GPAtlas
BEDWETTING (ENURESIS)
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🔍 When to Suspect
A child over 5 involuntarily passing urine during sleep; can be primary (never dry) or secondary (relapse after >6 months dry)
🩺 Assessment
- ◉ Symptoms → Daytime symptoms (wetting, urgency), fluid intake patterns (caffeinated drinks), primary vs secondary enuresis
- ◉ History → Thorough bowel habit assessment for constipation, recent stressors, family history, sleep disturbance
- ◉ Impact → Effect on child's self-esteem, social activities (sleepovers), and family life
- ◉ Exam findings → Abdominal exam for faecal loading or palpable bladder, inspect lower back for spinal abnormality, plot growth
💊 Management
🔸Key tests:
➤ Urine dipstick – not routine; only if onset is recent, daytime symptoms, signs of ill health, or UTI/diabetes suspected; bladder diary and stool chart
🔸Lifestyle:
➤ Treat constipation first; manage fluid intake (avoid caffeine before bed); establish regular toileting routines; use reward charts for adherence, not dryness
🔸Pharmacological: For children >5 years:
➤ First-line: Enuresis alarm. Review in 4 weeks; continue for 3-6 months if effective
➤ First-line (alongside alarm): Desmopressin. Offer when rapid or short-term dryness is the priority (e.g. sleepover/trip) or alarm is inappropriate. Fluid restriction 1 hour before to 8 hours after. Withdraw for 1 week every 3 months to check if dryness is achieved
🔸Follow-up/safety-net:
➤ Under 5s: provide reassurance. Refer if treatment fails or if there is significant distress
⚠️ Red Flags
• Signs of urinary tract infection (dysuria, fever)
• Signs of diabetes mellitus (polyuria, polydipsia, weight loss)
• Neurological symptoms (gait disturbance, weakness) or spinal signs
• New onset daytime wetting
➡️ Referral Criteria
Urgent: Any red flags, especially suspected diabetes or spinal pathology
Routine: Child >7, treatment failure, persistent daytime symptoms, or significant impact on child/family
📌 GP Tips
🔹Always ask about and aggressively treat constipation first, as it is a very common and reversible cause of bedwetting
🔹Reward charts should reward adherence to the plan (e.g., drinking well, using the alarm), not the outcome of dry nights