Management of nocturnal enuresis - myths and facts

Abstract

Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.

Brazilian consensus in enuresis–recomendations for clinical practice

“…Its administration is orally and should be taken one hour prior to bedtime and about 2 hours after dinner. It is recommended to start with a low dose of 0.1 to 0.2mg and adjust, when necessary, up to a maximum dose of 0.6mg/day, regardless of age or weight (48). One hour before taking the medication, children should stop fluid intake in order to avoid risk of hyponatremia and water intoxication, as well as obtain an optimal urine concentrating capacity (49).…”

“…Initial treatment should be maintained for 2 to 4 weeks in order to obtain maximum effect and if there is improvement in the number of dry night it should be continued for at least 3 more months. If the child is dry, withdrawn of the medication may be done gradually, which seems to reduce relapse (48, 49). In cases when symptoms worsen after beginning medication withdraw, dose should be increased again and treatment maintained for three more months.…”

Understanding of and misconceptions around monosymptomatic nocturnal enuresis: findings from patient and physician surveys

“…Decreased bladder capacity at night or bladder overactivity also plays an important pathophysiological role in a subgroup of children with MNE [9]. Although psychiatric disorders are often observed concomitantly, there is no evidence that they contribute to enuresis [10]. The current view is that persistent enuresis may cause psychological dysfunction related to a child's low selfesteem and disturbances within family [11,12].…”

Effects of Medicinal Plants on Nocturia: A Systematic Review

“…Because this disease is multifactorial, single drug therapies are not sufficiently efficacious [8]. Therefore, nocturia is treated by multiple treatments including improvement of lifestyle, chemical drugs, alpha-blockers, antimuscarinic agents, antidiuretic therapy, and surgery [9].The treatments for night time urination mainly include urotherapy and different drugs such as desmopressin, imipramine, and anticholinergic drugs as well as behavioral therapies [10,11]. However, these treatments should be promoted [10].…”