Nocturnal Enuresis

Involuntary urination during sleep - common in children

Non-drug treatment for nocturnal enuresis.

Advice on:

• fluid intake

• diet

• toileting behaviour

• use of reward systems

If more than 1–2 wet beds per week despite above advice, use an enuresis alarm.

• Assess maturity for alarm use in < 7 years

• Assess response after 3 months and continue only if improvement has been seen.

What is the age cut off for drug treatment?

Children over 5 years - under 5 should resolve symptoms without intervention.

What is first line treatment for nocturnal enuresis?

Oral / sublingual desmopressin

• To be used as alone or as add on treatment in those with partial response to alarm

• Can also be used if rapid-onset is a priority e.g. holidays

Assess response after 4 weeks and continue for 3 months if there are signs of response.

What can be added on if there is not enough response with desmopressin?

An antimuscarinic (e.g. oxybutynin hydrochloride, tolterodine tartrate) + desmopressin

If all other treatments do not work, what else can be used? (third line)

The tricyclic antidepressant, imipramine

When is desmopressin contraindicated?

• History of hyponatraemia

• Diuretic use

• Over 65 years - increased risk of hyponatraemia and renal impairment

What are the side effects of desmopressin?

Fluid retention and hyponatraemia which can cause:

• headaches

• nausea

• convulsions

What are some counselling points in regards to fluid intake whilst on desmopressin?

• Drink only to satisfy thirst in 1-2 hours before sleeping

• Avoid drinking 8 hours after dose

What are some drug interactions with desmopressin?

Other drugs that cause hyponatraemia:

• SSRIs

• Carbamazepine

• Diuretics