Enuresis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 commonly involves behavioral changes, alarm therapy, or desmopressin.
Emotional support and encouragement is vital to management.

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History & Exam
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

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. [Abstract][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. [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.[Abstract][Full Text]
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]

Other Online Resources

AAP: children's health topics - toilet training

Referenced Articles

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Text Revision, (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
2. Norgaard JP, van Gool JD, Norgaard JP, et al. Standardization and definitions in lower urinary tract dysfunction in children. International Children's Continence Society. Br J Urol. 1998;81(suppl 3):1-16.[Abstract]
3. European Association of Urology. Guidelines on paediatric urology. 2023 [internet publication].[Full Text]
4. Adam A, Claassen F, Coovadia A, et al. The South African guidelines on enuresis - 2017. African Journal of Urology. 2018 Mar;24(1):1-13[Full Text]
5. Jansson UB, Hanson M, Sillén U, et al. Voiding pattern and acquisition of bladder control from birth to age 6 years - a longitudinal study. J Urol. 2005 Jul;174(1):289-93. [Abstract]
6. Hirasing RA, van Leerdam FJ, Bolk-Bennink L, et al. Enuresis nocturna in adults. Scan J Urol Nephrol. 1997 Dec;31(6):533-6. [Abstract]
7. The International Children's Continence Society (ICCS): Hjalmas K, Arnold T, Bower W, et al. Nocturnal enuresis: an international evidence based management strategy. J Urol. 2004;171:2545-2561.[Abstract]
8. Lackgreen G, Hjalmas K, van Gool J, et al. Nocturnal enuresis: a suggestion for a European treatment strategy. Acta Paediatr. 1999;88:679-690.[Abstract]
9. Rittig S, Knudsen UB, Sorensen S, et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989;256:664-671.[Abstract]
10. Oredsson AF, Jorgensen TM. Changes in nocturnal bladder capacity during treatment with the bell and pad for monosymptomatic nocturnal enuresis. J Urol. 1998;160:166-169.[Abstract]
11. Yeung CK, Chiu HN, Sit FK. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol. 1999;162:1049-1055.[Abstract]
12. Yeung CK, Sit FK, To LK, et al: Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int. 2002;90:302-307.[Abstract]
13. Norgaard JP, Hansen JH, Wildschotz G, et al. Sleep cystometries in children with nocturnal enuresis. J Urol. 1989;141:1156-1159.[Abstract]
14. Ornitz EM, Russell AT, Hanna GL, et al. Prepulse inhibition of startle and the neurobiology of primary nocturnal enuresis. Biol Psychiatry. 1999;45:1455-1466.[Abstract]
15. Wolfish N. Sleep arousal function in enuretic males. Scand J Urol Nephrol. 1999;202:24-26.[Abstract]
16. Kovacevic L, Jurewicz M, Dabaja A, et al. Enuretic children with obstructive sleep apnea syndrome: should they see otolaryngology first? J Pediatr Urol. 2013;9:145-150.[Abstract]
17. von Gontard A, Schaumburg H, Hollman E, et al. The genetics of enuresis: A review. J Urol. 2001;166:2438-2443.[Abstract]
18. Basha S, Bialowas C, Ende K, et al. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. Laryngoscope. 2005;115:1101-1103.[Abstract]
19. Kalorin CM, Mouzakes J, Gavin JP, et al. Tonsillectomy does not improve bed wetting: results of a prospective controlled trial. J Urol. 2010:184;2527-2531.[Abstract]
20. Alexopoulos EI, Kostadima E, Pagonari I, et al. Association between primary nocturnal enuresis and habitual snoring in children. Urology. 2006;68:406-409.[Abstract]
21. Robson WL, Jackson HP, Blackhurst D, et al. Enuresis in children with attention-deficit hyperactivity disorder. South Med J. 1997;90:503-505.[Abstract]
22. Hagglof B, Andren O, Bergstrom E, et al. Self-esteem before and after treatment in children with nocturnal enuresis and urinary incontinence. Scand J Urol Nephrol. 1997;183:79-82.[Abstract]
23. Hagglof B, Andren O, Bergstrom E, et al. Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. Eur Urol. 1998;33(suppl 3):16-19.[Abstract]
24. 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]
25. European Association of Urology. Guidelines on paediatric urology. 2019 [internet publication].[Full Text]
