Nocturnal enuresis, commonly referred to as bedwetting, is a condition in which an individual, usually a child, involuntarily urinates during sleep

Aetiology

• Nocturnal enuresis is considered a typical part of development until the age of five
• It can be categorised as primary or secondary:
  • Primary nocturnal enuresis involves children who have never achieved urinary continence overnight, whereas secondary nocturnal enuresis refers to children who have previously achieved nighttime continence but have subsequently lost it
• Nocturnal enuresis can result from a variety of underlying physical conditions, such as:
  • Diabetes mellitus: this can cause excessive urination, leading to nighttime wetting
  • Urinary tract infections: these can cause urinary urgency and frequency, including during sleep
  • Constipation: this can result in compression of the bladder, reducing its capacity to hold urine

Clinical features

• The primary sign of nocturnal enuresis is involuntary urination during sleep
• However, it can also indicate an underlying medical condition, especially in cases of secondary nocturnal enuresis
• Therefore, children may also exhibit signs and symptoms related to conditions such as diabetes mellitus, urinary tract infections, and constipation

Investigations

• All cases of nocturnal enuresis should be evaluated with a detailed history, examination, and a urine dip
• For secondary nocturnal enuresis, more thorough investigations are necessary, such as a urine dip, measurement of urine osmolarity, and a renal ultrasound scan, to identify any underlying physical cause

Management

• The management of nocturnal enuresis varies depending on the root cause
• Generally, children and parents should be counseled about the commonality of bedwetting, and the child should not be blamed
• Star charts can serve as a useful initial conservative approach to reward positive behaviors that minimize bedwetting
• Typically, a nocturesis alarm is the first-line management approach
  • This device detects moisture in the underwear, activating an alarm and alerting the child to wake up and go to the bathroom.
  • These alarms are generally effective in training children
• In children over seven years old who have not responded to the alarm or require rapid control, a trial of DDAVP (synthetic ADH) can be considered
  • This medication promotes water re-absorption and reduces urine production overnight