Many professionals consider enuresis a minor disease based on its tendency to spontaneously resolve right individual and family tolerance; however, this is not entirely true.
The treatment, although it is indicated from the age of five, must be individualized. From the prevalence study, with more than 16,000 subjects with primary enuresis, it can be deduced that the majority of young children with mild enuresis (<3 nights/week) tend to spontaneous resolution.
Still, it is essential to remember that those who wet < three nights/week and cases that persist after the age of nine will hardly resolve without treatment, for which the following recommendations are made:
Children who wet daily or more than once a night do not tend to heal spontaneously at any age. They must be treated with curative intent, and it is not worth waiting. For such children parents can also buy bedwetting alarm.
Children who wet 3-6 times/week and are > eight years old do not tend to heal spontaneously. Most of these patients remain enuretic in adulthood. They must be treated with curative intent, and it is not worth waiting.
Children older than nine years, regardless of the frequency, do not tend to heal spontaneously. From this age on, the prevalence does not vary and is similar to adulthood. They must be treated with curative intent, and it is not worth waiting. Or they can start use of bedwetting alarm.
What Treatment Options Do We Have?
The first measure is to demystify the problem and avoid punitive actions. Restricting evening fluids, mostly avoiding diuretic drinks and colas, and going to the bathroom before going to bed are good general attitudes that parents have already taken many times, and it is recommended to maintain them.
In addition to the general measures described, PC treatment is based on behavioral therapy with bedwetting alarm and pharmacological treatment with desmopressin. Currently, no other drugs are recommended as a first choice.
Motivational therapy with calendars of dry/wet nights through drawings, suns or clouds, etc. (a type of simple behavioral treatment), helps to objectify the baseline situation of the number of wet nights and to assess the evolution.
Thus, and despite the lack of quality studies, it is recommended before and together with the other treatments mentioned since it has no adverse effects.
Waking the child up at night to urinate, even while asleep, is a measure that helps prevent bedwetting but not cure enuresis. Training for bladder retention (exercises to progressively delay urination for more extended periods) does not benefit and is not recommended. The jet cutting technique during voiding predisposes functional bladder pathology (functional obstructive voiding) and is not recommended.
Since constipation can interfere with treatment, it is recommended to investigate and treat it beforehand.
Although it was previously recommended to investigate and treat obstructive sleep apnea in patients with enuresis, it has been shown that no such relationship exists except in severe cases of apnea in girls.
It is essential to assess the therapeutic objective with the family and the child before starting treatment. Usually, the purpose sought is a cure, which means complete dryness maintained after six months after finishing the treatment.
Sometimes, they consult us looking for immediate, short-term dryness, for sporadic situations or camps. In this case, you must take the opportunity to raise the objective of a posteriori cure.
Although you must always encourage the patient and his family towards healing in a more or less short term, they must also know that sometimes it is not possible. They also recommended using bedwetting alarm. In these cases, it would be appropriate to control enuresis with continuous long-term treatment.