Clinical Review

Management of nocturnal enuresis

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6259 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6259
  1. Patrina H Y Caldwell, staff specialist paediatrician12,
  2. Aniruddh V Deshpande, clinical and academic fellow in paediatric surgery and urology13,
  3. Alexander Von Gontard, child and adolescent psychiatrist and paediatrician, chair and professor of child and adolescent psychiatry4
  1. 1Centre for Kidney Research, Children’s Hospital at Westmead, Australia
  2. 2Discipline of Paediatrics and Child Health, University of Sydney, Australia
  3. 3John Hunter Children’s Hospital, Newcastle, Australia
  4. 4Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg (Saar), Germany
  1. Correspondence to: P H Y Caldwell, Discipline of Paediatrics and Child Health, Children’s Hospital at Westmead, Westmead NSW 2145, Australia patrina.caldwell{at}health.nsw.gov.au

Summary points

  • Nocturnal enuresis can be associated with daytime urinary incontinence, bowel problems, developmental or psychological problems, and sleep disordered breathing

  • Nocturnal enuresis commonly results from defective sleep arousal, nocturnal polyuria, lack of inhibition of bladder emptying during sleep, and reduced bladder capacity

  • Nocturnal enuresis affects quality of life and self esteem, which improve with successful treatment

  • The condition responds well to enuresis alarm training or desmopressin. In non-monosymptomatic nocturnal enuresis, treat daytime lower urinary tract symptoms first

  • In treatment resistance, a repeat thorough assessment and combination therapy may be effective

Sources and selection criteria

We searched Medline, Embase, and the Cochrane Database of Systematic Reviews using the search terms “enuresis” or “bedwetting” as keywords. Systematic reviews, meta-analyses, population based studies, randomised controlled trials, and studies published in the past five years were prioritised.

Nocturnal enuresis (enuresis or bedwetting) is the most common type of urinary incontinence in children. Depending on the definition, prevalence is 8-20% for 5 year olds, 1.5-10% for 10 year olds, and 0.5-2% for adults, with 2.6% of 7.5 year old children wetting on two or more nights a week.1 Prevalence seems to be similar worldwide. Here, we review current knowledge about the treatment of this common condition.

What is nocturnal enuresis?

Nocturnal enuresis is intermittent involuntary voiding during sleep in the absence of physical disease in a child aged 5 years or more. A minimum of one episode a month for at least three months is required for the diagnosis to be made.2

Who gets nocturnal enuresis?

A large epidemiological study showed that nocturnal enuresis is more common in males at all ages, and is more likely to persist in those with frequent wetting.3 Nocturnal enuresis is usually idiopathic and is commonly associated with daytime urinary incontinence (seen in 3.3% of 7.5 year olds in a large epidemiological study1), faecal incontinence, and chronic constipation. In …

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