Enuresis

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Summary of Enuresis

Enuresis refers to a repeated inability to control urination, resulting in bed-wetting or urination into clothes. Use of the term is usually limited to describing individuals old enough to be expected to exercise such power. Treatment is with a urine alarm and may include the prescription of desmopressin or imipramine.

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Enuresis

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▪ Age: > four years old ▪ Not caused by other condition/substance (except constipation) TREATMENT MEDICATIONS ▪ Daily laxatives (stool softeners: 1g/kg polyethylene glycol per day) OTHER INTERVENTIONS Dietary ▪ Avoid constipating foods ▪ Adequate hydration ▪ Increase ﬁber intake; ﬁber tablets Remove fecal impaction ▪ Polyethylene glycol/mineral oil ▪ Rectal enema PSYCHOTHERAPY ▪ Behavioral therapy ▫ Encourage toilet usage, normalize bowel movements ENURESIS osms.it/enuresis PATHOLOGY & CAUSES DIAGNOSIS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ Can be nocturnal, diurnal, both ▪ Can involve poor bladder control (physiological developmental reasons)/ exceeding bladder capacity ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ “Clinically signiﬁcant”: occurs > two times per week for > three consecutive months or affects day-to-day life ▪ Age: > ﬁve years old ▪ Not caused by other substance CAUSES ▪ Genetic, environmental; stress-related ▫ Often associated with psychiatric comorbidities ▫ More common in biological males SIGNS & SYMPTOMS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places 706 OSMOSIS.ORG TREATMENT MEDICATIONS ▪ Desmopressin (reduce urine production) PSYCHOTHERAPY ▪ Behavioral therapy (e.g. bedtime alarm therapy), bladder program

Flashcards

Enuresis

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is a tricyclic antidepressant that is useful in nocturnal enuresis due to its ability to decrease rapid eye movement sleep.

Questions

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A 4-year-old boy comes to your office for a well-child visit. His mother is concerned about bedwetting, noting he has never been completely dry, and wets the bed 1-2 nights a week. She is frustrated because she was able to potty train his two older siblings by 3 years of age. The patient has no daytime incontinence, no urgency or frequency, no constipation or fecal incontinence, weight loss, or excessive thirst. He is not allowed to drink excessively at night. His past medical history is noncontributory and he is otherwise developing normally. Which of the following is the most appropriate next step in management?

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