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Bladder Dysfunction


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Night-Time Enuresis (NE)



Night-time enuresis is discrete episodes of urinary incontinence in children during sleep in children older than age 5



1. Primary Enuresis



Children who have never achieved 6 months of continuously dry nights.


Causes of Primary Enuresis:


• Nocturnal polyuria:

• Increased urine production while asleep due to

• Decreased bladder capacity

• Detrusor overactivity

• Associated sleep arousal disturbances

• Global maturation delay

• Genetics:

- 75% incidence of NE in children when both parents had a history of NE

- 50% when only one parent had history of NE

- 15% when neither parent had a history of NE



2. Secondary Enuresis



Children who previously attained at least 6 months of night-time dryness but who have relapsed


Causes of Secondary Enuresis:


• Diabetes

• Urinary tract abnormalities

• Anatomical abnormalities (tethered cord)

• Constipation

• Psychological disturbances

• New baby

• New school



3. Monosymptomatic Enuresis



The only symptom is night-time bedwetting



Co-morbidities & Differential Diagnosis in Children with NE



• Constipation

• Urinary tract infections (UTI)

• Obstructive sleep apnoea

• Interesting fact: Post adenotonsillectomy: 61% of the children were free of enuresis, 23 % had a decrease in enuresis, 16 % no effect (Basha,2005)

• Overactive bladder (OAB)

• Attention Deficit Hyperactivity disorder (ADHD)



Risk Factors for NE



• Younger age

• Male sex

• Black race

• History of urinary tract infection

• Family history of enuresis

• Obesity

• Low socio-economic status

• Other conditions that may be present:

• Chronic kidney disease

• Diabetes

• Anorexia or other behavioural disorders

• Sickle cell disease

• Hyperthyroidism



Antoinette Jansen van Vuuren



Suite 13, Netcare Pretoria East Hospital, Cnr Garsfontein Road & Netcare Ave, Pretoria East