Managing childhood enuresis
Monosymptomatic nocturnal enuresis (MNE – nocturnal enuresis without any other lower urinary tract symptoms) is a common form of childhood bedwetting.
Although enuresis tends to disappear spontaneously as the child grows, a significant proportion of patients continue to wet the bed into adolescence or adulthood.
The International Children’s Continence Society recently developed guidelines for MNE management. Primary evaluation is recommended before commencing treatment for MNE. This initial evaluation helps the clinician to:
1. Identify the child who has enuresis secondary to underlying medical conditions;
2. Identify the child who for other reasons needs further examination;
3. Identify the child with relevant comorbid conditions; and
4. Commence treatment after excluding points 1-3.1
Primary evaluation, involving discussion with the child and the carer(s), should include:
• A comprehensive case history (bladder diary, frequency-volume chart, estimated fluid intake, bowel habits, history of UTI, general health and behavior are recommended);
• Physical examination (usually normal in a child with MNE, however symptoms such as weak stream or severe/continuous incontinence call for a thorough somatic examination); and
• Urinalysis.
Treatment options in uncomplicated MNE include:
• Bladder advice (the child should be instructed to void regularly during the day, always at bedtime and on awakening);
• Enuresis alarm; and/or
• Desmopressin.
Alarm therapy is best suited for:
• Motivated families and for children without polyuria but with low voided volume.
Desmopressin is best suited for:
• Children with nocturnal polyuria and normal bladder reservoir function; and
• For families in whom alarm therapy has failed; or
• For children considered unlikely to comply with alarm therapy.