Primary Nocturnal Enuresis: A Review

Abstract

ContextNocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. Enuresis nocturna is defined as the inability to hold urine during the night in children who have completed toilet training. It is termed as being “primary” if no continence has ever been achieved or “secondary if it follows at least 6 months of dry nights. The aim of this review was to assemble the pathophysiological background and general information about nocturnal enuresis.Evidence AcquisitionThis review was performed by evaluating the literature on nocturnal enuresis published between 1970 and 2015, available via PubMed and using the keywords “nocturnal enuresis,” “incontinence,” “pediatric,” “review,” and “treatment.”ResultsChildren with nocturnal enuresis produce urine at higher rates during the night, and may have lower bladder capacities. Some children with nocturnal enuresis may also have daytime urgency, frequency, and urinary incontinence. Treatment includes aggressive treatment of accompanying constipation or urinary tract infections, behavioral changes, and medical therapy. Alarm therapy remains the first-line treatment modality for primary nocturnal enuresis. High rates of patient compliance and relapse mean that alternative treatments remain on the agenda.ConclusionsNocturnal enuresis is a common problem that has multifaceted effects on both the child and the family. Due to multiple etiologic factors, nocturnal enuresis is still not clearly defined.

Primary nocturnal enuresis: Assessment and treatment at a single referral center

“…Also, it is likely that, in Abu Dhabi, the large intake of dry, low‐fiber foods such as rice, banana and lemon, along with the hot weather most of the year, and the stress of living in a chaotic city, negatively affect the incidence of fecal retention and, so far, of NE. We agree that the treatment approach to bowel symptoms in a pediatric population with bowel and bladder dysfunction is considered appropriate: early diagnosis and treatment of constipation not only improve enuresis, but also reduce the possibility of untreated constipation leading to treatment‐refractory enuresis . On this basis, we generally treat constipation from the start of therapy.…”

Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta‐analysis

“…In the present study, we compared two commonly used treatments (desmopressin and alarm) and two combined therapies (desmopressin plus alarm and desmopressin plus AA). Desmopressin and alarm have been applied as the first‐line treatment for paediatric MNE in clinical practice . Alarm therapy can be defined as a training programme to improve arousal by a full bladder and to increase night‐time bladder capacity .…”

“…Anticholinergic agents (AAs), such as tolterodine, oxybutynin and propiverine, can prevent involuntary detrusor contractions. They can significantly decrease urge incontinence in children . Desmopressin plus AA therapy is often used in non‐responders to desmopressin monotherapy or in those with a restricted bladder capacity and thickened bladder wall .…”

Urology as rehabilitation medicine: a literature review

“…NE is most common voiding abnormality in children that is the voluntary or involuntary wetting with urine and has significant psychological effects on both child and the family ( Arda et al, 2016 ). Bedwetting alarm is a representative therapy for the children with NE.…”