Nokturnal enuresis [Nokturnal enürezis]

Abstract

Nocturnal enuresis (NE) is defined as a complete or near complete micturition in the bed during the sleep. The pathophysiology of NE is still not fully understood. A conceptual model has been proposed for understanding. The remarkable fact is that the great majority of children sleep dry for 8-9 hours or more while sometimes finding it hard to wait for only a couple of hours during daytime. Thus, nocturnal dryness requires functions that are not present during daytime. The basic pathophysiology of NE is simple in that the bladder gets filled to capacity during sleep and needs to be emptied. However, the child not wakes up. If he/she wakes up, he/she walks to the bathroom and performs the socially acceptable act of nocturia. If he/she does not wake up, the socially unacceptable bedwetting ensues. For the management of a child with NE, the most important diagnostic procedure is to identify monosymptomatic enuresis by history and physical examination. Once the history and physical examination has classified the child as monosymptomatic only minimal additional diagnostic work is needed. Daywetting is the most important symptom to exclude in order to classify the enuresis as monosymptomatic. If there is any amount of daytime incontinence present, the enuresis is definitely not monosymptomatic. A dip stick will exclude protein, glucos, hematuria and most urinary pathogens. If there is a history of previous urinary infections, urinary culture should be added. Management of NE is based on 4 principles: (1) Verify the child's motivation to be treated. (2) Information and instruction about daily habits underlining the importance of having regular fluid intake and voidings and relaxed routines at bedtime. (3) Enuresis alarm (4) Antidiuretic medication.