There are no widely used evidence based assessment tools focused solely on enuresis. Other psychosocial consequences also result from the shaming, blaming and characterological attributions often directed at incontinent children in addition to an increased risk of child abuse. In surveys of child reported stressors, only divorce and parental fights exceed incontinence. However, incontinence of any sort is a significant source of stress. There are no significant health-related consequences of enuresis, although the presence of enuresis could be a marker for medical conditions such as urinary tract infections or vesicoureteral reflux. A 15 percent spontaneous cure rate is well documented. It will resolve in almost all cases, even without treatment. Although enuresis can impose social and psychological burdens (see below) on afflicted children and their families, it is, in itself, a relatively benign condition. These estimates decline to 2-3% of 10-year-old children, and continue to decline to near zero during productive adult years and then begin to increase with significantly advancing age. Prevalence and CourseĬurrent epidemiological range as high as 15% of six-year-old children for enuresis. There are 3 subdivisions-nocturnal, diurnal, and combined nocturnal and diurnal with nocturnal being the most prevalent by a very wide margin. The condition cannot be directly due to the physiological effects of a substance (e.g., diuretics) or a general medical condition. The child must be at least five years of age or exhibit that level of developmental ability. To qualify for a diagnosis of enuresis, the voiding must occur at least twice per week for at least 3 consecutive months or else must cause clinically significant distress or impairment in social, academic, occupational or other important areas of functioning. Usually this is involuntary, but occasionally it may be intentional. All rights reserved.Enuresis involves the repeated voiding of urine during the day or at night into bed or clothes. We conclude that while enuresis seems to be an often underestimated condition in terms of the suffering that children and their families may undergo, there are efficacious therapy options once a correct and full diagnosis is made.Ĭhildhood incontinence Enuresis Pediatric overactive bladder Pediatric urology.Ĭopyright © 2017 European Association of Urology. We describe the background of enuresis,including its complex underlying mechanisms, as well as diagnosis and treatment in the light of current scientific publications. This article reviews primary and secondary nocturnal enuresis, which is the medical term for the condition whereby children wet their beds regularly after their first birthday. While enuresis seems to be an often underestimated condition in terms of the suffering that children and their families, there are efficacious therapy options once a correct and full diagnosis is made. For therapy-refractory cases, after a thorough re-investigation to identify any missed comorbidities and anatomical or functional causes of enuresis, combination therapy and stationary urotherapy might be promising options. While desmopressin melt tablets and alarm systems constitute the mainstays of treatment in monosymptomatic enuresis, anticholinergics and urotherapy play an additional role in nonmonosymptomatic enuresis. In secondary enuresis, psychological causes should also be taken into consideration. Further imaging is indicated in complex cases with a suspicion of underlying congenital malformations or systemic or endocrine diseases and in children refractory to initial therapy. It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections. Diagnosis relies on history-taking and simple noninvasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms. Coexisting constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions influence its prevalence. The most relevant information from the papers with the highest level of evidence was extracted and incorporated into the review.Īn altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation are the main pathophysiological factors in primary enuresis. PubMed was searched for literature on enuresis, and all papers published in the last 5 yr were considered. Guideline and position papers from the European Society of Pediatric Urology, the European Association of Urology, and the International Children's Continence Society were acquired. To provide a comprehensive overview of the pathophysiology, diagnosis, and treatment of enuresis. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede timely child-adapted and successful therapy. Enuresis is a common and possibly underestimated condition.
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