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    Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Ebook198 pages1 hour

    Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

    By Kenneth Kee

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    About this ebook

    Nocturnal enuresis (NE) is when a child after age 5 or 6 wets the bed at night, more than twice a week.
    It affects boys more than girls and has a prevalence of 15%.
    There are 2 types of Nocturnal enuresis:
    1. Primary enuresis.
    Children who have never been consistently dry at night for more than 6 months.
    This most often happens when the body makes more urine at night than what the bladder can retain, and the child does not wake up when the bladder is full.
    The child's brain has not learned to respond to the signal that the bladder is full.
    This is the most frequent reason for nocturnal enuresis.
    This is the recurrent involuntary passage of urine during sleep by a child aged 5 years or older, who has never achieved consistent night-time dryness.
    This may further be subdivided into:
    a. Primary nocturnal enuresis without daytime symptoms: children who have enuresis only at night.
    b. Primary nocturnal enuresis with daytime symptoms: those who also have daytime symptoms, such as urgency, frequency, or daytime wetting.
    2. Secondary enuresis.
    Secondary enuresis indicates children who were dry for at least 6 months, but start nocturnal enuresis again.
    There are many reasons that children wet the bed after being fully toilet trained.
    It might be physical, emotional, or just a change in sleep.
    The cause of nocturnal enuresis is believed to be multi-factoral and that include:
    Genetic Causes
    Psychological Causes
    1.Nocturnal polyuria
    2.Small functional bladder capacity
    3.Detrusor instability
    4.Disorder of sleep arousal
    5.Delay in maturation
    6.Global maturation delay
    Social Causes
    Symptoms:
    Frequency
    Urgency
    Daytime wetting.
    Difficulty with poor stream.
    Pain on urination
    The doctor should assess for underlying cause:
    1.Constipation.
    2.UTI.
    3.Diabetes mellitus.
    4.Behavioral and emotional difficulties.
    5.Child maltreatment
    Diagnosis:
    The doctor should investigate (and treat) daytime symptoms before addressing enuresis - e.g., symptoms suggestive of diabetes, UTIs or constipation.
    The doctor should consider asking parents to keep a diary of the child's nocturnal enuresis patterns, daytime symptoms, toileting pattern and fluid intake
    A child should have a physical exam and a urine test to rule out urinary tract infection or other causes.
    No further investigations are needed if urinalysis is normal.
    Nocturnal enuresis can be very distressing, especially for older children.
    It may lead to social isolation, bullying and low self-esteem
    Conservative therapies
    1.Explanation and reassurance
    2.Advise children to avoid caffeine-containing drinks before bedtime.
    3.Manage constipation
    Simple behavioral therapies:
    More children become dry when given rewards
    If the child wakes at night, encourage them to use the toilet before returning to sleep
    Urotherapy involves:
    1.Timed voiding
    2.Advice on good hydration
    3.Reduction in diuretic fluids
    4.Avoiding fluid intake before sleep
    5.Emptying the bladder before sleep
    Constipation should be treated
    Enuresis alarms:
    It serves as a conditioning device using a noise to link the stimulus of a full bladder
    Treatment is continued for 3-4 months and stopped when the child has remained dry for a consecutive three weeks
    Desmopressin
    Desmopressin should be given first-line to children over 7 years of age when rapid control is required
    Otherwise it should be used second-line after an alarm has been tried.
    Tricyclics antidepressant is effective at reducing the number of wet nights during treatment
    Imipramine is approved for use in treating nocturnal enuresis in children aged 6 years and above but is reserved for treating resistant cases
    Combination therapy with anticholinergic treatment increases the efficacy of treatment.

    TABLE OF CONTENT
    Introductio

    LanguageEnglish
    PublisherKenneth Kee
    Release dateSep 8, 2017
    ISBN9781370787487
    Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Author

    Kenneth Kee

    Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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      Book preview

      Nocturnal Enuresis, (Night Urination) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee

      Nocturnal Enuresis,

      (Night Urination)

      A

      Simple

      Guide

      To

      The Condition,

      Diagnosis,

      Treatment

      And

      Related Conditions

      By

      Dr Kenneth Kee

      M.B.,B.S. (Singapore)

      Ph.D (Healthcare Administration)

      Copyright Kenneth Kee 2017 Smashwords Edition

      Published by Kenneth Kee at Smashwords.com

      Dedication

      This book is dedicated

      To my wife Dorothy

      And my children

      Carolyn, Grace

      And Kelvin

      This book describes Nocturnal Enuresis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

      (What The patient Need to Treat Nocturnal Enuresis)

      This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If the patient would like to share this book with another person, please purchase an additional copy for each reader.

      If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

      Thank you for respecting the hard work of this author.

      Introduction

      I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

      My purpose in writing these simple guides was for the health education of my patients.

      Health Education was also my dissertation for my Ph.D (Healthcare Administration).

      I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

      This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

      From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

      Some people have complained that the simple guides are too simple.

      For their information they are made simple in order to educate the patients.

      The later books go into more details of medical disorders.

      The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

      Since 2013, I have tried to improve my spelling and writing.

      As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

      Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

      I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

      I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

      I apologize if these repetitions are irritating to some readers.

      Chapter 1

      Nocturnal Enuresis

      What is Nocturnal enuresis?

      Nocturnal enuresis (NE) is when a child urinates after age 5 or 6 wets the bed at night, more than twice a week.

      It affects boys more than girls and has a prevalence of 15%.

