- The most common cause in children >5Y is detrusor instability.
- Common reversible causes: UTI, constipation, emotional stress.
- Diagnosis requires a full voiding and bowel history with examination to exclude neurological disorders.
- Treatment with oxybutynin, fluid restriction, bladder training and behavioural therapies may be effective.
Bed-wetting – enuresis
- Primary nocturnal enuresis (PNE)– this is where the child has never experienced a period of prolonged dryness and continues to wet the bed more than 2 nights a week after the age at which they would be expected to have outgrown the phenomenon.
- Secondary nocturnal enuresis(SNE) – this occurs after the child has had a period of at least 6 months without bed wetting. It can be related to emotional stress and bladder infection.
- Waiting! – many parents get anxious when their child wets the bed, but often they will outgrow it if you give them long enough. Some research shows that punishing a child for bed wetting can make the situation worse, as the punishments results in lower self-esteem and a downward spiral of symptoms.
- ADH spray
- Alarm – the child wears an alarm at night time that is attached to their pants, and goes off when they get wet. This wakes up the child, and helps them to associate the feeling of a full bladder, with having to wake up. These alarms make children 13x more likely to stop bed wetting, however there is a high relapse rate (up to 50%) and treatment regimens often have to be repeated.
- Most commonly due to constipation in children with psychological predisposing factors.
- History and examination is required to rule out physical cause e.g. celiac disease and Hirschsprung’s disease.
- Management involves explaining the physiology of the condition (remove blame from child); treatment of constipation (stimulant laxative); behavioural strategies (toilet-sitting times).
- 5 year cure is 75%