Overview

• Enuresis → involuntary urination.
  • Diurnal Enuresis → inability to control bladder function during the day. Due to urge or stress incontinence. (>7/day = daytime symptoms)
  • Nocturnal Enuresis → bed wetting. Control of nighttime urination usually achieved by 3-4 years.
• Primary Nocturnal Enuresis → child never managed to be consistently dry at night.
• Secondary Nocturnal Enuresis → child begins wetting the bed when they have previously been dry for at least 6 months.
  • More indicative of underlying illness than primary enuresis → UTI, constipation, T1DM, stress, maltreatment.

Making Diagnosis

Clinical Features

Investigations

• Bedside → urine dip (look for UTI or diabetes), urine MCS, 2 week bladder diary.
  • Thorough investigation if secondary enuresis.
• Imaging → USS of renal tract.

Management Plan

• Primary Nocturnal Enuresis WITH DAYTIME SYMPTOMS → referral to secondary care / enuresis clinic.
• Primary Nocturnal Enuresis (no daytime symptoms)
  • Children <5 years old → reassure that can be normal in this age group. Ensure easy access to toilet at night. Encourage bladder emptying before bed. Use a positive reward system (eg. star chart for drinking recommended fluid amount of toileting regularly - helps establish good habits).
  • Children >5 years old → if infrequent (<2/wk) reassure parents. If long term… (BED - BEHAVIOURAL → ENURESIS ALARM → DESMOPRESSIN)
    • Offer treatment to children and young people whose bedwetting has not responded to advice on fluids, toileting, or an appropriate reward system.
    • 1st Line → enuresis alarm with positive reward system. Assess after 4 weeks for response.
      • Device that makes a noise at the first sign of bed wetting, waking the child and stopping them from urinating.
    • 2nd Line → desmopressin. Particularly good for short-term control (eg. school trips).
    • If doesn’t respond to at least two complete courses of treatment with either an alarm or desmopressin → refer to secondary care.
• Secondary Nocturnal Enuresis (previously been dry at night for 6 months)
  • Assess for underlying cause → UTI, constipation.
    • Refer to paediatrician or enuresis clinic if cause cannot be managed in primary care or is not clearly identified.
  • Specialist referral if underlying cause of → diabetes, recurrent UTI, psychological problem, family problem, developomental difficulties.

Complications →

Prognosis →