• Tricyclics-Last resort; can cause mood changes and sleep problems in young children.