Treatment Plan

TREATMENT PLAN

1. Primary without daytime symptoms: Conservative measures:
   • Lifting/waking
   • Fluid/dietary management
   • Toileting routine
   • Positive reward system
   • Reassurance if <5 years

First-line (if >5 years and persists >2 weeks):

• Enuresis alarm
• Review at 4 weeks

Second line:

• Desmopressin
  • It can be used for short-term (school trips) or long-term
  • Take 1-2 hours before bed
  • Fluid restriction 1 hour before bed
  • Avoid swimming
  • Avoid concurrent NSAIDs, antiepileptics, antidepressants, loperamide, and furosemide.
  • Adverse effects: Hyponatremia, Nausea

Specialist referral if the above fails:

• May consider antimuscarinic (oxybutynin)
• May consider TCA (imipramine)

2. Primary with daytime symptoms:
   • Refer to secondary care

3. Secondary enuresis:
   • Treat the underlying cause
   • Refer if the cause is unclear/untreatable