1. Nocturnal Enuresis (in 10 minutes) By Mohammad Adnan

2. Definition(s) ‘The Diagnostic & Statistical Manual of Mental Disorders (DSM- IV) defines nocturnal enuresis as an involuntary voiding of urine during sleep, with a severity of at least twice a week, in children aged >5 years in the absence of congenital or acquired defects of the central nervous system ’* Primary – Never been dry at night Secondary – 6m> of bladder control * There is no minimum age limit to allow consideration of the benefit of interventions in younger children (under 7 years) previously excluded from treatment.NICE

3. Epidemiology 30% aged 4yrs 14% aged 5yrs 10% aged 6yrs 3% aged 12yrs 1% aged 18 Male>Female 1-2% underlying physical abnormality Can run in families

4. Pathophysiology There are a number of different disturbances of physiology that may be associated with the development of bedwetting. These disturbances may be categorised as: 1. Sleep arousal difficulties – a reduced ability to wake to noise or to bladder contractions. 2. Polyuria – the production of larger than normal volumes of urine overnight that typically exceed the nocturnal bladder capacity. 3. Bladder dysfunction – most often either a small bladder capacity or overactive bladder.

5. History (1) When did it start? Ever been dry at night? How often? Wet in the Day? Bowels opening ok, constipation/soiling? Fluid intake, fizzy drinks/caffeinated SHx – school/bullying/stress PMH/DHx/Developmental Hx

6. Red Flags Polyuria Polydipsia Weight Loss Abdominal mass

7. History (2)

8. History (3) Secondary NE

9. Examination Should be unremarkable but... Urine Dipstick Abdo Exam Neuro – reflexes?? Do not perform urinalysis routinely, unless the child or young person has: ● started bedwetting recently (in the last few days or weeks) ● daytime symptoms ● any signs of ill health ● a history, symptoms or signs suggestive of urinary tract infection ● a history, symptoms or signs suggestive of diabetes mellitus.

10. Management Enuresis clinic Refer to nice Enuresis Guidelines Three main option -Conservative -Alarm -Desmopressin