Boorman Nocturnal enuresis is Intermittent incontinence of urine when sleepingNice 2010 in a child at least 5 years old Primary never or only very occasionally dry Secondary have been dry for 6 months previously ID: 912398
Download Presentation The PPT/PDF document "Nocturnal Enuresis Fiona" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Nocturnal EnuresisFiona Boorman
Slide2Nocturnal enuresis is........‘Intermittent incontinence of urine when sleeping....(Nice 2010) in a child at least 5 years old’
Primary –never or only very occasionally dry.
Secondary- have been dry for 6 months previously.
Slide3Prevalence (Approx.)
Age
Girls
Boys
5 years
5%
10%
7 years
3.5%
7%
9 years
1%
2%
19 years
0.7%
1.5%
Slide4Causes and resolutionCommon problem
More common in boys
Can run in families, if both parents were, risk is about 75%, if one parent was, 40% chance.
Evidence suggests if we did not treat it, it would slowly resolve until about 1% of pop. who continue, but usually develop ways of managing it.
Slide5Why treat?
For child Self esteem,’
i’m
the only one!’
fear of discovery, avoid sleep
overs
sibling cruelty, parent assigning blame
For parent Shame, embarrassment, thinks child is lazy, may punish them laundry costs, mattress damage, extra work worried about holidays failure, can’t fix it, blame selves.
Slide6What is tried before seeking help?Lifting
Restricting fluids
Rewarding dry beds
Pull ups
Chastisement
Slide7Reasons for bedwetting
1 .Lack of Vasopressin (posterior pituitary)
due to genetics-delayed production
body drought in day- used it up
lights/screens on at night
symptoms- big patch
/patches of dilute wee -not so smelly
Slide8Reasons 2Poor arousal during sleep (sleeps through)
deep sleeper (
except wee in peak not trough of circadian rhythm
)
poor quality of sleep (yawns in day) PS2, screens, phone checking, short nights?
worrier
Slide9Reasons 3
Over active bladder (OAB)
will have daytime symptoms too
frequency and/or urgency
Most common cause is strong urine,
due to poor drinking (less than 6 good) poorly spread over day (try 50% early) wrong drinks- dark fruit, caffeine, fizz,?orangeNight wets are frequent and small, may smell strong.
Slide10Reasons 4 plus
Other reasons- UTI (
diptest
-treat)
Bladder issues (Neuropathic)
Poorly controlled T1 Diabetes
Add. Problems eg. ADHD, behaviour hypermobility CONSTIPATION Biggest cause of delayed or compromised continence.
Slide11Full assessment
Always complete proper assessment (sample document on ERIC.org.uk professionals)
www.eric.org.uk/pdf-continence-assessment-form
Documents from family
-
Poo
chart- 2 weeks of stool type/frequency, any soiling?
- Fluid type and amount in/out for 3 days If CONSTIPATED treat first.Good assessment, leads to treatment options
Slide12NICE Guidelines 111 (2010 UK)Dont
exclude children under 7
Inform parents- not
childs’
fault.
Patient centred care.
Alarm treatment first choice (most efficacy)
Choice of treatment based on age/frequency of problem, type/motivation of child and needs of family.
Slide13Pre-treatment
Address drinking pattern, type and amounts
6-8 of 150-300mls, more in early part of day, last one 90
mins
before bed (ice cube if need)
Bedding, ‘Brolly sheet’- not
pullup
, water-resistant quilt cover or cheap duvet.Screen ban, lighting, bottom bunk Good wee before final settle (double void?) Boys sitting wee.Reward compliance and drinking
Slide14Bedwetting Alarm
Improves arousal to full bladder
Assess
childs
motivation, not parents!
Leave sign in bathroom to achieve reward if responding to alarm or to body signals
No harm, unless troubled family,
or anxious child. Shared bedroom.
Types of alarm, how to make louder......
Parents guide for 1st few nights.Wear for 1 month after last wet.
Slide15Desmopressin
Tab 200 or 400mcg
Melts 120 or 240 mcg , no drink needed
Causes kidney to concentrate urine
IMPORTANT- virtually no drink for 1 hr before and 8 hours after, only sip with tablets.
If working -try a few days without every 6-12 weeks to see if still needed. (School holidays)
Works for 1 night only- sleepovers/
residentials
, if D & V or large evening drink, omit.
Most effective for children passing dilute wee in large amounts and familial type N.E.Dont give if drinking still poor in day. Keep records.
Slide16Oxybutynin
Treatment for
OAB, has day symptoms too. To
be seen by specialist nurse or GP as bladder scan needed (to ensure bladder emptying properly) and side affects need discussion.
Dry mouth, skin, eyes. Urine
retention, behaviour, constipation
I prefer short term use.
If poor drinker ,often doesn’t work.
Slide17Combining treatments Any of the three treatments can be used together as they all work in different ways.
These families may need support to manage treatments
.
Other drugs
Amitriptyline
Imipramine
Slide18Other stuff...........Stripping bed from 7 years, re making it from 10?
Snoring/ sleep apnoea
Basic problem analysis
Slide19Secondary Nocturnal EnuresisPreviously dry for >6 /12, then starts wetting
Think Constipation
UTI
Poorer drinking
Poor sleep
Noct
. activities
Slide20More information
Bladder & Bowel UK- Leaflets to download
- Helpline
- online shop
ERIC.org.uk -online information
-leaflets, downloadable.
-helpline Mon-
thurs 10:00-14:00 -online shopNICE clinical guideline 111 (2010)