Managing Nocturnal Enuresis

Nocturnal enuresis, also known as involuntary urination or bedwetting, is common among children. It affects about 15% of 5-year-olds and 1% of teenagers older than 15. The condition can cause significant stress and affect quality of life and social relationships.
Monosymptomatic nocturnal enuresis is strongly related to sleep patterns, as children who sleep very deeply may not wake in response to the body’s signals that the bladder is filling. Rarely, it may be related to an anatomic or physiologic pathology.
The condition usually resolves over time, but there are options to reduce symptoms and improve quality of life. Brian Miller, PA-C, MSPAS, lead advanced practice provider in the Department of Pediatric Urology at Children’s Hospital Colorado, says the decision to intervene should be guided by the child and family. If symptoms do not cause distress, observation is always appropriate. Behavioral interventions are often effective, such as voiding regularly throughout the day, double voiding before bed, ensuring daily bowel movements, and fluid shifting (drinking fluids earlier in the day and minimizing fluids one to two hours before bed).
A bedwetting alarm can help condition the child to wake up in response to bladder signals. In addition, the first-line pharmacologic choice is desmopressin tablets (DDAVP), which concentrate urine during sleep so there is less urine production during the night. Alternative treatments include anticholinergics and transcutaneous electrical nerve stimulation (TENS).
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