[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Nocturnal enuresis [Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/) # Nocturnal enuresis Bedwetting during sleep in a child aged 5 or older. It is common, runs in families and usually goes away; alarms and reassurance help. Updated 2026-11-01 ## Structures involved Tap one to see what it is and open it in 3D. - [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) - [External urethral sphincter](https://durgical.com/en/anatomy/female-external-urethral-sphincter/) - [Ureters](https://durgical.com/en/anatomy/ureter/) ## Why it happens - [ADH, thirst and water balance](https://durgical.com/en/physiology/adh-thirst-and-water-balance/) - [The posterior pituitary: ADH and oxytocin](https://durgical.com/en/physiology/the-posterior-pituitary-adh-and-oxytocin/) - [Micturition and the bladder reflex](https://durgical.com/en/physiology/micturition-and-the-bladder-reflex/) ## What it is Involuntary passage of urine during sleep at least once a month (more often for diagnostic criteria) in a child aged 5 years or older, for at least 3 months. It is a symptom of delayed maturation of bladder control in most children. ## Who gets it Affects about 15–20% of 5-year-olds, falling by about 15% each year; 1–2% of adolescents still wet. More common in boys. Shame and the belief that the child does it on purpose often delay consultation and can lead to punishment. ## Causes - Night-time polyuria from low nocturnal vasopressin secretion - Reduced functional bladder capacity or overactive bladder - Difficulty waking to the signal of a full bladder (high arousal threshold) - Strong genetic component ## Risk factors - Family history (risk rises sharply if one or both parents wet the bed) - Male sex - Constipation - Obstructive sleep apnoea and snoring - ADHD and developmental delay - Psychosocial stress (mainly in secondary enuresis) ## Pathophysiology Bladder control matures with age. Enuresis occurs when the night-time urine volume exceeds bladder capacity and the child does not wake to void. The [external urethral sphincter](https://durgical.com/en/anatomy/female-external-urethral-sphincter/) relaxes reflexly as the detrusor contracts during sleep. ## Classification - Primary: never dry for 6 months - Secondary: wetting returns after at least 6 months dry; look for a cause - Monosymptomatic: night wetting only - Non-monosymptomatic: with daytime symptoms (urgency, frequency, daytime wetting) ## Symptoms and signs - Wet bed at night with normal daytime control (monosymptomatic) - Daytime urgency, frequency or leakage in non-monosymptomatic forms - Deep sleep and difficulty waking - Embarrassment, low self-esteem and avoidance of sleepovers ## Red flags - Secondary enuresis with polyuria, polydipsia or weight loss (diabetes mellitus or insipidus) - Dysuria, fever or foul urine (urinary tract infection) - Weak urinary stream or continuous dribbling (posterior urethral valves, ectopic [ureter](https://durgical.com/en/anatomy/ureter/)) - Leg weakness, back abnormalities or faecal incontinence (neurogenic bladder, spinal dysraphism) - Loud snoring with pauses in breathing - Signs of abuse or major emotional stress ## Diagnosis **Clinical** History and a 2-week bladder and fluid diary (voided volumes, night wetting); bowel history; examination of the [abdomen](https://durgical.com/en/anatomy/region/abdomen/), genitals, lower back and lower-limb neurology; growth and blood pressure. **Tests** Urinalysis for all children (glucose, specific gravity, infection, protein). Further tests only if red flags are present. **Imaging** Not needed in monosymptomatic enuresis. Renal and bladder ultrasound or spinal MRI when an anatomical or neurological cause is suspected. ## Differential diagnosis - Urinary tract infection - Diabetes mellitus and diabetes insipidus - Neurogenic bladder (spina bifida, tethered cord) - Posterior urethral valves or ectopic ureter - Constipation with bladder dysfunction - Obstructive sleep apnoea ## Goal of treatment Reach dry nights, protect the child's self-esteem and treat any underlying cause; treatment usually starts at 6–7 years when the child is motivated. ## Treatment **Conservative** Education and reassurance that it is not the child's fault, no punishment, praise for dry nights; regular daytime drinking with less fluid in the evening, voiding before bed, and treating constipation. **Conservative** Enuresis (moisture) alarm used every night for several weeks: first-line with the best long-term cure rate, needs family commitment. **Medical** Desmopressin (a vasopressin analogue) is first-line for nocturnal polyuria or when a quick effect is needed; evening fluid restriction is essential because of hyponatraemia risk. Anticholinergics are added for overactive bladder. **Follow-up** Nursing: review diaries, alarm adherence and relapse; on desmopressin, teach families to restrict evening fluids and recognise headache, vomiting or confusion (water intoxication). ## Complications - Low self-esteem, anxiety and social isolation - Family conflict and risk of punishment or abuse - [Skin](https://durgical.com/en/anatomy/skin/) irritation - Hyponatraemia with desmopressin if fluids are not restricted ## Prognosis Most children become dry spontaneously over time, with about 15% resolving each year. Alarms give the most lasting results; relapses are common after stopping desmopressin. ## Prevention - Regular daytime voiding and adequate daytime fluids - Prevention and treatment of constipation - Avoiding caffeine and sugary drinks in the evening ## Test yourself Think of the answer, then tap the question to see it. ## From what age is bedwetting called enuresis? From 5 years of age. ## What is the first-line treatment with the best long-term results? The enuresis (moisture) alarm, with behavioural measures. ## What serious adverse effect of desmopressin must families know? Hyponatraemia and water intoxication if fluids are not restricted in the evening. ## Which test should every child with enuresis have? A urinalysis, to exclude infection, diabetes and concentrating defects. ## What is secondary enuresis? Wetting that returns after at least 6 months of dryness; an underlying cause should be sought. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/nocturnal-enuresis/) ## Related conditions - [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/) - [Diabetes insipidus (central and nephrogenic)](https://durgical.com/en/conditions/diabetes-insipidus/) - [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/) - [Functional constipation in children](https://durgical.com/en/conditions/functional-constipation-in-children/) - [Neurogenic bladder](https://durgical.com/en/conditions/neurogenic-bladder/) - [Posterior urethral valves](https://durgical.com/en/conditions/posterior-urethral-valves/) - [Spina bifida (myelomeningocele)](https://durgical.com/en/conditions/spina-bifida/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Bladder Control Problems & Bedwetting in Children](https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-bedwetting-children) (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2017); [Bedwetting in Children (Enuresis)](https://kidshealth.org/en/parents/enuresis.html) (Nemours KidsHealth, 2023). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/nocturnal-enuresis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/nocturnal-enuresis/