The majority of children achieve day and night time continence by 3 or 4 years of age. Enuresis may be defined as the 'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract'

Nocturnal enuresis can be defined as either primary (the child has never achieved continence) or secondary (the child has been dry for at least 6 months before)

Causes

Nocturnal enuresis can have a variety of underlying physical causes, such as:

• Diabetes mellitus
• Urinary tract infections
• Constipation - due to compression of the bladder

Investigation

• A detailed history, examination and a urine dip should always be performed.
• Secondary nocturnal enuresis requires more in-depth investigation to ensure there is no underlying physical cause, with a urine dip, urine osmolarity and renal ultrasound scan.

Management

• general advice
  • fluid intake
  • toileting patterns: encourage to empty bladder regularly during the day and before sleep
  • lifting and waking
• reward systems (e.g. Star charts)
  • NICE recommend these 'should be given for agreed behaviour rather than dry nights' e.g. Using the toilet to pass urine before sleep
• enuresis alarm
  • generally first-line for children
  • have sensor pads that sense wetness
  • high success rate