Enuresis Alarms
DESCRIPTION
Enuresis describes the involuntary discharge of urine beyond the age when a child is old enough to be able to control urination. This is usually considered to be five to six years of age for nighttime control. There are several different types of enuresis. Diurnal enuresis is wetting that occurs during waking hours. Primary nocturnal enuresis is a lack of total bladder control during sleep; and secondary nocturnal enuresis is the loss of bladder control that happens after a child (or adult) has been dry at night for a long period of time (usually defined as three to six months).
The cause of bedwetting is not completely understood. Some physicians feel that children who have nocturnal enuresis (NE) might have small bladders or be such deep sleepers that the urge to urinate does not wake them. Research has shown, however, that some children with NE have normal-sized bladders and have sleep patterns that are no different from other non-bedwetting children. Recent medical research has shown that children who have NE may have a deficiency during sleep of the antidiuretic hormone (ADH). ADH helps concentrate the urine during sleep; therefore the child's bladder would not overfill with urine. Testing of many children with NE has shown that they do not have the usual increase in ADH during sleep.
There are several different treatment methods for NE. Some of these include exercises, changing of habits, hypnosis, medications, and waking the child periodically throughout the night. Moisture alarms have been proposed as a successful, non-pharmaceutical treatment for nocturnal enuresis. The alarms seem to have a good long-term success rate, and the users may have fewer relapses, with fewer side effects, than those who were treated with medication. Alarms usually consist of a clip-on sensor probe that attaches to the outside of bed clothing. An alarm will be set off when the child begins to wet the bed. The alarm will wake the child, who will then go to the bathroom.
POLICY
The use of enuresis alarms for the treatment / prevention of nocturnal enuresis is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
The use of enuresis alarms for the treatment / prevention of nocturnal enuresis will be considered medically appropriate if ALL of the following criteria are met:
Ordered by a licensed practitioner
Presence of primary nocturnal enuresis, defined as continuous or persistent involuntary bed-wetting at least twice a week
Age five to fourteen years
Normal physical exam that consists of growth, neurologic, and genitourinary assessment
Normal urinalysis and urine culture
SOURCES
Butler, R. J., Robinson, J. C. (2002). Alarm treatment for childhood nocturnal enuresis: an investigation of within-treatment variables. Scandinavian Journal of Urology and Nephrology, 36 (4), 268-272. Abstract retrieved December 30, 2002 from PubMed database.
El-Anany, F. G., Maghraby, H. A., Shaker, S. E., Abde-Moneim, A. M. (1999). Primary nocturnal enuresis: a new approach to conditioning treatment. Urology, 53 (2), 405-408. Abstract retrieved December 30, 2002 from PubMed database.
Fai-Ngo, N. C.& Wong, S. N. (2005). Comparing alarms, desmopressin, and combined treatment in Chinese enuretic children. Pediatric Nephrology, 20 (2). 163-169. Abstract retrieved September 14, 2007 from PubMed database.
Glazener, C. M. A., Peto, R. E., Evansd, J. H. C. (2003). Effects of interventions for the treatment of nocturnal enuresis inchildren. Quality and Safety in Health Care, 2003 (12), 390-394.
Jensen, I. N., Kristensen, G. (1999). Alarm treatment: analyses of response and relapse. Scandinavian Journal of Nephrology, Supp. 202, 73-75.
Kahan, E., Morel, D., Amir, J., Zelcer, C. A. (1998). A controlled trial of desmopressin and behavioral therapy for nocturnal enuresis. Medicine (Baltimore), 77 (6), 384-388.
Medem: Medical Library. (2002). American Academy of Pediatrics: Bed-wetting. Retrieved December 30, 2002 from http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ30FMNH4C&sub_cat=109.
Monda, J. M., Husmann. D. A. (1995). Primary nocturnal enuresis: a comparison among observation, imipramine, desmopressin acetate and bedwetting alarm systems. The Journal of Urology, 154 (2 Pt 2), 745-748.
National Guideline Clearinghouse. American Academy of Child and Adolescent Psychiatry. (2002, December). Practice parameters for the assessment and treatment of children and adolescents with enuresis. Retrieved September 14, 2007 from http://www.guidelines.gov.
National Institute of Diabetes and Digestive and Kidney Diseases. (2006, October). Urinary incontinence in children. Retrieved September 14, 2007 from http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/UI-Children.pdf.
Rakel, R. E. (Ed.). (2007). Textbook of Family Medicine (7th ed., pp. 615-616).Philadelphia: Saunders Elsevier.
Schmitt, B. D. (1997). Nocturnal enuresis. Pediatrics in Review, 18 (6), 183-190.
Wille, S. (1986). Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Archives of Disease in Childhood, 61 (1), 30-33.
ORIGINAL EFFECTIVE DATE: 10/1/2001
MOST RECENT REVIEW DATE: 5/1/2008
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.