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Key Features

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  • Defined as repeated urination into the clothing during the day and into the bed at night by a child who is chronologically and developmentally older than 5 years

  • Must occur at least twice a week for 3 months

  • Has been categorized by the International Children's Continence Society as monosymptomatic or non-monosymptomatic

    • Monosymptomatic enuresis is uncomplicated nocturnal enuresis (NE; must never have been dry at night for over 6 months with no daytime accidents); it is a reflection of a maturational disorder and there is no underlying organic problem

    • Complicated or non-monosymptomatic enuresis often involves NE and daytime incontinence and often reflects an underlying disorder

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Clinical Findings

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  • Child does not achieve urine continence by 5–6 years of age and generally has no underlying pathology to which the incontinence can be attributed

  • Child does not respond to a full bladder or rectum

  • More common in boys than in girls

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Diagnosis

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  • Involves a complete history and physical examination to rule out any anatomic abnormalities or underlying pathology

  • Urinalysis should be obtained, including a specific gravity

  • Urine culture should be obtained, especially in girls

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Treatment

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  • Involves education and the avoidance of being judgmental and shaming the child

  • A variety of behavioral strategies have been used such as limiting liquids before sleep and waking the child at night so that he or she can go to the toilet

  • If this simple approach is unsuccessful, the use of bedwetting alarms is suggested

    • A form of cognitive-behavioral therapy

    • Has been found to cure two-thirds of affected children

  • Desmopressin acetate (DDAVP), an antidiuretic hormone analog

    • Has been used successfully when nonpharmacologic strategies fail

    • Decreases urine production

  • Imipramine, a tricyclic antidepressant, also has been used successfully but should be used only as last resort due to risk of death from overdose

  • When such medications are stopped, there is a very high relapse rate

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