Nocturnal enuresis

Nocturnal enuresis treatment for children under 5

None - should resolve without intervention

Treatment for nocturnal enuresis

Advice on fluid intake, diet, toileting behaviour & use of reward system → enuresis alarm → add in/replace with desmopressin

When should enuresis alarm be reviewed & how long to continue

Review alarm after 4 weeks. Continue until minimum 2 weeks of uninterrupted dry nights.

Drug treatment for nocturnal enuresis

Desmopressin (over 5 years) → (Specialist) desmopressin +/- antimuscarinic (oxybutynin or tolterodine) → imipramine

Minimum age for desmopressin

Over 5 years

When to initiate desmopressin for nocturnal enuresis

If alarm is undesirable or rapid results needed (e.g. to cover holidays)

Assessing & reviewing desmopressin

Assess treatment after 4 weeks; continue for 3 months of responding. Repeated courses should be withdrawn gradually at regular intervals to prevent dependence.

Electrolyte imbalance side effect of desmopressin

Hyponatraemia