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Introduction

Bedwetting, or nocturnal enuresis, a frequent medical condition affecting children, adolescents, and adults, can cause significant secondary psychosocial and emotional impacts on the patient and his/her family.

When evaluating a child who wets the bed after the age of 5, an important first distinction is whether the bedwetting is accompanied by daytime symptoms (non-monosymptomatic nocturnal enuresis; NMNE) or not (monosymptomatic nocturnal enuresis; MNE).

While most cases of MNE/”isolated” bedwetting are familial, a specific gene remains to be identified. The pathophysiology of bedwetting is known, and consists of high arousal threshold combined with either an overactive night-time bladder or a very high level of night-time urine production (nocturnal polyuria; NP), or a combination of both.

In most cases, a simple, but correct, patient history and a clinical examination can establish an accurate diagnosis of MNE/bedwetting. Spontaneous resolution of MNE/bedwetting occurs at a rate of 15% per year per age group (exponential decrease in incidence). The most rapid and efficient treatment approaches include the combination of a change in drinking habits with desmopressin and an anticholinergic night-time medication. Other treatment methods involving the use of an enuresis alarm are equally effective, but require more effort from the patient and his/her family.

It is important to educate the patient and his/her family on the true pathophysiology of bedwetting, to inform them that while there are no “easy-fix” solutions, that solutions do exist, and that the urologist can provide help and support in finding such solutions. For treatment to be successful, it is important that the patient can help to choose his/her own treatment.

Nocturnal enuresis presents a special challenge for the urologist. Treatments, although available, are not considered “easy fixes”, and contrary to therapeutic strategies for other urological conditions, the treatment of nocturnal enuresis requires a different approach. The child and his/her parents need to understand why bedwetting occurs and what evidence-based treatments are available. Together, they must choose the treatment that tailors best to their needs, with the urologist on hand to offer support and advice. The motivation of the child and his/her parents is most likely the best predictive factor for a successful treatment outcome.

A visit to the urologist for treatment is considered a significant step for both the child and parents, and it is important that the urologist fully engages with them to identify any secondary effects that might be present. Even if not apparent initially, bedwetting can influence significantly the quality of life of both the child and his/her parents.

 

 

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.