Enuresis- What to Know and How to Treat: IAP Guidelines

The word "enuresis" has become synonymous with bedwetting. There can be nothing further from the truth and we need to erase this kind of thinking. Enuresis is defined as involuntary passage of urine beyond the age at which bladder control is deemed to be achieved.

The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for Enuresis. The lead author for these guidelines on Enuresis is Dr Pankaj Deshpande along with co-author Dr Fagun Shah and Dr Rajiv Sinha. The guidelines come Under the Auspices of the IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan.

Following are the major recommendations of guidelines:

Mainly can be divided as:

Daytime enuresis: Often missed and the one that every pediatrician should be aware of to be able to diagnose and treat appropriately. Most children in this group get treated for the "nonexistent" urinary tract infections (UTIs)!

Nocturnal enuresis: The enuresis occurs predominantly at night when the child is fast asleep (including wetting when asleep in the day). Enuresis can be clinically considered as follows:

Predominantly daytime (overactive bladder):

Both daytime and nocturnal (posterior urethral valves, tubular problems, and neurogenic bladder) Predominantly nocturnal (primary nocturnal enuresis).Different causes of enuresis and their management is given in Table 1.

Conclusion:

There is varied etiology for enuresis. After identifying whether daytime or nocturnal, treatment should be directed at the cause of the enuresis.

Treatment:

Reference:

Arda E, Cakiroglu B, Thomas DT. Primary nocturnal enuresis: A review. Nephro Urol Mon. Further Reading 2016;8(4):e35809.

Deshpande AV, Craig JC, Smith GH, Caldwell PH. Management of daytime urinary incontinence and lower urinary tract symptoms in children. J Paediatr Child Health. 2012;48(2):E44-52.

Mahadik P, Vaddi SP, Godala CM, Sambar V, Kulkarni S, Gundala R. Posterior urethral valve: Delayed presentation in adolescence. Int Neurourol J. 2012;16(3):149-52.

Nieuwhof-Leppink A, Schroeder RP, van de Putte EM, Jong TP, Schappin R. Daytime urinary incontinence in children and adolescents. Lancet Child Adolesc Health. 2019;3(7):492-501. ; Ramsay S, Bolduc S. Overactive bladder in children. Can Urol Assoc J. 2017;11(1-2):S74-9.

The guidelines can be accessed on the official site of IAP :https ://iapindia.org/standard-treatment-guidelines/