Nocturnal enuresis

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Chapter 33 NOCTURNAL ENURESIS

Jonathan M. Wong

General Discussion

Enuresis refers to the persistence of inappropriate voiding of urine beyond the age of anticipated bladder control, which is age 4 to 5 years at the latest. The International Children’s Continence Society, in order to standardize the diagnosis, has defined nocturnal enuresis as “the involuntary loss of urine that occurs only at night. It is normal voiding that happens at an inappropriate and socially unacceptable time and place.” In the past, various classification schemes were also used to describe this problem such as nocturnal versus diurnal, primary versus secondary, and uncomplicated versus complicated.

Children are not considered to be enuretic until they have reached 5 years of age. Mentally disabled children should have reached a mental age of four years before being considered enuretic. A child of 5 to 6 years of age has nocturnal enuresis if he or she has two or more bedwetting episodes per month. A child older than 6 years of age has nocturnal enuresis if he or she has one or more wetting episodes per month.

Nocturnal enuresis affects some five to seven million children in the United States, making it the most common pediatric urologic complaint. At 5 years of age, 15% to 25% of children still wet the bed; males predominate. The spontaneous resolution rate of nocturnal enuresis is about 15% per year. Thus, 8% of 12-year-old boys and 4% of 12-year-old girls are enuretic. Only 1% to 3% of adolescents are still wetting the bed.

Despite its prevalence, nocturnal enuresis is not completely understood, and the condition is believed to be multifactorial. Organic causes are responsible for nocturnal enuresis in fewer than 5% of cases. Such organic causes should be searched for and ruled out if the history suggests their presence.

Medications Associated with Nocturnal Enuresis

Causes of Nocturnal Enuresis

The current belief is that enuresis is a multifactorial condition involving genetic, familial, psychological, urologic, and hormonal factors. It is also likely related to a maturational delay in affected patients. The following is a list of causes:

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