ParasomniaEnuresisSleep Disorders of Pediatrics and Special Populations

Professor: John Murray

Student: Felix Alonzo

School: Northern Essex Community College

Table of Content

• Definition

• Etiology, Causes

• Evaluation

• Treatment

• Age related treatment

Table of Content (continue(

•Stats

•Age Stats Graph

•Gender Stats Graph

•Conclusion

•Reference

Definition

•Enuresis: The involuntary release of urine from

the bladder. Nocturnal enuresis refers to wetting

the bed during sleep. This usually occurs during

stage N3 in the first third of the night.

Etiology, Causes

•Anatomic problems

•Diabetes insipidus

•Diabetes mellitus

•Endocrine dysfunction

•Child abuse

•Drinking habits

Etiology, Causes (continue(

•Urinary tract infection

•Spinal cord abnormalities with associated neurogenic

bladder

•Ectopic ureter in females

•Posterior urethral valves in males

•Psychiatric symptoms

Evaluation

• History: check family history of enuresis, check patient

sleeping patterns, check patterns of when the patient wets

the bed, patient medical condition, does the patient

urinate during the day, how often the patient uses the

bathroom during the day.

Evaluation (continue(

• Physical Examination: Perform a complete

examination, focus on the urogenital, neurologic and

gastrointestinal system. Palpate bladder, look for signs

of sexual abuse, look for signs of mouth breathing

because it might indicate sleep apnea, it might indicate

hypertrophy.

Evaluation (continue(

•Laboratory/Imaging Studies: Have urinalysis of a clean

catch midstream urine specimen done on the patient, to

rule out diabetes or diabetes mellitus. Urine culture to

see if there is a urinary tract infection.

Treatment

• Patient needs to be willing to get treatment or be

motivated, and acceptance.

• Support from family is important.

• Generate a treatment plan that fits the patient age group.

• Building the patient self-esteem.

• Develop a copying mechanism.

Treatment (continue(

•Pharmacotherapy: Drugs used to treat enuresis, for

example, Imipramine, Desmopressin (DDAVP), and

Oxybutynin.

Treatment (continue(

•Imipramine: Tricyclic antidepressant that’s used for

treatment of enuresis.

•DDAVP: Synthetic analog of arginine vasopressin, it

increases water reabsorption.

•Oxybutynin: Anticholinergic and antispasmodic drug

that has a role in reducing uninhibited bladder

contractions.

Treatment (continue(

• Behavioral Therapy: The use of an alarm system to

wake the patient up at a specific time. Hypnotherapy

maybe implemented, teaching patient and family.

• Motivational Therapy: Educating family about enuresis,

giving printed handouts with instructions on how to

manage the condition. Positive reinforcement, rewards.

Age related treatments

•Younger than age 8: Two important things with this age

group are, reassurance and education.

•Ages 8 through 11: Using the alarm system would work

best for this age group, and also medication.

•Ages 12 and older: Aggressive intervention is necessary,

the alarm system and or medication.

STATS

•15% of children still wet the bed at age 5

•7 to 10% of children still wet the bed at age 7

•3% of boys and 2% of girls still wet the bed at age 10

•1% of boys and very few girls still wet the bed at age 18

Age Stats Graph

Gender Stats Graph

Conclusion

Enuresis or bedwetting can have a big impact on every

aspect of that person life. One must learn to identify the

problem and treat it appropriately according to the age

group. The most effective way to treat enuresis is probably

the alarm system and with medication.

Reference

Works Cited

Michael R. Lawless, M. a. (2001). Nocturnal Enuresis: Current

Concepts. Article Urology , 22 (12), 399-406.

Pack, M. a. (2007). Pediatric Parasomnias. Sleep , 30 (2), 147-148.

Vicent Iannelli, M. (2008, 11 24). Bedwetting-Bedwetting Statistics.

Retrieved 2 13, 2014, from About.com Pediatrics:

http://pediatrics.about.com/od/bedwetting/a/1108_bedwetting.htm?p=1