Nocturnal Enuresis

Abstract

Nocturnal enuresis affects one in ten children at school start and lingers until adulthood in approximately one percent of the population. The condition is often inherited, and the pathogenesis is usually a combination of nocturnal polyuria, nocturnal detrusor overactivity, and/or high arousal thresholds. Enuresis adversely affects quality of life and selfesteem. The vast majority of enuretic children can, and should, be managed without blood tests, radiology, or invasive urodynamics. With a proper case history, the small minority of children who need extensive evaluation can easily be found. Constipation and/or daytime incontinence, if present, should be managed before the enuresis is addressed. Active treatment is indicated from approximately the age of six and involves an enuresis alarm and/or desmopressin medication. The alarm is a conditioning device which demands a high degree of motivation from the child and family but has a high chance of curing the child. Desmopressin acts antidiuretically, is given in the evening, and is effective mainly in enuretic children who have nocturnal polyuria. The drug is safe to give as long as it is not combined with excessive fluid intake. Second-line therapies include anticholinergics and tricyclic antidepressant treatment. Anticholinergics carry a risk for constipation or the accumulation of residual urine. Tricyclic antidepressants are severely cardiotoxic if overdosed.