Nursing Care Plan for Enuresis / Bedwetting

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Pathophysiology

Urinary incontinence, known as enuresis, is normal for children under the age of 3, but as they grow, children gain more control of the bladder.  

  1. Nocturnal enuresis (bedwetting) – the most common and occurs when the child, who normally has bladder control, has episodes of wetting during the night.
  2. Diurnal enuresis (daytime) – when the child has wetting episodes during the day.
  3. Primary enuresis describes a child who is not fully toilet trained
  4. Secondary enuresis- when a toilet-trained child has episodes of wetting after periods of dryness.

Etiology

Unintentional wetting, or incontinence, may stem from many factors that include having a small bladder, developmental delays, persistent urinary tract infections or stress and anxiety. There may also be some hereditary factors as well, as it appears to run in families. Often, enuresis may occur if a child was forced to start toilet training too early or before they had full bladder control. Some children are just very heavy sleepers and don’t awaken enough to recognize the urge to void.

Desired Outcome

Patient will have optimal voiding pattern; patient will be free from infection; patient will understand and act on urge to void; patient will have decreased number of incontinent episodes

Enuresis / Bedwetting Nursing Care Plan

Subjective Data:

  • Repeat bedwetting
  • Wetting twice a week for 3 months or more
  • Anxiety
  • Pain with urination
  • Abdominal pain

Objective Data:

  • Small sized bladder
  • Blood or mucus in urine

Nursing Interventions and Rationales

  1. Perform physical assessment, noting signs of rash or irritation of the genital area

  2. Skin irritation may cause a child to hold urine if there is pain with voiding. Observe for signs of sexual abuse.

  3. Obtain history from patient and parents/caregivers. Note any changes in home or social situation that may cause stress.

  4. Help determine cause of symptoms: social or emotional stress and changes in family dynamics can cause children to have wetting accidents

  5. Assess abdomen

    • Look for signs of distention
    • Listen – auscultate for bowel sounds
    • Feel- palpate for distended bladder or signs of constipation. Note presence of tenderness
  6. Chronic constipation can be a factor in causing enuresis. A large mass of stool in the colon puts pressure on the bladder, which may lead to a diminished ability to control urine or a decreased capacity to hold urine.

  7. Collect sample and monitor results for urinalysis

  8. To determine if a urinary tract infection is the cause of symptoms

  9. Administer medication as appropriate

    • Antibiotics may be given if the cause of enuresis is determined to be urinary tract infection.
    • The medication desmopressin may be given for low levels  of vasopressin, a hormone that tells the kidneys to slow urine production.
    • Imipramine may be given to help stimulate vasopressin secretion and decrease REM sleep so patient wakes with urge to void.

  10. Provide education and motivational interventions:

    • Keep a calendar of wet and dry days
    • Set a toileting schedule
    • Avoid caffeine or high-sugar drinks
    • Minimize fluid intake in the evening
    • Consider enuresis alarms
    • A calendar can help determine if there is a pattern to wetting and what may trigger the incidences.
    • Help the child train their body to void at appropriate times.
    • Sugar and caffeine can increase urgency and frequency of urination, especially at night.
    • Encourage fluid intake in the daytime hours, but limit fluid in the evenings to prevent overload during the night.
    • Alarms may be placed on the bed to alert or wake the child when they void.

  11. Provide education and resources for parents

    • Encourage parents/caregivers to be patient with child.
    • Remind parents/caregivers that the child is not at fault and discourage punishments which can cause stress and worsen the situation.
    • Provide referrals as appropriate for behavioral health or urology specialists if necessary.


References

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