Nocturnal enuresis

Differential diagnosis

  • Primary
    • Neurological problems
  • Secondary
    • Diabetes
    • UTI
    • Constipation
    • Excessive fluid intake
    • Psychological


Data gathering

  • Red flags – frequency/thirst/weight loss, previously been dry
  • Others –  daytime wetting, fluid intake, dysuria, bowels, social stress, general (growth, pregnancy, birth, development)
  • Examination – height, weight (centile chart), abdo, urine dip


Clinical management

  • Investigations
    • Bedwetting diary
  • Explanation
    • urine stretches the bladder as it fills, when it stretches to a point, the nerves send a message to the brain saying it needs to be emptied, if the child is asleep, the brain does not hear the message but the bladder empties anyway.
    • Different reasons include infection, constipation, fizzy drinks, psychological factors
  • Treatment
    • Lifestyle
      • Patient reassurance – remind the child it is not their fault and not to be punished
      • Avoid fizzy/caffeinated drinks before bedtime
      • Go to toilet before bed – reward system
      • Leave bathroom light on at night
      • Waterproof mattress cover
  • Refer enuresis clinic
    • Bed wetting alarm – teaches child to wake and go to toilet before bladder is full
    • Desmopressin – reduces amount of urine made at night, offered if over 7yrs old or for short term improvement
  • Follow-up / Safety net – come back if not improving