Management of nocturnal enuresis - myths and facts

Table 1 Lower urinary tract symptoms

Consistently increased (≥ 8 times/d) or decreased ( ≤ 3 times/d) voiding frequency

Daytime incontinence

Urgency

Hesitancy

Straining (application of abdominal pressure to initiate and maintain voiding)

A weak stream

Intermittency (micturition occurs in several discrete spurts)

Holding maneuvers (strategies used to postpone voiding)

A feeling of incomplete emptying

Post-micturition dribbling

Genital or lower urinary tract pain

Table 2 Common sense approaches for the management of uncomplicated monosymptomatic nocturnal enuresis[39,40]

What to do	How to do	How it works
Educate parents about	High prevalence of enuresis	Reduce their guilt
	Relatively high spontaneous cure rate	Encourage hope
	Non-volitional nature of the symptom	Avoid a punitive response or the development of a control struggle
Encourage child	Keeping of a journal	Raises awareness in the child
	Keeping a dry bed chart
	Changing the wet bed
Maintain voiding diary record	Daytime diary used to: Measurement of maximum voiding volume (excluding the first morning void); over a minimum of 3-4 d for accuracy; measurement on weekends or school holidays are ideal	Assess the child’s bladder capacity
	Bedwetting diary completed for seven consecutive days/nights	Assess for the presence of nocturnal polyuria
Fluid intake regulation	Decrease fluids especially caffeinated beverages, before bedtime. Ensuring adequate fluid consumption in the morning and afternoon and avoiding excessive fluid during evening	Decrease nocturnal urine production