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 commonly involves behavioral 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 the 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
- 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
- psychological disorders
- male sex
1st investigations to order
Investigations to consider
- urinary tract ultrasound
age <7 years
age ≥7 years
Erin C. Grantham, MD
Department of Urology
ECG declares that she has no competing interests.
Dr Erin C. Grantham would like to gratefully acknowledge Dr Duncan T. Wilcox and Dr Nicholas G. Cost, the previous contributors to this topic. DTW and NGC declare that they have no competing interests.
Prasad Godbole, FRCS, FRCS (Paed), FEAPU
Consultant Paediatric Urologist
Paediatric Surgical Unit
Sheffield Children's NHS Foundation Trust
PG declares that he has no competing interests.
Elizabeth Jackson, MD
Cincinnati Children's Hospital Medical Center
EJ declares that she has no competing interests.
- 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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