Enuresis in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Enuresis is the involuntary urination during sleep in children over five. It can be nocturnal (night-time), diurnal (day-time), or mixed.

Aetiology

• Genetics: Family history of bedwetting.
• Bladder dysfunction: Reduced bladder capacity.
• Sleep disturbances: Deep sleepers may not wake up for bladder signals.
• Hormonal: Low antidiuretic hormone (ADH) production.
• Psychosocial stressors: Life changes or trauma.
• Constipation: Can obstruct urine flow.

Pathophysiology

• Impaired arousal from sleep: Failure to wake in response to a full bladder.
• Increased nocturnal urine production: Insufficient ADH.
• Reduced bladder capacity: A smaller bladder that cannot hold urine overnight.

Risk Factors

• Male gender.
• Family history of enuresis.
• Developmental delays.
• Stress or trauma.
• Constipation.

Signs and Symptoms

• Involuntary urination during sleep, usually nocturnal.
• No daytime urinary symptoms.

Investigations

• Urine dipstick: Exclude UTI.
• Bladder diary: Track fluid intake and wetting episodes.
• Ultrasound: Assess for urinary tract abnormalities.

Management

First-line:

• Enuresis alarms: Most effective first-line treatment.
• Positive reinforcement: Rewards for dry nights.
• Bladder training: Increase daytime bladder capacity.

Second-line:

• Desmopressin: ADH analogue to reduce nocturnal urine production.
• Anticholinergics: Oxybutynin for daytime enuresis or bladder overactivity.

References

1. NICE (2024). Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. Available at: NICE Guidance
2. NHS (2023). Bedwetting in Children (Enuresis). Available at: https://www.nhs.uk/conditions/bedwetting/
3. BMJ (2023). Enuresis in Children: Diagnosis and Management. Available at: BMJ