Management of nocturnal enuresisBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6259 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6259
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Caldwell and colleaguers provide an excellrnt overview about the management of Nocturnal Enuresis in children. As a paediatrician I am struck by the reported prevalence of the problem in adults. Most studies suggest a prevalence of at least 2% with a general practice based sudy suggesting the figure is three times this.(1)
When talking to GP trainees none can recall an adult consultation for nocturnal enuresis - which suggests that either the figures are wrong or the consultations are not happening. I suspect that although Buckley's study suggests that most adults would present to the GP in reality few do. This may be, as suggested, that they feel that no treatment will be of benefit.
I suspect that many may be too embarassed to present at all, and most doctors if told by an adult that they need to pass urine at night will presume the issue is of nocturia rather than nocturnal enuresis.
As highlighted in Yeung's article(2), the secondary impact of wetting increases with age, and even this paper does not discuss the impact on intimate relationships.
Yeung highlights in his work that adults with NE often have bladder problems but does not indicate whether they have had treatment. The implication is that they may respond well to treating constipation and trying anticholinergics or imipramine with or without desmopressin.
NICE guidelines (3) limit the prescribing of anticholinergics to professional with experience, implicitly excluding GPs. This means that adults may have received simple, ineffective treatment and believe that there are no more effective ones and hence refrain from representing.
As a paediatrician with an interest in continence I feel very strongly that we need to wake up to the problem of adult nocturnal enuresis.
1.Buckley BS, Lapitan
MCM Prevalence of urinary and faecal incontinence and nocturnal enuresis and
attitudes to treatment and help-seeking amongst a community-based representative
sample of adults in the United Kingdom.
International Journal of Clinical
Practice 2009; 63 (4): 568–573
2.Yeung CK et al Epidemiological study of primary
nocturnal enuresis (bed-wetting) in
young adults in Hong Kong Hong Kong Med J 2008;14(Suppl 3):S28-30
3. NICE Nocturnal enuresis - the management of bedwetting in children and young people (CG111) October 2010
Competing interests: No competing interests