Nocturnal enuresis in children: Etiology and evaluation
- Naiwen D Tu, MD
Naiwen D Tu, MD
- Texas Children's Pediatrics - Pediatric Medical Group
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Anne M Arnhym, CPNP
Anne M Arnhym, CPNP
- Certified Pediatric Nurse Practitioner
- UCSF Pediatric Urology
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Carolyn Bridgemohan, MD
Carolyn Bridgemohan, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Assistant Professor of Pediatrics
- Harvard Medical School
Urinary incontinence is a common problem in children. At five years of age, 15 percent of children are incompletely continent of urine. Most of these children have isolated nocturnal enuresis (monosymptomatic nocturnal enuresis).
An overview of the causes and evaluation of nocturnal enuresis in children will be presented here. The management of nocturnal enuresis and bladder dysfunction are discussed separately. (See "Nocturnal enuresis in children: Management" and "Etiology and clinical features of bladder dysfunction in children" and "Evaluation and diagnosis of bladder dysfunction in children" and "Management of bladder dysfunction in children".)
The International Children's Continence Society (ICCS) has developed standardized terminology for lower urinary tract function and malfunction in children .
Enuresis (synonymous with intermittent nocturnal incontinence) refers to discrete episodes of urinary incontinence during sleep in children ≥5 years of age . Enuresis is divided into monosymptomatic and non-monosymptomatic forms.
Monosymptomatic enuresis is defined as enuresis in children without any other lower urinary tract symptoms and without a history of bladder dysfunction . Monosymptomatic nocturnal enuresis usually is divided into primary and secondary forms. Children who have never achieved a satisfactory period of nighttime dryness have primary enuresis. An estimated 80 percent of children with nocturnal enuresis have this form. Children who develop enuresis after a dry period of at least six months have secondary enuresis . Secondary enuresis often is ascribed to an unusually stressful event (eg, parental divorce, birth of a sibling) at a time of vulnerability in a child's life. Stool retention and suboptimal daytime voiding habits often play a role. However, the exact cause of secondary enuresis may remain unknown.
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- EPIDEMIOLOGY AND NATURAL HISTORY
- BLADDER MATURATION
- Maturational delay
- Small bladder capacity
- Nocturnal polyuria
- - Role of ADH
- Detrusor overactivity
- Disturbed sleep
- ASSOCIATED CONDITIONS
- DIFFERENTIAL DIAGNOSIS
- - Voiding diary
- Physical examination
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS