- positive family history - institutionalization or low socioeconomic status - reduced functional bladder capacity (small bladder) - delayed or lax toilet training - constipation - psychological factors or developmental delay - circadian rhythm abnormality
Monitoring bedwetting symptoms:
- # of nights/week - # of times/night - amt of urine - waking up after bedwetting
1st step tx:
- education and counseling - adequate fluid intake - appropriate diet - toileting patterns - reward for following above
2nd step tx:
Enuresis alarm - wakes child at first sign of wetness
How soon should enuresis alarm therapy be assessed?
by 4 weeks
3rd step tx:
Desmopressin +/- enuresis alarm
How soon is complete dryness usually seen after initiating desmopressin +/- enuresis alarm? and how long should therapy last?
1-2 weeks continue therapy for 3-6 months, then stop, assess, and repeat 3 month course if needed
4th step tx:
Desmopressin + anticholinergic agent (oxybutynin) x 3 months --> reassess