When should absorbent products be used at night if nocturnal enuresis (bedwetting) starts?

Management of Nocturnal Enuresis: When to Use Absorbent Products

Absorbent products should be introduced immediately when bedwetting episodes begin to preserve dignity, quality of sleep, and prevent skin complications, while continuing to pursue definitive treatments for the underlying condition.

Assessment of Nocturnal Enuresis

When evaluating a patient with nocturnal enuresis who is experiencing "quarter-sized leaks" that may progress to full bedwetting episodes, consider:

• Documentation of episodes: Keep a calendar of wet and dry nights to establish a baseline and monitor treatment effectiveness 1
• Frequency-volume chart: Measure fluid intake and voided volume for at least 2 days, documenting enuresis episodes for at least 1 week 1, 2
• Nocturnal urine production: Consider weighing absorbent products to assess the volume of nocturnal urine production 1, 2

When to Implement Absorbent Products

Immediate Implementation Indications:

• When any bedwetting begins (even with small leaks)
• When sleep quality is affected
• When there is risk of skin irritation or breakdown
• When the condition causes psychological distress

Product Selection Algorithm:

1. For initial/small leaks (quarter-sized):

   • Small absorbent pads or underwear liners
   • Position strategically based on leak location

2. For moderate-heavy incontinence:

   • For men: Disposable diapers are most cost-effective for both day and night use 3
   • For women: Disposable pull-ups are preferred but more expensive; disposable inserts are a cost-effective alternative 3
   • For nighttime only: Some men may prefer washable diapers at night as they are the least expensive option 3

Concurrent Management Strategies

While using absorbent products, simultaneously implement:

Behavioral Interventions:

• Regular voiding schedule (morning, at least twice during the day, after work/school, dinner time, and bedtime) 1
• Minimize evening fluid and solute intake 1, 2
• Encourage liberal water intake during morning and early afternoon 1
• Treat any constipation if present 1
• Maintain proper voiding posture to relax pelvic floor muscles 1

Pharmacological Options (if appropriate):

• Desmopressin: Consider for patients with nocturnal polyuria and normal bladder capacity 1, 2
  • Response rates: 30% full response, 40% partial response 2
  • Caution: Risk of water intoxication with excessive fluid intake 2

Alarm Systems:

• Enuresis alarms have higher long-term success rates and lower relapse rates than medications 4
• Most effective for motivated individuals who can comply with the regimen 2

Important Considerations

• Psychological impact: Using absorbent products can preserve dignity and reduce anxiety while working on definitive treatment 2
• Skin care: Regular changes of absorbent products and proper skin hygiene are essential to prevent irritation 3
• Combination approach: Different product designs may be needed for day/night or different activities 3
• Reassurance: Emphasize that bedwetting is not the fault of the patient 1

Monitoring and Follow-up

• Regular assessment of skin condition under absorbent products
• Monthly follow-up to sustain motivation and adjust treatment plan 1
• Evaluation of treatment response using the calendar of wet/dry nights
• Consideration of alternative or additional treatments if no improvement after 2-3 months

Remember that absorbent products are not a definitive treatment but rather a management strategy to maintain quality of life while pursuing treatments for the underlying condition. They should be used as part of a comprehensive approach to nocturnal enuresis.