Skip to main content
SpringerLink
Log in

Nocturnal enuresis

  • Practical Pediatric Nephrology
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Nocturnal enuresis is a very common pediatric problem which often has strong genetic roots. In the vast majority of children it resolves spontaneously, with time, therefore research and treatment of bedwetting cannot carry any risk to the child. The research on the etiology of bedwetting has been focused on sleep disturbances, nocturnal urine production and functional bladder capacity. So far it has not provided conclusive evidence of the pathophysiology of the phenomenon. It is possible that different factors may be predominant in different age groups. Although bedwetters are basically mentally healthy, several studies have shown that the problem may cause secondary emotional and social problems which can be alleviated with successful intervention. Of the treatment modalities currently available to the pediatrician, the most effective is the moisture alarm. Combined with its safety and low cost it should become the treatment of choice in most cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Novello AC, Novello JR (1987) Enuresis. Pediatr Clin North Am 34: 719–732

    PubMed  Google Scholar 

  2. Fitzwater D, Macknin ML (1992) Risk/benefit ratio in enuresis therapy. Clin Pediatr (Phila) 308–310

  3. De Jonge GA (1973) Epidemiology of enuresis: a survey of the literature. In: Kolvin I, MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Lippincott, Philadelphia, pp 39–46

    Google Scholar 

  4. Poulton ME (1952) Relative nocturnal polyuria as a factor in enuresis. Lancet II: 906–907

    Google Scholar 

  5. Bakwin H (1973) The genetics of enuresis. In: Kolvin I, MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Lippincott, Philadelphia, pp 73–77

    Google Scholar 

  6. Hallgren B (1960) Nocturnal enuresis in twins. Acta Psychol Neurol Scand 35: 73–77

    Google Scholar 

  7. Hallgren B (1958) Nocturnal enuresis: aetiologic aspects. Acta Paediatr [Suppl] 118: 66–44

    Google Scholar 

  8. Jarvelin MR, Vikevainen-Tervonen L, Moilanen I, Huttunen NP (1988) Enuresis in seven-year-old children. Acta Paediatr Scand 77: 148–153

    PubMed  Google Scholar 

  9. Kaffman M, Elizur E (1977) Infants who become enuretics: a longitudinal study of 161 Kibbutz children. Monogr Soc Res Child Dev 42: 2–12

    Google Scholar 

  10. Hallman N (1950) On the ability of enuretic children to hold urine. Acta Paediatr 39: 87–93

    PubMed  Google Scholar 

  11. Berger MR, Maizels M, Moran CG, Conway JJ, Firlit FC (1983) Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns. J Urol 129: 347–349

    PubMed  Google Scholar 

  12. Vullimay D (1956) The day and night output of urine in enuresis. Arch Dis Child 31: 439–443

    PubMed  Google Scholar 

  13. Starfield B (1967) Functional bladder capacity in enuretic and nonenuretic children. J Pediatr 70: 777–781

    PubMed  Google Scholar 

  14. Readett J, Morris J (1990) Determinants of nocturnal enuresis in homozygous sickle cell disease. Arch Dis Child 65: 615–618

    PubMed  Google Scholar 

  15. Zaleski A, Gerrard JW, Shokeir MHK (1973) Nocturnal enuresis: the importance of small bladder capacity. In: Kolvin I, MacKeith RC, Meadows SR (eds) Bladder control and enuresis, Lippincott, Philadelphia, pp 95–109

    Google Scholar 

  16. Hagglund TB, Parkulainen KV (1964) Enuretic children treated with imipramine (Tofranil): a cystometric study. Ann Pediatr Fenn 11: 53–59

    Google Scholar 

  17. Troup CW, Hodgson NB (1971) Nocturnal functional bladder capacity in enuretic children. J Urol 105: 129–132

    PubMed  Google Scholar 

  18. Starfield B, Mellits E (1968) Increase in functional bladder capacity and improvement in enuresis. J Pediatr 72: 483–487

    PubMed  Google Scholar 

  19. Esperanca M, Gerrard JW (1969) Nocturnal enuresis. Can Med Assoc J 101: 721–724

    Google Scholar 

  20. Berg I, Forsythe I, McGuire R (1982) Response of bedwetting to the enuresis alarm. Arch Dis Child 57: 394–396

    PubMed  Google Scholar 

  21. Fielding D (1980) The response of day and night wetting children and children who wet only at night to retention control training and the enuresis alarm. Behav Res Ther 18: 305–317

