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enuresis

Urinary incontinence, intentional or involuntary not secondary to a physical disorder, frequently used in reference to children. Enuresis may be nocturnal (bed-wetting) or during wakefulness (diurnal eneresis). Nocturnal or sleep enuresis also occurs in adults. Etiology: - obstructive sleep apnea - allergy* [6] * asthma only allergic disease not associated with enuresis [6] * among boys, only allergic rhinitis associated with enuresis [6] Epidemiology: 1) 1-3% of adults 2) 70% of mentally retarded adults Management: 1) education to relieve guilt 2) bladder training 3) fluid restriction at night 4) pharmaceutical agents a) do not use pharmaceutical therapy if child is < 7 years of age [4] b) desmopressin (DDAVP) tabs are effective in the majority of children c) avoid the nasal spray because it's easier for children to overdose & develop hyponatremia [4] d) if DDAVP is ineffective, consider 1] imipramine (low dose) 2] anticholinergic agent - oxybutynin - tolterodine (Detrol)

General

urinary incontinence (UI)

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Prescriber's Letter 15(10): 2008 COMMENTARY: Treatment of Primary Nocturnal Enuresis (Bedwetting) in Children GUIDELINES: Assessment and Treatment of Enuresis in Children and Adolescents Detail-Document#: 241003 (subscription needed) http://www.prescribersletter.com - Fritz G et al; Work Group on Quality Issues; AACAP. Practice parameter for the assessment and treatment of children and adolescents with enuresis. J Am Acad Child Adolesc Psychiatry. 2004 Dec;43(12):1540-50. Review. PMID: 15564822 http://www.aacap.org/galleries/PracticeParameters/Enuresis.pdf
  5. Prescriber's Letter 19(4): 2012 Treatment of Primary Nocturnal Enuresis (Bedwetting) in Children Detail-Document#: 280407 (subscription needed) http://www.prescribersletter.com
  6. Tsai J-D, Chen H-J, Ku M-S et al. Association between allergic disease, sleep-disordered breathing, and childhood nocturnal enuresis: A population-based case-control study. Pediatr Nephrol 2017 Dec; 32:2293. PMID: 28735503 https://link.springer.com/article/10.1007%2Fs00467-017-3750-0