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Enuresis

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 6 Apr 2025
Last updated: 19 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • increased fluid intake at night
  • urinary frequency
  • constipation
  • caffeine and other bladder irritants
  • urinary urgency
Full details

Other diagnostic factors

  • abnormal voiding habits
  • abnormal breathing pattern at night
Full details

Risk factors

  • genetic predisposition
  • constipation
  • upper airway obstruction/sleep-disordered breathing
  • ADHD
  • psychological disorders
  • male sex
Full details

Diagnostic tests

1st tests to order

  • urinalysis
Full details

Tests to consider

  • urinary tract ultrasound
Full details

Treatment algorithm

ACUTE

age <7 years

age ≥7 years

ONGOING

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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 Differentials

  • Guidelines

    • Guidelines on paediatric urology
    • Diagnosis and management of nocturia
    More Guidelines

  • Patient information

    Bedwetting

    More Patient information
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