    PubMed  Google Scholar 

  22. Mills JN (1951) Diurnal rhythm in urine flow. J Physiol 113: 528–536

    PubMed  Google Scholar 

  23. Ditman SK, Blinn AK (1955) Sleep levels in enuresis. Am J Psychiatry 111: 913–920

    PubMed  Google Scholar 

  24. Graham P (1973) Depth of sleep and enuresis: a critical review. In: Kolvin I, MacKeith RC, Meadows SR (eds) Bladder control and enuresis. Lippincott, Philadelphia, pp 78–83

    Google Scholar 

  25. Inoue M, Shimojima H, Chiba H, Tsukahara N, Tajika Y, Taka K (1987) Rhythmic slow wave observed on nocturnal sleep encephalogram in children with idiopathic nocturnal enuresis. Sleep 10: 570–579

    PubMed  Google Scholar 

  26. Salmon MA, Taylor DC, Lee D (1973) On the EGG in enuresis. In: Kolvin I, MacKeith RC, Meadows SR (eds) Bladder control and enuresis. Lippincott, Philadelphia, pp 78–83

    Google Scholar 

  27. Alon U, Woodward V, Howard CP (1992) Urine volume, age and nocturnal enuresis: a prospective study on newly diagnosed children with diabetes mellitus. Child Hosp Q 4: 157–160

    Google Scholar 

  28. Boyd MM (1960) The depth of sleep in enuretic school children and in non-enuretic controls. J Psychosom Res 4: 274–281

    PubMed  Google Scholar 

  29. Ranson SW, Karbat H, Magoun HW (1935) Autonomic responses to electrical stimulation of hypothalamus, preoptic region and septum. Arch Neurol Psychiatry 33: 467–477

    Google Scholar 

  30. Strom-Olsen R (1950) Enuresis in adults and abnormality of sleep. Lancet II: 133–135

    Google Scholar 

  31. Martin JG (1971) Imipramine pamoate in the treatment of childhood enuresis. Am J Dis Child 122: 42–47

    PubMed  Google Scholar 

  32. Oppel WC, Harper PA, Rider RV (1968) Social, psychological and neurological factors associated with nocturnal enuresis. Pediatrics 42: 627–641

    PubMed  Google Scholar 

  33. Werry JS, Cohrssen J (1965) Enuresis — an etiologic and therapeutic study. J Pediatr 67: 423–431

    PubMed  Google Scholar 

  34. Hallgren B (1957) Enuresis: a clinical and genetic study. Acta Psychiatr Neurol Scand 32 [Suppl 114]: 1–159

    Google Scholar 

  35. Wagner W, Johnson SB, Walker D, Carter R, Wittner J (1982) A controlled comparison of two treatments for nocturnal enuresis. J Pediatr 101: 302–307

    PubMed  Google Scholar 

  36. Fergusson DM, Hons BA, Horwood LJ, Shannon FT (1986) Factors related to the age of attainment of nocturnal bladder control: an 8-year longitudinal study. Pediatrics 78: 884–890

    PubMed  Google Scholar 

  37. Weir K (1982) Night and day wetting amongst a population of three-years-old. Dev Med Child Neurol 24: 479

    PubMed  Google Scholar 

  38. Couchells SM, Johnson SB, Carter R, Walker D (1981) Behavioral and environmental characteristics of treated and untreated enuretic children and matched nonenuretic controls. J Pediatr 99: 812–816

    PubMed  Google Scholar 

  39. Butler RJ, Brewin CR, Forsythe WI (1988) A comparison of two approaches to the treatment of nocturnal enuresis and the prediction of effectiveness using pre-treatment variables. J Child Psychol Psychiatr 29: 501–509

    Google Scholar 

  40. Dische S, Yule W, Corbett J, Hand D (1983) Childhood nocturnal enuresis: factors associated with outcome of treatment with an enuresis alarm. Dev Med Child Neurol 25: 67–80

