Subtyping

NE is primary when the child has not previously been dry at night for more than 6 months.

If the child has previously been dry for more than 6 months, the condition is, per definition, secondary. In some cases, this is due to infections (UTI), diabetes, renal disease, or even the result of an event in the child’s life. Essentially, if such issues are excluded, the approach to diagnostics and treatment is similar.

Red flags

Symptoms and signs that warrant further workup in secondary nocturnal enuresis:

  • Universal polyuria (>2L/m2/day)
  • Painful voiding
  • Hematuria
  • Any concurrent neurological symptoms
  • Newly recognized behavioral disorders
  • Signs of urinary tract infection

If the child with NE does not experience symptoms from the lower urinary tract during the daytime, the condition is monosymptomatic.

*The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report From the Standardization Committee of the International Children’s Continence Society 2015

LUT symptoms during the daytime are common in children with NE and can signify a non-monosymptomatic condition.

These symptoms can include: daytime urgency, daytime urinary incontinence, frequency (pollakiuria), voiding difficulties (poor stream, straining, pain). In the majority of patients, these symptoms are related to an overactive bladder, and it is important to identify and address these issues in children with NE.

*The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Update Report From the Standardization Committee of the International Children’s Continence Society 2015

Bedwetting | 1. Basics of ne pathophysiology
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