enuresis

Enuresis is the involuntary passage of urine during sleep by a child who is developmentally old enough to have nocturnal continence, when no other medical explanation is present. It is commonly categorized as primary nocturnal enuresis, in which the child has never achieved a period of sustained nighttime dryness, and secondary enuresis, in which dryness has been interrupted for at least six months before relapse.

Prevalence and natural history: It is common in childhood and tends to improve with age. Approximately 5–15% of five-year-olds experience it, with diminishing prevalence in older children; most cases resolve during adolescence.

Etiology: multifactorial: delayed arousal to bladder fullness, nocturnal polyuria, reduced functional bladder capacity, and genetic predisposition. Constipation, sleep disorders, urinary tract infections, and psychosocial stress can contribute. Less commonly, other medical conditions should be considered if daytime symptoms are present.

Evaluation: History and physical exam are first-line. Red flags include daytime urinary symptoms, unusual thirst, weight loss, fever, visible blood in urine, or neurological symptoms. Urinalysis may be performed if indicated; extensive testing is not routine.

Management: Education and reassurance; behavioral strategies such as urine alarm therapy and bladder training; adequate daytime hydration and regular toilet routines; treatment of constipation. Desmopressin is the most commonly used medication for persistent nocturnal enuresis; it can be used alone or with alarms. Tricyclic antidepressants are less favored due to side effects. For secondary enuresis or underlying conditions, treat the underlying issue.

Prognosis: Many children outgrow enuresis with time; likelihood of persistence is higher with male sex, family history, and constipation. Regular follow-up recommended if symptoms persist or worsen.