Nocturnal Enuresis: Causes, Signs and Symptoms, Prevalence, Treatment Options, Nursing considerations.

By Peter Jumba

Nocturnal Enuresis: Causes, Signs and Symptoms, Prevalence, Treatment Options, Nursing considerations.


Credit: Google Images 


Worried about bedwetting? Understand the causes, signs, and effective treatment options for nocturnal enuresis in children. Learn about behavioral strategies, medication, and key nursing considerations to help your child achieve dry nights."

Get more knowledge if you're a learner nurse or health practitioner who wants to improve on his or her skills.

Nocturnal enuresis, or bedwetting, is the involuntary urination while asleep after the age when a child would be expected to stay dry at night. This is generally considered a problem in children over the age of five. There are two main types: primary nocturnal enuresis, where a child has never consistently been dry at night, and secondary nocturnal enuresis, where a child who has been dry for at least six months begins wetting the bed again.


Causes:

The exact cause is often a combination of factors, not a single issue. The most common causes include:


  • Genetics: Nocturnal enuresis often runs in families. If one parent was a bedwetter, their child has a 40% chance of being one, and that chance increases to 70% if both parents were.


  • Delayed bladder maturation: In some children, the nerves that signal the brain that the bladder is full aren't fully mature. This leads to them not waking up when they need to urinate.


  • Hormonal issues: The body produces an antidiuretic hormone (ADH) called vasopressin, which reduces urine production at night. Some children don't produce enough of this hormone, leading to an overproduction of urine while they sleep.


  • Small bladder capacity: While a child's bladder may be of normal size, it may not be able to hold all the urine produced during the night.



  • Psychological stress: Significant life events like a new sibling, parental divorce, or moving to a new house can trigger secondary enuresis.


Signs and Symptoms:

The primary and most obvious symptom is involuntary urination during sleep. Other related signs may include:


  • Waking up to a wet bed or pajamas.


  • Reluctance to attend sleepovers or overnight camps due to embarrassment.


  • Feelings of shame, low self-esteem, or anxiety related to the bedwetting.



Prevalence:

Nocturnal enuresis is a common childhood condition that decreases in prevalence with age.


  • Approximately 15% to 20% of 5 year-olds wet the bed.


  • The prevalence drops to about 10% by age 7 and 2% by age 15.


  • Boys are more likely to experience nocturnal enuresis than girls.


While most children will outgrow the condition spontaneously, many can benefit from treatment.


Treatment Options:

Treatment is usually not recommended for children under five, as bedwetting is considered part of normal development. For older children, a combination of behavioral and medical interventions can be effective.


Behavioral Interventions (First-line treatment):


  • Fluid management: Encourage the child to drink plenty of fluids throughout the day but to limit them in the evening. Avoid caffeinated and sugary drinks before bed, as they can irritate the bladder.



  • Toileting habits: Encourage double voiding—having the child urinate at the beginning of their bedtime routine and again just before falling asleep.


  • Enuresis alarms: These devices are highly effective. A moisture-sensitive pad is placed on the child's pajamas or bedding. When it detects wetness, an alarm sounds to wake the child, training them to respond to the sensation of a full bladder.


  • Positive reinforcement: Reward the child for following their routine and for dry nights, focusing on effort rather than the outcome.


Medication:


  • Desmopressin (DDAVP): This medication is a synthetic form of the ADH vasopressin. It reduces the amount of urine the kidneys produce at night and is often used for children with nocturnal polyuria (overproduction of urine).



  • Oxybutynin (Ditropan): This medication is an anticholinergic that can help calm an overactive bladder and increase its capacity. It is typically used for children who also have daytime wetting symptoms.


Nursing Considerations:

Nurses play a crucial role in managing nocturnal enuresis by providing education, support, and care coordination.


  • Assessment: Conduct a thorough history and physical exam to rule out underlying medical causes. This includes a detailed voiding and bowel habit diary, family history, and psychosocial assessment to identify stressors.


  • Education and counseling:  Educate both the child and family about the nature of nocturnal enuresis, emphasizing that it is not the child's fault and is a common developmental issue.


  • Dispel myths and discourage punishment.


  • Teach families how to implement behavioral strategies, like fluid management and alarm use.


  • Support and emotional care: Acknowledge the emotional impact of enuresis, including embarrassment and low self-esteem. Encourage the child's active participation in their care plan to give them a sense of control.


  • Care coordination: Collaborate with other healthcare providers, such as pediatricians and urologists, to ensure a comprehensive treatment plan. Refer families to specialists if conservative measures fail or if underlying issues are suspected.


  • Monitoring and follow-up: Regularly follow up with the child and family to assess the effectiveness of the treatment plan. Adjust interventions as needed and provide ongoing encouragement.

Take the first step toward a solution—learn more about treatment options and talk to your pediatrician today."



Location: Nairobi Nairobi, Kenya

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