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