1 / 14

Nocturnal Enuresis

Nocturnal Enuresis. Aims. Understand aetiology of nocturnal enuresis Be aware of treatments available in Primary Care Known when to refer. Aetiology. 1/6 of 5 year olds will bed-wet, this is normal (although the parents may not think so) Enuresis more common in boys (2:1)

reuben
Télécharger la présentation

Nocturnal Enuresis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nocturnal Enuresis

  2. Aims • Understand aetiology of nocturnal enuresis • Be aware of treatments available in Primary Care • Known when to refer

  3. Aetiology • 1/6 of 5 year olds will bed-wet, this is normal (although the parents may not think so) • Enuresis more common in boys (2:1) • Genetic predisposition (70% have a 1st degree relative) • UTI – a history is more common in enuritic children

  4. Rates of enuresis • Age 5: 20% • Age 6: 10–15% • Age 7: 7% • Age 10: 5% • Age 15: 1–2% • Age 18–64: 0.5–1%

  5. Secondary Causes • Diabetes (mellitus or insipidus) • Renal failure • Structural abnormality of urinary tract • Impaired night-time arrousal • Neurogenic bladder • A secondary cause must be suspected if enuresis is new onset • Drugs – valproate, SSRIs, also caffeine

  6. Assessment - history • Detailed! • Urinary symptoms • Bowel habit • Developmental history • Family history • Secondary causes (see previous slide)

  7. Assessment - examination • Growth parameters • Lower limb neurology • Abdominal examination • Blood pressure (raised in renal disease) • Consider examining genitalia especially if you suspect physical cause

  8. Investigation • In primary care, relatively simple: • Dip urine and send for culture • Biochemical testing to rule out diabetes.

  9. Management • Rule out all other causes first • Assess parental expectation • Non-pharmacological measures – 1st line • Bedwetting alarms (see next slide) • Bladder training in the day • Star charts to award progress and dry nights • Pharmacological measures – 2nd line, should not be used in <7s

  10. Bedwetting Alarms • Most effective treatment - 70-90% cure • Pad senses wetting and sounds alarm • Teaches child to recognise full bladder • Requires parental effort • 6 month training period, 1 month training for relapse • Considered successful once 14 consecutive dry nights are achieved • Available for lone from ‘local continence advisor’ – probably school nurse, advise there may be a waiting list. Also available to buy

  11. Desmopressin • Synthetic vasopressin • Limits amount of water excreted by kidneys • 12-40% cure, 80% have some benefit • Can be used as ‘one-off’ dose (i.e. for if staying over at a friend’s house) • Use for over 3 months not recommended unless supervision by specialist • Risk of hyponatraemic convusions – need to avoid fluid overload • High relapse rate

  12. More pharmacology • TCAs • Imipramine main drug used • Antimuscarinic effect • Treatment success and relapse rate similar to desmopressin, however risk of SEs higher. • 2004 review states risks outweigh benefits • Oxybutynin • Sometimes used if symptoms of bladder insability

  13. Referral criteria • Majority of cases can be managed in primary care • Referral criteria as follows: • Failure of treatment in primary care • Complex psychological difficulty – consider referral to a child psychologist • Suspicion of a physical abnormality – these cases rarely have problems only at night

  14. The last word • Most of the presentation based on guidance in CKS 2005 • HOWEVER, NICE are issuing their first guidelines on nocturnal enuresis in October 2010 • Unfortunately this presentation has come a bit too early!

More Related