Wide-set eyes

Disease Description (Causes and Symptoms)

• Definition: A condition in which a person is unable to remain continent of urine during nighttime sleep after age 5 (enuresis, Enuresis). It is commonly diagnosed when it recurs two or more times per week.
• Main causes and pathophysiology:
  • Genetic predisposition (increased risk when there is a parental history).
  • Delayed maturation of bladder function (small bladder capacity or inadequate nighttime bladder control).
  • Nocturnal polyuria due to insufficient secretion of antidiuretic hormone (ADH) at night.
  • Inadequate sleep–wake response (some respond to alarm therapy).
  • Rarely, underlying diseases such as anatomical abnormalities of the urinary tract, urinary tract infections, neurological abnormalities, or chronic constipation may be the cause.
• Symptoms: Recurrent bedwetting during sleep (most cases are monosymptomatic enuresis without daytime symptoms). If daytime wetting, frequent urination, urinary urgency, residual urine, difficulty urinating, constipation, or other symptoms are present, organic or complicated enuresis should be suspected.

Treatment Methods

• General principles: Consider treatment after age 5 (spontaneous improvement occurs at a rate of approximately 15% per year). Active education and treatment are recommended to prevent emotional harm and reduced self-confidence.
• Behavioral therapy (first-line recommendation)
  • Restrict fluids in the evening and establish the habit of urinating before bedtime.
  • Bedwetting alarm (alarm therapy): When the sensor detects moisture, the alarm induces awakening → formation of a conditioned response. Effective from age 6–7 and older (treatment success rate approximately 70–80%, recurrence rate approximately 30%).
  • Motivational reinforcement (praise, sticker rewards, etc.): Long-term positive reinforcement is helpful.
• Pharmacological treatment
  • Desmopressin (antidiuretic hormone analogue): Effective in children with nocturnal polyuria (response rate approximately 60–80%). The likelihood of recurrence is high after discontinuation. Main precaution: risk of hyponatremia (especially with excessive fluid intake).
  • Imipramine (tricyclic antidepressant): Effective in some cases (60–70%), but should be used cautiously because of the recurrence rate after discontinuation and adverse effects (anticholinergic and cardiovascular).
  • Oxybutynin (anticholinergic): Mainly used for overactive bladder or when daytime symptoms are also present. Adverse effects include dry mouth, constipation, flushing, and dizziness.
  • The choice of medication is determined according to the symptom type (nocturnal polyuria versus bladder overactivity, etc.).
• Specialized treatment and diagnostic evaluation
  • If complicated findings such as daytime symptoms, abnormal urinalysis, recurrent urinary tract infections, constipation, or neurological signs are present, additional evaluation such as ultrasonography, voiding cystourethrography (VCUG), or urodynamic testing is necessary.
• Precautions (during treatment)
  • Check the adverse effects and contraindications of prescribed medications (such as heart disease and impaired renal function).
  • When taking desmopressin, restricting fluids before bedtime and providing education on fluid intake are essential.
  • Scolding and blaming are prohibited; punishing failure can worsen symptoms and cause psychological harm.

Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Items to bring/record
  • A list of recently taken medications, including supplements.
  • Urinalysis results or previous test results related to urinary tract infections, if available.
  • A voiding diary (bladder diary): for at least 2–3 days, including the number of daytime and nighttime urinations, voided volume, whether nighttime wetting occurred, and constipation or bowel movement patterns.
  • Family history, including a parental history of childhood enuresis.
  • Sleep patterns, the timing and amount of fluid intake, and whether daytime urinary symptoms are present.
• Items to show the doctor during the outpatient visit
  • The voiding diary (bladder diary), recent urinalysis results, and information related to constipation or bowel movement problems.

Examples of General Questions to Ask the Doctor

• "What are the possible side effects and risks of this medication?"
• "How long should we wait to see a treatment effect? What is the risk of recurrence?"
• "What specific changes should be made to daily habits?"

Examples of Condition-Specific Questions

• "How can we tell whether our (or our child's) bedwetting is caused by nocturnal polyuria or a bladder problem?"
• "If using a bedwetting alarm is not effective, what are the next treatment options?"

Additional Information

• Cases requiring immediate medical evaluation: If fever, painful urination, hematuria, acute difficulty urinating (when no urine comes out at all), sudden behavioral changes, numbness in the legs, or other neurological symptoms occur.