Use pharmacological options sparingly and cautiously in children with nocturnal enuresis
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Use pharmacological options sparingly and cautiously in children with nocturnal enuresis Nocturnal enuresis (bedwetting) is the most common cause of urinary incontinence in children and carries a significant psychosocial impact. Bedwetting alarm therapy is the recommended first-line therapy, with desmopressin indicated if alarm therapy is not feasible or is ineffective, or as an adjuvant to alarm therapy. Anticholinergic medications are an option in children who have daytime urinary symptoms in addition to night-time symptoms.
Bedwetting a common problem According to the International Children’s Continence Society (ICCS), nocturnal enuresis is defined as intermittent urinary incontinence during sleep in the absence of physical disease beyond the age of 5 years.[1] It is a common problem in children, with prevalence rates of 15–20%, 7% and 5% reported in those aged 5, 7 and 10 years, respectively.[2] The rate of spontaneous remission is 14% per year (until teenage years are reached).[3] Prevalence rates are lower in adults (0.5–2%). Children with constipation, upper airway obstruction (including sleep apnoea) and attention-deficit hyperactivity disorder have a higher incidence of nocturnal enuresis.[4] Although nocturnal enuresis is a source of considerable anxiety to the child and the family, and can adversely affect self-esteem, peer relationships and educational opportunities,[5] medical advice for the treatment of the condition is sought by only one-third of patients.[2] This article summarizes the management of nocturnal enuresis, as reviewed by Desphande and Caldwell.[3]
May be caused by multiple factors Nocturnal enuresis is primarily caused by the interplay between the following three factors:[3] Nocturnal polyuria. Occurs as a result of inadequate secretion of antidiuretic hormone at night, resulting in the production of large amounts of relatively dilute urine. Affects approximately two-thirds of enuretic children.[6] Defective sleep arousal. Enuretic children do not experience the urge to void, and thus sleep arousal, when bladder storage capacity is exceeded, potentially resulting in bed wetting.[7] May be caused by chronic overstimulation of the arousal centre, resulting in a paradoxical suppression and an inability to awake when the bladder is at capacity, although the exact cause remains unknown.[8] Drugs Ther Perspect 2012; Vol. 28, No. 12
Reduced bladder capacity. Children with a small bladder capacity and who have a defective arousal response (with or without nocturnal polyuria) may have enuresis. Nocturnal enuresis may also be the result of detrusor overactivity, which results in urinary leakage while asleep.[9]
Classified into different types Nocturnal enuresis can be classified into the following two types:[1] Primary nocturnal enuresis. Enuresis in children who have never been dry at night for >6 months. Most common type of nocturnal enuresis in children. Secondary nocturnal enuresis. Enuresis in children who have previously been dry for >6 months. More likely to be associated wit
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