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Diseases

Enuresis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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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.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          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]

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