What is the included in the initial management of enuresis?

Updated: Mar 26, 2020
  • Author: Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg); Chief Editor: Marc Cendron, MD  more...
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Answer

A positive attitude and motivation to be dry are important components of treatment. Children with enuresis benefit from a caring and patient parental attitude; punishment has no role whatsoever. A positive approach by the physician is also important for instilling confidence and enhancing compliance. Many children have given up on achieving dryness, and an optimistic attitude must be encouraged. Behavioral modification with positive reinforcement may enhance treatment results. Consistent follow-up is important to assess therapeutic results.

An explanation of the probable cause of the enuresis is important for every family. If a child has no daytime symptoms or has experienced significant dry spells in the past, it is unlikely that a structural abnormality is causing the enuresis. This should be explained to the parents to allay any fears about other causes and to reassure them that invasive investigations are not necessary. Parents should be asked to provide specific examples of potential causes that have them worried, so that the physician can address and help relieve these often irrational fears.

Keen attention to a normal daytime voiding pattern is important. The child should be encouraged to void upon awakening, at common transition times and approximately every 1.5-2 hours, before leaving home or school for any reason, and always before bed. With voiding, the child should relax, use optimal posture, and take time to empty the bladder completely.

At school, children should be encouraged to void regularly, at least two or three times daily. A note for the teacher should be written to ensure that the child is allowed regular access to the bathroom. Children should not be expected to wait for scheduled breaks to void. Holding the urine to the last minute must be discouraged.

Children should be instructed to drink liberal amounts during the day and to maintain optimal hydration throughout the entire day. A well-hydrated child is not thirsty when he or she returns home from school and is not thirsty at bedtime. Thirst should be prevented so that a child does not drink excessive amounts in the evening hours before bed. Children who play sports or who are otherwise physically active in the evening after mealtime should be well hydrated for the activity.

Parents should be asked to take the child to the bathroom to void before bedtime. Because this therapeutic measure is designed only to minimize the quantity of fluid in the bladder, full wakefulness is neither necessary nor desirable. Careful monitoring by a parent is necessary for the trip from bed to bathroom and back. Children should go to bed at an hour calculated to offer the optimal number of sleep hours for their age.

If attention to the above preliminary management program for up to 3 months does not result in dryness, then either alarm therapy or pharmacologic therapy should be considered. Because neither therapy has been shown to be consistently superior to the other, the preliminary choice should be dictated by the clinical setting, the family preference, and the experience of the practitioner.


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