Evaluation and treatment of enuresis.

Full Abstract

Enuresis is defined as repeated, spontaneous voiding of urine during sleep in a child five years or older. It affects 5 to 7 million children in the United States. Primary nocturnal enuresis is caused by a disparity between bladder capacity and nocturnal urine production and failure of the child to awaken in response to a full bladder. Less commonly, enuresis is secondary to a medical, psychological, or behavioral problem. A diagnosis usually can be made with a history focusing on enuresis and a physical examination followed by urinalysis. Imaging and urodynamic studies generally are not needed unless specifically indicated (e.g., to exclude suspected neurologic or urologic disease). Primary nocturnal enuresis almost always resolves spontaneously over time. Treatment should be delayed until the child is able and willing to adhere to the treatment program; medications are rarely indicated in children younger than seven years. If the condition is not distressing to the child, treatment is not needed. However, parents should be reassured about their child's physical and emotional health and counseled about eliminating guilt, shame, and punishment. Enuresis alarms are effective in children with primary nocturnal enuresis and should be considered for older, motivated children from cooperative families when behavioral measures are unsuccessful. Desmopressin is most effective in children with nocturnal polyuria and normal bladder capacity. Patients respond to desmopressin more quickly than to alarm systems. Combined treatment is effective for resistant cases.

Author information

Author/s: Ramakrishnan, Kalyanakrishnan (K);

Affiliation: Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. kramakrishnan(-atsign-)ouhsc.edu

Journal and publication information

Publication Type: Journal Article

Journal: American family physician (Am Fam Physician), published in United States. (Language: eng)

Reference: 2008-Aug; vol 78 (issue 4) : pp 489-96

Dates: Created 2008/09/01; Completed 2008/09/19;

PMID: 18756657, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MeSH Headings (categories) shown below.

Deamino Arginine Vasopressin - therapeutic use
Enuresis - diagnosis; epidemiology; therapy
Humans
Imipramine - therapeutic use
Practice Guidelines as Topic
Precipitating Factors
Treatment Outcome

Note: Bold headings indicate primary MeSH headings or qualifiers.

Associated Chemicals: Antidepressive Agents, Tricyclic (0) ; Antidiuretic Agents (0) ; Deamino Arginine Vasopressin (16679-58-6) ; Imipramine (50-49-7)

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