Enuresis has primarily nocturnal symptoms in children older than 5 years of age.
Differentials include diabetes, medications, emotional problems, urinary tract infection, spina bifida, seizure disorder, and neurogenic bladder.
Treatment is commonly involves behavioural changes, alarm therapy, or desmopressin.
Emotional support and encouragement is vital to management.
Enuresis is defined as normal micturition that occurs at an inappropriate or socially unacceptable time or place. As recommended by International Children's Continence Society, in this topic 'enuresis' is reserved for micturition during sleep, or bedwetting. Daytime wetting is called 'incontinence'.
History and exam
Key diagnostic factors
- presence of risk factors
- increased fluid intake at night
- urinary frequency
- caffeine and other bladder irritants
- urinary urgency
Other diagnostic factors
- abnormal voiding habits
- abnormal breathing pattern at night
- genetic predisposition
- upper airway obstruction/sleep-disordered breathing
- attention deficit hyperactivity disorder (ADHD)
- psychological disorders
- male sex
1st investigations to order
Investigations to consider
- urinary tract ultrasound
age <7 years
age ≥7 years
- Congenital abnormality of the urinary tract (e.g., ectopic ureter, ureterocele, and urethral valves)
- Guidelines on paediatric urology
- The South African guidelines on enuresis
BedwettingMore Patient leaflets
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