From the Guidelines
Primary nocturnal enuresis in a 10-year-old male should be managed with a comprehensive approach, starting with behavioral modifications and considering medication options like desmopressin (DDAVP) if necessary, as it has been shown to be effective in reducing nocturnal urine production with minimal side effects 1.
Behavioral Modifications
Behavioral modifications are the first line of treatment for primary nocturnal enuresis. This includes:
- Limiting fluid intake 1-2 hours before bedtime
- Ensuring regular bathroom visits before sleep
- Using a bedwetting alarm, which has 60-80% success rates
- Considering a voiding diary to track patterns These modifications can help the child develop better bladder control and reduce the frequency of bedwetting.
Medication Options
If behavioral modifications are insufficient after 2-3 months, medication options can be considered. Desmopressin (DDAVP) is a synthetic analogue of antidiuretic hormone (ADH) that reduces urine production at night. It is available in oral tablets and has been shown to be effective in reducing nocturnal urine production with minimal side effects 1. The recommended dose is 0.2-0.4 mg orally at bedtime.
Evaluation for Underlying Conditions
It is also important to evaluate the child for underlying conditions that may be contributing to the enuresis, such as:
- Constipation
- Urinary tract infections
- Diabetes
- Sleep apnea Treating these underlying conditions can help resolve the enuresis.
Psychological Support
Psychological support is also important for children with primary nocturnal enuresis, as bedwetting can affect self-esteem. Reassuring the child and family that the condition is common and often resolves spontaneously can help alleviate anxiety and stress.
Treatment Duration
Treatment should continue until the child achieves 14 consecutive dry nights, then gradually withdraw. Most children outgrow bedwetting, with annual spontaneous resolution rates of 15% 1.
From the Research
Definition and Prevalence of Primary Nocturnal Enuresis
- Primary nocturnal enuresis is a condition where a child has never achieved nighttime dryness by the age of 5 or 6 years 2.
- It affects around 15-20% of five year olds, and up to 2% of young adults 2.
- The condition can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms, with MEN occurring without any other symptoms of bladder dysfunction 3.
Treatment Options for Primary Nocturnal Enuresis
- Simple behavioural methods, such as reward systems, lifting, and waking, may be effective for some children 2.
- Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of abnormalities such as excessive nocturnal urine production, poor sleep arousal, and/or reduced bladder capacity 4.
- Desmopressin has been shown to be effective in treating primary nocturnal enuresis, with a minimum dosage of 25 μg orally disintegrating sublingual desmopressin appearing to be ideal for women, whereas men usually benefit from a minimum of 50 μg 5.
- A study comparing observation, imipramine, desmopressin acetate, and bed-wetting alarm systems found that alarm therapy demonstrated persistent effectiveness in treating primary nocturnal enuresis 6.
Management of Primary Nocturnal Enuresis in 10-Year-Old Children
- A careful clinical history is fundamental to the evaluation of enuresis in children, including a medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine 3.
- Urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN, and instructions about therapeutic strategies is the mainstay of treatment 3.
- Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis, and may require anticholinergic drugs in addition to urotherapy 3.