Enuresis interventions

FIGURE 51.3 Paradigm for pure nocturnal enuresis intervention. TCAs, tricyclic antidepressants. 

Behavioral therapies are the treatment of choice for enuresis in both typically developing children and children with MR. No medical intervention should be undertaken before considering behavioral interventions, such as a star chart for dry nights, evening fluid restriction, bladder-stretching exercises (where children are asked to hold their urine for as long as they can, past the initial bladder spasm), and/or the buzzer-and-pad. However, some MR/DD patients will be unable to cooperate with such strategies and may need medical... 

INTERVENTIONS FOR ELIMINATION DISORDERS General Concepts for Enuresis... 

Historically, interventions for enuresis, as well as en-copresis, have often reflected intolerance, seeming harshness, and/or a poor understanding of child development (Glicklich, 1951). The vast majority of children over the age of 6 or 7 years as well as their parents will request treatment. Very occasional parents or children may be interested in intermittent treatment—for example, treatment may be desirable for overnight sleep-overs or for camping. Trials of interventions will be necessary to determine what approaches will work in such children and how much time is required for the intervention to be effective. 

Finally, there are children with intermittent minimal incontinence and so-called giggle incontinence (Niren-berg, 1991). Although it is seldom that these conditions require treatment, in such cases where children do request it the standard enuresis approach will generally suffice. Figure 51.4 provides an algorithm for DE interventions. 

Glazener, C.M. and Evans, J.H. (2001) Alarm interventions for nocturnal enuresis in children (Cochrane Review). Cochrane Database Syst Rev 1 CD002911. 

The Cochrane Library is a relatively new and growing electronic library that provides more than 850 summaries of published literature about pharmaceutical and other interventions to improve health. The Library adds new titles four times a year to its cumulative online and CD versions (the latter, available by subscription, offers more databases). The Library s 2000 Issue 3 contains evidence on dozens of clinical dilemmas, such as antibiotic treatment for traveler s diarrhea, antileukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma, opioid antagonists for alcohol dependence, and bromocriptine versus levodopa in early Parkinson s disease. The Cochrane Library also updates earlier reviews when important new evidence becomes available. Among the newest updates are tacrine for Alzheimer s disease, tricyclic and related drugs for nocturnal enuresis in children, and nicotine replacement therapy for smoking cessation. 

---