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Charting Pediatrics

May 17, 2018

In this episode, we discuss the management of and treatments for nocturnal enuresis, nighttime bedwetting. Joining us is pediatric urology nurse practitioner, Marguerite Korber, NP, who runs many of the enuresis clinics at Children's Colorado.

In this episode:

  • At age 5, the primary care physician should make a formal diagnosis of nighttime wetting and give the family a proactive, therapeutic treatment plan.
  • It's recommended that families come to a urology specialist or enuresis clinic around age 7
  • The reasons for bedwetting may differ according to whether patient has primary or secondary nocturnal enuresis.
  • Before making a referral to urology, primary care physicians can perform an initial workup, evaluating:
    • If the child is ready to become potty-trained and, therefore, dry at night
    • Functional bladder capacity to see if nocturnal enuresis has anything to do with diabetes or UTI concerns
    • If their bladder is releasing earlier than it should and/or doesn't have the appropriate, expected capacity
  • Despite the parents' frustration, until the child is affected by their nighttime bedwetting, initiating them to be responsible for some of their behavioral modifications during the day will be difficult.
  • The important aspects to focus on in a physical exam are the abdominal exam, lumbar spine evaluation, neurologic evaluation and urethral opening evaluation.
  • Constipation plays a large role in nocturnal enuresis.
    • The abdominal exam will tell you whether or not constipation is a contributing factor, specifically in that descending colon. "If you can palpate stool, then you know that it's probably sitting in the rectum as well."
  • The urethral opening tends to be more of an issue for boys specifically.
  • Bedwetting enuresis management options include behavioral therapy, fluid shifting and addressing constipation.
  • How to effectively implement the use of alarm therapy as a bedtime wetting management option – and what parents need to know up front.
  • What criteria allows for using Desmopressin, a DDAVP, as the right option when pursuing pharmacologic therapy
  • Options for managing chronic nocturnal enuresis:
    • By changing any dysfunctional voiding components to their day time habits, patients will be better prepared for the natural progression of the night time to occur.
  • Providers need to provide alternative treatments for patients when cost is a barrier to care, such as with a bed alarm.
    • Pull-ups can be a cost effective solution to involuntary nighttime bed wetting.
  • Oftentimes with nocturnal enuresis, it's necessary to treat the whole family, helping parents to manage their frustration.