Question

How will you manage a child with nocturnal enuresis?

Hint:

Behavioral techniques, like bladder training and enuresis alarms, are the first line of treatment for nocturnal enuresis and are often effective before considering medications.

Answer 1

Step 1: Initial Approach to Management.
Management of nocturnal enuresis depends on the underlying cause, age, and severity of symptoms. The approach typically involves non-pharmacological interventions and, if necessary, medications.
Step 2: Non-Pharmacological Management.
(1) Establishing a Routine:
- Encourage the child to use the toilet before bed and reduce fluid intake in the evening to minimize the chance of bedwetting.
(2) Bladder Training:
- Gradually increase the time between bathroom visits during the day to help the child gain better control over their bladder.
(3) Nighttime Awakening:
- Some children benefit from being woken up once or twice during the night to use the bathroom, though this may not work for all children.
(4) Enuresis Alarm:
- Bedwetting alarms are a highly effective treatment that wakes the child when they start to urinate, helping to condition them to wake up before wetting the bed.
Step 3: Pharmacological Management.
(1) Desmopressin (DDAVP):
- A synthetic antidiuretic hormone that reduces urine production during the night. It is typically used in cases where other methods have failed.
(2) Imipramine (Tofranil):
- An antidepressant with anticholinergic properties, which is sometimes used to treat enuresis, though it has more side effects and is less commonly used today.
(3) Oxybutynin:
- Used if there is a bladder storage issue or overactive bladder, which may contribute to enuresis.
Step 4: Addressing Underlying Causes.
(1) Treatment of UTI or Constipation:
- If a UTI or constipation is found, appropriate treatments should be initiated.
(2) Psychological Support:
- If the enuresis is secondary to stress or anxiety, appropriate psychological support and counseling may be needed to address the underlying issue.
(3) Diabetes Management:
- If diabetes is diagnosed, proper glycemic control is essential.
Step 5: Long-Term Management and Follow-up.
- Regular follow-up visits should be scheduled to monitor progress, adjust treatment plans, and provide reassurance and support for both the child and family.