ENURESIS (Bed wetting)ENURESIS (Bed wetting)

ENURESIS (Bed wetting)

Def : Involuntary voiding of urine into cloths or bed after developmental age when bladder control should be established .

this should be twice a week for at least three consecutive month, or clinically significant distress in child life .

Prevalence

Age/ yr

Total percent.

Male Female

510%7%3%

105%3%2%

181%1%-

60% ==> boys

50% ==> F / H

44% ==> one parent

77% ==> both parent

15 – 20 % of patient yearly will spontaneously improve with out treatment .

Classification

1) Primary or persistent 90% .2) Secondary or regressive 10% due

to stressful environmental events . Distinction is important as the

pathogenesis of the tow patterns is different .

Further classification :

• Nocturnal only En.• Diurnal only En.• Nocturnal / diurnal En .

Pathogenesis :

• Delayed maturation of the cortical mechanism that allow voluntary of the micturition reflex .

• Sleep disorder most of them are described as deep sleeper .

• Decrease ADH at night this will increase U.O.P .

• Genetic factor .• Psychologic factor mainly in secondary En.• Sleep apnea (snoring) secondary to

enlarged adenoid .

Management I. General suggestion - Reasurance & avoid punishment . - restrict fluid intake after 7 pm . - void before retiring . - waking the child few hour, after sleep for voiding . - reword the child for dry night . - secondary En. As a result of environmental

stressors . - refer al to ENT especially if the child snoring . II. Condition therapy : a device alarm that rings when

the child wet, a special sheet … success rate 60% .

III. Pharmacologic therapy : * Desmopressin : synthetic analog of vasopressin . 0.2 – 0.6 mg at night 0.10 µg Effectiveness 40 – 60 % * Imipramine tah. mild anticholinergic mild alfa – adrenergic Effectiveness 30 – 60 % * Oxybutinin anticholinergic , antispasmodic limited studies available . Effectiveness

17 % * Active treatment a voided before seven years .