Article Text
Abstract
Aim Provide supportive guidance to paediatricians and families in the management of nocturnal enuresis. 1. Define the diagnostic process. In the case of monosymptomatic NE (MNE), manage the therapeutic phase. In non-monosymptomatic NE cases, children should be referred to second-level centers. 2. Adjust the treatment of MNE. 3. Play a positive motivational role with patient and family.
Material and Method Clinical and pratical evidence.
Results Advice to patients/family: 1. Consume at least 1.5l of water between 8:00–18:00, providing children with a 500 ml bottle to drink at school. Rational: a) children will be less thirsty in the evening, b) children will need to empty the bladder during the day. 2. Empty the bladder every 2.5/3 hours for a daily number of urinations between 5–7, trying to resist and gradually gaining the minutes needed to achieve this goal. Rational: The bladder wall has a significant elastic component, responding well to dilation maneuvers and ensuring the attainment of a bladder capacity in line with age expectations if properly trained. 3. Avoid consuming liquid calcium-rich foods such as milk and its derivatives at dinner. Rational: a) In anticipation of the night ahead, liquid food facilitates the accumulation of fluids at the wrong time of day b) Calcium, like sodium, plays an osmotically active role. Therefore, does not aid the urine concentration process. 4. Take the necessary time for micturition acts, possibly sitting on the toilet with the face turned towards the wall (inverted position) if female. Rational: a) To promote complete bladder emptying, b) post-micturition residues can trigger bladder hyperactivity. 5. Treat any overlapping condition of constipation. Rational: a) Constipation worsens bladder hyperactivity, b) An intestine filled with feces compresses the bladder, amplifying its hyperactivity. 6. Do not wake children at night to accompany them to urinate. Rational: the individual will never learn to recognize unnoticed detrusor contractions and inhibit them.
Conclusions eneral pediatrician plays a crucial role in nocturnal enuresis (NE).