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)

Management

• look for possible underlying causes/triggers
  • constipation
  • diabetes mellitus
  • UTI if recent onset
• 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
• desmopressin
  • particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family