26. Hansen MN, Rittig S, Siggaard C, et al. Intra-individual variability in nighttime urine production and functional bladder capacity estimated by home recordings in patients with nocturnal enuresis. J Urol. 2001;166:2452-2455.[Abstract]
27. Koff SA. Estimating bladder capacity in children. Urology. 1983;21:248.[Abstract]
28. 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][Full Text]
29. Yeung CK, Sreedhar B, Leung VT, et al. Ultrasound bladder measurements in patients with primary nocturnal enuresis: a urodynamic and treatment outcome correlation. J Urol. 2004;171:2589-2594.[Abstract]
30. O'Regan S, Yazbeck S, Hamberger B, et al. Constipation a commonly unrecognized cause of enuresis. Am J Dis Child. 1986;140:260-261.[Abstract]
31. Nguyen LN, Randhawa H, Nadeau G, et al. Canadian Urological Association best practice report: diagnosis and management of nocturia. Can Urol Assoc J. 2022 Jul;16(7):E336-49.[Abstract][Full Text]
32. 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]
33. Kruse S, Hellstrom AL, Hjalmas K. Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy. Scand J Urol Nephrol. 1999 Feb;33(1):49-52. [Abstract]
34. Caldwell PH, Nankivell G, Sureshkumar P. Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2013 Jul 19;(7):CD003637.[Abstract][Full Text]
35. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997 Aug;100(2 Pt 1):228-32.[Abstract]
36. Oredsson AF, Jorgensen TM. Changes in nocturnal bladder capacity during treatment with the bell and pad for monosymptomatic nocturnal enuresis. J Urol. 1998 Jul;160(1):166-9.[Abstract]
37. 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.[Abstract][Full Text]
38. Evans J, Malmsten B, Maddocks A, et al.; UK Study Group. Randomized comparison of long-term desmopressin and alarm treatment for bedwetting. J Pediatr Urol. 2011 Feb;7(1):21-9. [Abstract]
39. Kruse S, Hellstrom AL, Hanson E, et al. Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors. BJU Int. 2001 Oct;88(6):572-6.[Abstract]
40. Rushton HG, Belman AB, Zaontz MR, et al. The influence of small functional bladder capacity and other predictors on the response to desmopressin in the management of monosymptomatic nocturnal enuresis. J Urol. 1996 Aug;156(2 Pt 2):651-5.[Abstract]
41. Glazener CM, Evans JH. Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev. 2002;(3):CD002112.[Abstract][Full Text]
42. Hjalmas K, Hanson E, Hellstrom AL, et al. Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre study. Swedish Enuresis Trial (SWEET) Group. BJU. 1998 Nov;82(5):704-9. [Abstract]
43. Nevéus T, Läckgren G, Tuvemo T, et al. Desmopressin resistant enuresis: pathogenetic and therapeutic considerations. J Urol. 1999 Dec;162(6):2136-40. [Abstract]
44. Bolduc S, Upadhyay J, Payton J, et al. The use of tolterodine in children after oxybutynin failure. BJU Int. 2003 Mar;91(4):398-401. [Abstract]
45. Geller B, Reising D, Leonard HL, et al. Critical review of tricyclic antidepressant use in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1999 May;38(5):513-6.[Abstract]
46. Tingelstad JB. The cardiotoxicity of the tricyclics. J Am Acad Child Adolesc Psychiatry. 1991 Sep;30(5):845-6.[Abstract]
47. Caldwell PH, Sureshkumar P, Wong WC. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev. 2016 Jan 20;2016(1):CD002117.[Abstract][Full Text]
48. Hussiny M, Hashem A, Soltan MA, et al. The safety and efficacy of fluoxetine for the treatment of refractory primary monosymptomatic nocturnal enuresis in children: a randomized placebo-controlled trial. J Urol. 2022 Nov;208(5):1126-34.[Abstract]
49. The International Children's Continence Society (ICCS): Hjalmas K, Arnold T, Bower W, et al. Nocturnal enuresis: an international evidence based management strategy. J Urol. 2004 Jun;171(6 Pt 2):2545-61. [Abstract]
50. Huang T, Shu X, Huang YS, et al. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2011;(2):CD005230.[Abstract]
51. Canadian Paediatric Society. Management of primary nocturnal enuresis. Jan 2013 (reaffirmed 2016) [internet publication].[Full Text]
52. Vande Walle J, Rittig S, Bauer S, et al; American Academy of Pediatrics; European Society for Paediatric Urology; European Society for Paediatric Nephrology; International Children's Continence Society. Practical consensus guidelines for the management of enuresis. Eur J Pediatr. 2012 Jun;171(6):971-83. [Abstract][Full Text]
53. National Institute for Health and Care Excellence (UK). Bedwetting in under 19s. Oct 2010 (reaffirmed 2018) [internet publication].[Full Text]
54. 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]