Hi, this is Tom, and in this episode I'm going to be going through enuresis, and you can find

notes at zero to finals.com and in the zero to finals pediatrics book, and you can find flashcards

and questions at members.0.0.0.com. And at the end of this episode, we'll go through some questions

so you can test yourself on what you just heard. So let's jump straight in.

Enureesis refers to involuntary urination. Nocturnal enuresis refers to bedwetting at night time.

Diurnal aneuryses refers to daytime wetting.

Most children have daytime control of urination by three years of age

and night time control by four years of age.

Let's start by talking about primary nocturnal aneurysus.

Primary nocturnal aneurysis is where the child has never managed to be consistently dry at

night time. Primary nocturnal aneurysis can be a variation of normal development,

particularly in children under five years.

There may be a family history of delayed dry nights.

Reassurance is important at this stage.

Other causes of primary nocturnal an uresis include an overactive bladder, reduced bladder capacity,

fluid intake before bedtime, particularly fizzy drinks, juice and caffeine which can have a diuretic effect,

failure to wake up due to particularly deep sleep or underdeveloped bladder signals.

Psychological distress, for example, low self-esteem, too much pressure or stress at home or at school.

And secondary medical causes such as chronic constipation, urinary tract infections,

learning disability or cerebral palsy.

A history and examination can help identify and exclude any physical or psychological causes.

A bladder diary recording the fluid intake, the urine output, and any

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