Summary
Definition
History and exam
Key diagnostic factors
- increased fluid intake at night
- urinary frequency
- constipation
- caffeine and other bladder irritants
- urinary urgency
Other diagnostic factors
- abnormal voiding habits
- abnormal breathing pattern at night
Risk factors
- genetic predisposition
- constipation
- upper airway obstruction/sleep-disordered breathing
- ADHD
- psychological disorders
- male sex
Diagnostic tests
1st tests to order
- urinalysis
Tests to consider
- urinary tract ultrasound
Treatment algorithm
age <7 years
age ≥7 years
recurrence
Contributors
Authors
Erin C. Grantham, MD
Pediatric Urologist
Department of Urology
Billings Clinic
Billings
MT
Disclosures
ECG declares that she has no competing interests.
Acknowledgements
Dr Erin C. Grantham would like to gratefully acknowledge Dr Duncan T. Wilcox and Dr Nicholas G. Cost, the previous contributors to this topic. Dr Erin C. Grantham would also like to acknowledge Jillian Hatfield for her contribution to this topic.
Disclosures
DTW and NGC declare that they have no competing interests.
Peer reviewers
Prasad Godbole, FRCS, FRCS (Paed), FEAPU
Consultant Paediatric Urologist
Paediatric Surgical Unit
Sheffield Children's NHS Foundation Trust
Western Bank
Sheffield
UK
Disclosures
PG declares that he has no competing interests.
Elizabeth Jackson, MD
Associate Professor
Pediatric Nephrology
Cincinnati Children's Hospital Medical Center
Cincinnati
OH
Disclosures
EJ declares that she has no competing interests.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Text Revision, (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
European Association of Urology. Guidelines on paediatric urology. 2023 [internet publication].Full text
European Association of Urology. Guidelines on paediatric urology. 2019 [internet publication].Full text
Nevéus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol. 2010 Feb;183(2):441-7.Full text Abstract
Nevéus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society. J Urol. 2010 Feb;183(2):441-7. Abstract
Caldwell PH, Codarini M, Stewart F, et al. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2020 May 4;5(5):CD002911.Full text Abstract
Longstaffe S, Moffat M, Whalen J. Behavioral and self-esteem changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics. 2000;105:935-940. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Congenital abnormality of the urinary tract (e.g., ectopic ureter, ureterocele, and urethral valves)
- Constipation
- Diabetes
More DifferentialsGuidelines
- Guidelines on paediatric urology
- Diagnosis and management of nocturia
More GuidelinesPatient information
Bedwetting
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer