From the Guidelines
Nocturnal enuresis in an 8-year-old child is typically caused by a combination of factors, including nocturnal polyuria, detrusor overactivity, and an increased arousal threshold, as well as potential comorbid conditions such as constipation and neuropsychiatric disorders 1. The most common causes of nocturnal enuresis in children include:
- Delayed maturation of bladder control mechanisms
- Developmental delay in the brain-bladder connection
- Reduced bladder capacity
- Excessive nighttime urine production
- Deep sleep patterns that prevent the child from waking when the bladder is full
- Genetic factors, as bedwetting often runs in families Other potential causes include:
- Constipation
- Urinary tract infections
- Diabetes
- Sleep apnea
- Psychological stress It is essential to approach this condition with patience and support, as punishment or shame can worsen the situation. Treatment options should prioritize behavioral modifications, such as limiting fluid intake before bedtime, scheduled bathroom trips, and using a bedwetting alarm, as these have been shown to be effective in managing nocturnal enuresis 1. For persistent cases, medications such as desmopressin (DDAVP) at 0.2-0.6 mg at bedtime may be prescribed to reduce nighttime urine production, although imipramine is sometimes used but has more side effects 1. Medical evaluation is recommended if bedwetting begins suddenly after a period of dryness, is accompanied by daytime accidents, painful urination, unusual thirst, or if there are concerns about the child's overall development. Most children outgrow bedwetting naturally, with approximately 15% of children resolving each year without intervention. A good case history is the cornerstone of the evaluation, and a minimal primary evaluation should make the healthcare provider able to identify the child who has enuresis secondary to underlying medical conditions, identify the child who needs further examinations, identify the child with relevant comorbid conditions, and start adequate first-line treatment after excluding these conditions 1.
From the Research
Causes of Nocturnal Enuresis
The causes of nocturnal enuresis in an 8-year-old child can be attributed to several factors, including:
- Sleep arousal disorder: Children with nocturnal enuresis may have difficulty waking up to the sensation of a full bladder 2, 3.
- Overproduction of urine: Excess urine production during sleep can contribute to nocturnal enuresis 2, 3.
- Small bladder storage capacity: A smaller bladder capacity can increase the likelihood of bedwetting 2.
- Detrusor overactivity: An overactive bladder muscle can lead to involuntary contractions and bedwetting 2.
- Genetic factors: Nocturnal enuresis can be hereditary, with a delay in maturation of the somatic mechanisms that prevent bedwetting 4.
Subtypes of Nocturnal Enuresis
Nocturnal enuresis can be categorized into different subtypes, including:
- Monosymptomatic nocturnal enuresis (MNE): Characterized by nighttime bedwetting without daytime urinary incontinence 2, 5.
- Nonmonosymptomatic nocturnal enuresis (NMNE): Associated with daytime urinary incontinence and other symptoms of bladder dysfunction 2, 5.
- Primary and secondary monosymptomatic nocturnal enuresis: Primary MNE is characterized by a lack of bladder control from an early age, while secondary MNE is characterized by a return to bedwetting after a period of dryness 2.
Evaluation and Treatment
A comprehensive evaluation, including a medical history, physical examination, and urinalysis, is essential to determine the underlying cause of nocturnal enuresis 2, 5, 6. Treatment options may include:
- Behavioral modification: Education on proper bladder and bowel habits, as well as strategies to prevent bedwetting 2, 5.
- Enuresis alarm therapy: A device that alerts the child when they start to urinate, helping to train them to wake up and use the bathroom 2, 5, 6.
- Oral desmopressin: A medication that helps reduce urine production during sleep 2, 5, 6.
- Anticholinergic drugs: Medications that help relax the bladder muscle and reduce contractions 5, 6.