      There are 2 types of Nocturnal enuresis:

      1. Primary enuresis.

      Children who have never been consistently dry at night for more than 6 months.

      This most often happens when the body makes more urine at night than what the bladder can retain, and the child does not wake up when the bladder is full.

      The child's brain has not learned to respond to the signal that the bladder is full.

      It is not the child's or the parent's fault.

      This is the most frequent reason for nocturnal enuresis.

      This is the recurrent involuntary passage of urine during sleep by a child aged 5 years or older, who has never achieved consistent night-time dryness.

      This may further be subdivided into:

      a. Primary nocturnal enuresis without daytime symptoms: children who have enuresis only at night.

      b. Primary nocturnal enuresis with daytime symptoms: those who also have daytime symptoms, such as urgency, frequency, or daytime wetting.

      2. Secondary enuresis.

      Secondary enuresis indicates children who were dry for at least 6 months, but start nocturnal enuresis again.

      There are many reasons that children wet the bed after being fully toilet trained.

      It might be physical, emotional, or just a change in sleep.

      This is less common, but still not the fault of the child or parent.

      Between the ages of 5-18 years, 15% of children become dry each year without treatment.

      This is the involuntary passage of urine during sleep by a child who has previously been dry for at least six months.

      Primary enuresis most often indicates developmental delay which recovers in time.

      In secondary enuresis the patient regresses after a period of continence, which requires the exclusion of underlying pathology - e.g., a urinary infection.

      The great majority of children have primary nocturnal enuresis 80%.

      It is considered normal up to the age of 5 years, and is common up to the age of 10 years.

      Children with nocturnal enuresis may have too much nocturnal urine production, poor sleep wakening and reduced bladder capacity.

      Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine.

      Incidence is reported:

      1. 8-20% of 5-year-olds.

      2. 1.5-10% of 10-year-olds.

      3. 0.5-2% of adults.

      2.6% of children aged 7½ years wet their bed on two or more nights a week.

      What are the causes of Nocturnal enuresis?

      Causes

      The last stage of toilet training is staying dry at night.

      To stay dry at night, the child's brain and bladder must work together so the child wakes up to go to the bathroom.

      Some children form this capability later than others.

      Bedwetting is very frequent.

      Millions of children in the U.S.A wet the bed at night.

      Some children still wet the bed at age 7, or even older.

      While the disorder normally goes away over time, many children, and even a small number of adults, continue to have nocturnal enuresis episodes.

      The cause of nocturnal enuresis is believed to be multi-factoral and that include:

      Genetic Causes:

      Nocturnal enuresis also runs in families.

      Parents who wet the bed as children are more likely to have children who wet the bed.

      Up to 75% of affected children have an affected first degree relative.

      The possibility of NE in a child with one affected parent is up to 44% and 68% with parents being affected.

      Linked genetic loci have been identified on chromosomes 8q, 12q, 13q, and 22q11.

      Psychological Causes:

      Psychological factors that have a role to play in the pathogenesis of NE are:

      1. Nocturnal polyuria - Involved children have been discovered to have low overnight vasopressin levels, and excessive production of dilute urine during the night.

      2. Small functional bladder capacity - There may be a low nocturnal bladder capacity and an overactive bladder.

      Emptying reflexes are not inhibited during sleep.

      3. Detrusor instability

      4. A disorder of sleep arousal: The child is not wakened by the sensation of a full bladder.

      5. Delay in maturation of bladder capacity at night

      6. Global maturation delay

      There is increasing evidence that all these mechanisms can be due to an underlying brainstem disturbance of the locus coeruleus.

      Obstructive sleep apnea may have a contributing role to play in NE.

      Constipation may be an additional aggravating condition.

      Social Causes:

      A child above the age of 5 years with the problem of NE may affect the child’s normal social development and school work.

      While less frequent, physical causes of nocturnal enuresis may include:

      1. Lower spinal cord lesions

      2. Birth defects of the genitourinary tract

      3. Urinary tract infections

      4. Diabetes

      5. Self-care at Home

      There may be neurological disorders such as spina bifida or cerebral palsy.

      Those with physical disorders are more likely to have daytime enuresis or trouble with encopresis.

      Physical disorders are a rare cause of nocturnal enuresis by themselves.

      Stresses in the child's life, such as an admission to hospital with separation from the mother, or bullying, tend more likely to cause secondary enuresis.

      The older the child, the more likely it is that psychological disorders are the result of enuresis and not the cause.

      Risk factors

      There are a number of factors that predispose to persistent nocturnal enuresis.

      1. More frequent in males.

      2. More likely to persist if nocturnal enuresis is frequent.

      3. Frequent association with daytime incontinence, fecal incontinence and constipation.

      4. Association with delay in gaining daytime bladder control.

      5. Family history. There is a strong link with parental history of enuresis.

      6. Associated with sleep apnea and upper airway obstructive symptoms (present in 30% of children with sleep-disordered breathing).

      7. More frequent in obese children (present in 30% of obese children).

      Enuresis is believed to be a presentation of developmental delay, in those with global developmental delay, with or without a linked syndrome such as Down's syndrome.

      Even without gross developmental delay, there tends to be continuous nocturnal enuresis in children with delayed developmental milestones, premature delivery or behavioral disorders such as hyperactivity or inattention deficits and autism spectrum disorders.

      What are the symptoms of NE?

      A detailed history to establish the pattern of enuresis is important in the initial evaluation.

      It is important to assess for any co-existent daytime enuresis and associated urinary complaints such as urgency, frequency or incontinence.

      Other salient points are history of constipation or

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