Enuresis

What is primary enuresis?

never free from bed-wetting

What is secondary enuresis?

starting bed-wetting after development of control

How is primary enuresis distinguished from secondary enuresis?

Absence vs. loss of previously established bladder control

What hormonal imbalance is associated with enuresis?

Low antidiuretic hormone (ADH) levels

How do developmental delays contribute to enuresis?

Delay in achieving bladder control

What risk factors contribute to enuresis?

• family hx

• bladder disorders

• males

• emotional factors

• genetic or developmental delays

• low levels of ADH

• stress

Why should underlying conditions be evaluated in enuresis?

May be linked to infections or metabolic disorders

How does increased evening fluid intake affect enuresis?

Raises likelihood of nighttime episodes

Findings associated with enuresis?

• chronic/acute infections (UTI, diabetes)

• family hx

• increased fluid intake in evening

What bedtime habit helps reduce nighttime incidents?

Emptying the bladder before sleep

Why should fluids be limited before bedtime in enuresis management?

Decreases nighttime urine production

How do caffeine and carbonated beverages affect enuresis?

Increase bladder stimulation

Why is positive reinforcement preferred over punishment?

Encourages behavioral improvement without emotional harm

How can environmental adjustments support children with enuresis?

Improve nighttime accessibility and comfort

What is the purpose of scheduled nighttime waking?

Promotes regular voiding patterns

Why is assessing emotional well-being important in enuresis care?

Identifies stress-related contributors

How can involving the child in care planning improve outcomes?

Increases cooperation and adherence

What support options may benefit children with persistent enuresis?

Counseling or support groups

What is the mechanism of desmopressin acetate (DDAVP)?

Reduces urine production

When should desmopressin be administered?

At bedtime

What age restriction applies to desmopressin use?

Not for children under 6

How do tricyclic antidepressants help with enuresis?

Suppress urination

What an example of tricyclic antidepressant?

imipramine hydrochloride (Tofranil)

What is the typical duration of tricyclic therapy before tapering?

6 to 8 weeks

When should imipramine be given for enuresis?`

About 1 hour before bedtime

What safety concern is associated with tricyclic antidepressants in children?

Risk of suicidal ideation

What precaution is necessary regarding sun exposure with tricyclics?

Avoid excessive sun

Why should OTC medications be used cautiously with tricyclics?

Risk of interactions

How do anticholinergics like oxybutynin help manage enuresis?

Reduce bladder contractions

What age restriction applies to anticholinergic use?

Not for children under 5

What’s an example of an anticholinergic?

oxybutynin chloride (Ditropan)