Nocturnal Enuresis

The majority of children achieve day and night-time continence by 3 or 4yrs.

Enuresis may be defined as

“the involuntary discharge of urine by day or night or both, in a child aged 5 years and 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

NICE guidelines (2010) guidance:

  • Look for possible underlying cause / triggers (eg constipation, diabetes mellitus, UTI if recent)
  • Advise on fluid intake, diet and toileting behaviour
  • reward systems (eg Star charts). NICE recommend these “should be agreed behaviour rather than dry nights” eg Using the toilet to pass urine before sleep
  • Consider whether alarm or drug treatment is appropriate, depending on age, maturity, and abilities of the child or young person, the frequency of bedwetting and the motivation and needs of the family.
  • Generally:
    • An enuresis alarm is first line for children under the age of 7years – particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family