Enuresis

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Involuntary, urinary incontinence during sleep after age of expected bladder control; term generally reserved for children ≥5 years of age; may be
    • Primary: has never been “dry” for 6 months (80%)
    • Secondary: Patient was previously “dry” for ≥6 months.
  • Classified as
    • Monosymptomatic nocturnal enuresis: no other lower urinary tract symptoms
    • Nonmonosymptomatic nocturnal enuresis: evidence of lower urinary tract malfunction (e.g., delayed voiding, frequency, urgency, holding maneuvers in order to postpone voiding)

EPIDEMIOLOGY

  • Male > female
  • Prevalence
    • 10–15% of children at age 5 years
    • 7–15% of children at 7 years
    • 5% of children at 10 years
    • 0.5–1% in teenagers and adults

ETIOLOGY

  • Primary nocturnal enuresis: results from interplay of one or more of the following:
    • Genetics (60–70% have a positive family history of enuresis.)
    • Delayed maturation of bladder function
    • Nocturnal polyuria (increased nighttime urine output)
    • Decreased functional bladder volume
    • Detrusor overactivity
    • Increased arousal threshold when asleep
    • Inadequate secretion of antidiuretic hormone
  • Nonmonosymptomatic enuresis
    • More concerning for underlying urologic and neurologic disorder
    • Urinary reflux into vagina with seepage after conclusion of voiding
    • Insertion of ureter into urethra or vagina
    • Stress incontinence with increased abdominal pressure (laughing, coughing, increased intravesicular pressure)
  • Secondary enuresis can result from:
    • Urinary tract infection (UTI)
    • Constipation/encopresis
    • Any condition causing polyuria (including diabetes, hypercalcemia)
    • Sleep disorders (sleep apnea, snoring)
    • Emotional stress or trauma including physical and sexual abuse, parental divorce, depression, new sibling, moving households, new school

RISK FACTORS

  • Constipation
  • Lower urinary tract dysfunction or infection
  • Sleep disorders (e.g., obstructive sleep apnea [OSA])
  • Neuropsychiatric (e.g., attention-deficit/hyperactivity disorder [ADHD], anxiety, and oppositional behavior) and developmental disorders

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