From the Guidelines
Nocturnal enuresis is not exclusively a condition of childhood, as it can persist into adolescence and adulthood, affecting approximately 1-2% of adults. While the study by the international children's continence society 1 focuses on monosymptomatic enuresis in children, it acknowledges that a significant proportion of patients continue to experience bedwetting into adolescence or adulthood. The underlying pathogenetic mechanisms, including nocturnal polyuria, detrusor overactivity, and an increased arousal threshold, can affect individuals across the lifespan. Key factors to consider in the management of nocturnal enuresis include:
- Comorbid conditions, such as constipation and neuropsychiatric disorders, which can impact treatment outcomes
- The potential for underlying medical conditions, such as urinary tract infections, diabetes, neurological disorders, sleep apnea, or bladder dysfunction, particularly in adults
- Lifestyle modifications, including limiting fluid intake before bed, avoiding caffeine and alcohol, scheduled voiding before sleep, and using bedwetting alarms, which can be effective for both children and adults. Medications like desmopressin (DDAVP) at 0.2-0.4 mg before bedtime may also be considered, although adults should be evaluated for underlying causes before treatment begins, as noted in the context of managing enuresis 1.
From the Research
Definition and Prevalence of Nocturnal Enuresis
- Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older 2
- Approximately 10% of 7-year-old children wet the bed regularly during sleep 3
- Nocturnal enuresis can occur in adults as well, with a prevalence of 0.5% in the adult population 4
Causes and Types of Nocturnal Enuresis
- Nocturnal enuresis in children is often caused by a delay in maturation of the somatic mechanisms that prevent bedwetting 4
- There are different types of nocturnal enuresis, including monosymptomatic and nonmonosymptomatic enuresis 2, 3
- Monosymptomatic enuresis is characterized by nighttime bedwetting without daytime urinary incontinence, while nonmonosymptomatic enuresis is associated with dysfunction of the lower urinary tract with or without daytime incontinence 3
Treatment and Management of Nocturnal Enuresis
- Treatment should be given when the enuretic child wants to sleep dry 4, 5
- Behavioral interventions are considered first line and are most successful when the child is invested in succeeding 6
- Medications, such as desmopressin, can be effective in treating nocturnal enuresis and should be used in conjunction with behavioral interventions 2, 6, 5
- Active treatment, whether medical or behavioral, should be started as soon as the child is ready to receive it 5