GPAtlas🧭 When to suspect
Enuresis is the involuntary passing of urine during sleep. Children are generally expected to be dry at night by a developmental age of 5 years, and bedwetting remains common up to around age 10 – roughly 1 in 5 at age 5 and 1 in 10 at age 10. It is rarely a sign of serious disease, but it carries a real burden of distress and shame for the child and family.
The single most useful step in primary care is to characterise the bedwetting before treating it: is it primary or secondary, and is it monosymptomatic (night-time only) or non-monosymptomatic (with daytime symptoms)? This distinction drives the entire plan. Treatment can be offered from age 5 wherever the wetting causes distress, and children under 7 should not be excluded on the basis of age alone.
| Pattern | Definition | Clinical significance |
|---|---|---|
| Primary | Never reliably dry for ≥ 6 months | Usually maturational / physiological; often a strong family history |
| Secondary | Relapse after ≥ 6 months of dryness | Exclude UTI, diabetes, constipation and emotional triggers |
| Monosymptomatic | Night-time wetting only | Responds to alarm or desmopressin |
| Non-monosymptomatic | Bedwetting plus daytime symptoms (urgency, frequency, daytime wetting) | Suggests bladder dysfunction; assess and treat daytime symptoms first |
Source: NICE CG111 · NICE QS70
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