Transcript Enuresis Referrals

Enuresis Referrals
Dr Rick Fulton
09/06/2014
Enuresis
• Diurnal vs nocturnal
• NICE guidance on Bed-wetting
• Referrals
Daytime Enuresis
• Daytime wetting more likely to represent an
underlying secondary cause of enuresis –
consider:
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Recurrent UTI
Constipation
Diabetes
Adequate fluid intake
Underlying bladder control issues
Emotional/Psychological factors (safeguarding)
Bedwetting
• NICE Guidance
• 1 in 6 5yo children wet the bed once per week
• 1 in 15 children aged 10y still wet the bed
• Inadequate or excessive fluid intake still most
common cause
NICE guidance
• Fluid intake, diet and toileting patterns
• Rewards (for behaviours not dry nights)
• Lifting and waking (short term solution only)
• Trial without nappies
NICE guidance
• Consider alarm (not appropriate for all
families)
• Desmomelt (Desmopressin dissolvable
tablets) – 120mcg at bedtime (up to 240mcg)
• Rules: No drinking after tablet. Stop if D and V.
Wean off when stopping drug.
Referrals
• Nurse-led nocturnal enuresis clinic: The Jarvis
Centre, Stoughton Road, GU1 1LJ.
• Accept referrals direct from GPs.
• Refer to paediatrics if other cause suspected.
References
• Ferring pharmaceuticals resource pack
• Nocturnal Enuresis. NICE Guidance. CG 111.
2010. (see NICE pathway)
• ERIC – Enuresis Resource and Information
Centre.