This document discusses enuresis, or bedwetting, in children and adolescents. It defines enuresis as the involuntary release of urine during sleep, usually during the first third of the night. The document outlines the causes of enuresis including anatomical, endocrine, psychiatric, and sleep issues. It describes how enuresis should be evaluated through history, physical exam, and testing. Treatment options are also discussed including behavioral therapies, medication, and age-appropriate approaches. Statistics on the prevalence of bedwetting at various ages are presented in both paragraph and graph form. The conclusion emphasizes that enuresis can impact a person's life and should be properly diagnosed and treated based on their age.

1. Parasomnia
Enuresis
Sleep Disorders of Pediatrics and Special Populations
Professor: John Murray
Student: Felix Alonzo
School: Northern Essex Community College

2. Table of Content
• Definition
• Etiology, Causes
• Evaluation
• Treatment
• Age related treatment

3. (Table of Content (continue
Stats •
Age Stats Graph •
Gender Stats Graph •
Conclusion •
Reference •

4. 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

5. Etiology, Causes
Anatomic problems •
Diabetes insipidus •
Diabetes mellitus •
Endocrine dysfunction •
Child abuse •
Drinking habits •

6. (Etiology, Causes (continue
Urinary tract infection •
Spinal cord abnormalities with associated neurogenic •
bladder
Ectopic ureter in females •
Posterior urethral valves in males •
Psychiatric symptoms •

7. 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.

8. (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.

9. (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

10. 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.

11. (Treatment (continue
Pharmacotherapy: Drugs used to treat enuresis, for •
example, Imipramine, Desmopressin (DDAVP), and
.Oxybutynin

12. (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

13. (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.

14. 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

15. STATS
of children still wet the bed at age 5 15% •
to 10% of children still wet the bed at age 7 7 •
of boys and 2% of girls still wet the bed at age 10 3% •
of boys and very few girls still wet the bed at age 18 1% •

16. Age Stats Graph

17. Gender Stats Graph

18. 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.

19. 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