Bedwetting (enuresis)
CKS Bedwetting
NICE guideline Bedwetting in under 19s
Definition
Bedwetting (Nocturnal enuresis) is involuntary discharge of urine during sleep, which is common in young children.
Children are generally expected to be dry by a developmental age of 5 years, however, it is common practice to consider treatment only when they reach 7 years.
Daytime symptoms include
urgency, frequency, daytime wetting, abdominal straining or poor urinary stream, pain passing urine, or passing urine fewer than four times a day.
Classification
Primary bedwetting
child has never achieved sustained continence at night
No daytime symptoms:
Causes: sleep arousal difficulties, polyuria, and/or bladder dysfunction.
Management
reassurance
enuresis alarm with positive reward systems
desmopressin (if age>7y) if the alarm is unsuitable.
combined enuresis alarm and desmopressin
With daytime symptoms:
disorders of the lower urinary tract
overactive bladder
congenital malformations
neurological disorders
chronic constipation
chronic urinary tract infection (UTI)
chronic emotional problems.
Management
Refer to secondary care or an enuresis clinic
Secondary bedwetting
bedwetting occurs after the child has been dry at night for more than 6 months
Causes: diabetes, UTI, constipation, psychosocial problems
Management
Treatment of UTIs and constipation in primary care.
Referral to a paediatrician or an enuresis clinic if children have other underlying causes (e.g. diabetes and learning difficulties).
Risk factors
A family history of bedwetting.
Gender — boys are more likely than girls to have bedwetting.
Delay in attaining bladder control.
Being obese — approximately 30% of obese children have bedwetting.
Psychological or behavioural disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, anxiety, depressive, and conduct disorders.
Assessment and initial management
Age <5yr? For children under 5 years, treatment is usually unnecessary as the condition is likely to resolve spontaneously. Reassurance and advice can be useful for some families
Are there are any daytime symptoms?
Has the child has previously been dry at night without assistance for 6 months?
Address excessive or insufficient fluid intake or abnormal toileting patterns before starting other treatment for bedwetting in children and young people.
Drug treatment of primary nocturnal enuresis
For Child 5–17 years
200 micrograms once daily, only increased to 400 micrograms if lower dose not effectve
Withdraw for at least 1 week for reassessment after 3 months
Dose to be taken at bedtime
Limit fluid intake from 1 hour before to 8 hours after administration
Enuresis alarm
An alarm is considered inappropriate, if bedwetting is very infrequent (that is, less than 1–2 wet beds per week)
Suggested daily intake of drinks for children
4–8 years
Female 1000–1400 ml
Male 1000–1400 ml
9–13 years
Female 1200–2100 ml
Male 1400–2300 ml
14–18 years
Female 1400–2500 ml
Male 2100–3200 ml