    PubMed  Google Scholar 

  41. Devlin JB, O'Cathain C (1990) Predicting treatment outcome in nocturnal enuresis. Arch Dis Child 65: 1158–1161

    PubMed  Google Scholar 

  42. Foxman B, Valdez RB, Brook RH (1986) Childhood enuresis: prevalence, perceived impact, and prescribed treatments. Pediatrics 77: 482–487

    PubMed  Google Scholar 

  43. Hague M, Ellerstein NS, Gundy JH, Shelov SP, Weiss JC, McIntire MS, Olness KN, Jones DJ, Heagarty MC, Starfield BH (1981) Parental perceptions of enuresis. Am J Dis Child 135: 809–810

    PubMed  Google Scholar 

  44. Baker LB (1969) Symptom treatment and symptom substitution in enuresis. J Abnorm Psychol 74: 42–49

    PubMed  Google Scholar 

  45. Moffatt MEDK, Kato C, Pless IB (1987) Improvements in selfconcept after treatment of nocturnal enuresis: randomized controlled trial. J Pediatr 110: 647–652

    PubMed  Google Scholar 

  46. Fireman G (1989) Nocturnal enuresis: psychological correlates and behavior therapy. Child Hosp Q 1: 349–352

    Google Scholar 

  47. Butler RJ (1991) Establishment of working definitions in nocturnal enuresis. Arch Dis Child 66: 267–271

    PubMed  Google Scholar 

  48. MacLean REG (1960) Imipramine hydrochloride (Tofranil) and enuresis. Am J Psychiatry 117: 551

    PubMed  Google Scholar 

  49. Poussaint FA, Ditman SK (1965) A controlled study of imipramine (Tofranil) in the treatment of childhood enuresis. J Pediatr 67: 283–290

    Google Scholar 

  50. Drew LRH (1966) Control of enuresis by imipramine. Med J Aust 2: 1225–1227

    PubMed  Google Scholar 

  51. Forsythe WI, Merrett JD (1969) A controlled trial of imipramine (Tofranil) and nortriptyline (Allegron) in the treatment of enuresis. Br J Clin Pract 23: 210–215

    PubMed  Google Scholar 

  52. Shaffer D, Costello AJ, Hill ID (1968) Control of enuresis with imipramine. Arch Dis Child 43: 665–671

    PubMed  Google Scholar 

  53. Kunin SA, Limbert DJ, Platzker CG (1970) The efficacy of imipramine in the management of enuresis. J Urol 104: 612–615

    PubMed  Google Scholar 

  54. Blackwell B, Currah J (1973) The psychopharmacology of nocturnal enuresis. In: Kolvin I, MacKeith RC, Meadow SR (eds) Bladder control and enuresis. Lippincott, Philadelphia, pp 231–257

    Google Scholar 

  55. Anderson RP, Morris BAP (1988) Acrocyanosis due to imipramine. Arch Dis Child 63: 204–205

    PubMed  Google Scholar 

  56. Fletcher ES, Case LC, Sallee F, Hand DL, Gillettee CP (1993) Prospective study of the electrocardiographic effects of imipramine in children. J Pediatr 122: 652–654

    PubMed  Google Scholar 

  57. Sesso AM, Snyder RC, Schott CE (1973) Propranolol in imipramine poisoning. Am J Dis Child 120: 652–654

    Google Scholar 

  58. Young CG (1965) Conditioning treatment of enuresis. Dev Med Child Neurol 7: 557–562

    PubMed  Google Scholar 

  59. Wickes GI (1958) Treatment of persistent enuresis with the electric buzzer. Arch Dis Child 33: 160–164

    PubMed  Google Scholar 

  60. Dische S (1971) Management of enuresis. BMJ 2: 33–36

    PubMed  Google Scholar 

  61. Forsythe WI, Redmond A (1970) Enuresis and the electric alarm. BMJ 1: 211–213

    PubMed  Google Scholar 

  62. Meadow R (1977) How to use buzzer alarms to cure bed-wetting. BMJ 2: 1073–1075

    PubMed  Google Scholar 

  63. Robertson GL, Mahr EA, Athar S, Sinha T (1973) Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest 52: 2340–2352

    PubMed  Google Scholar 

  64. George PLC, Messerli HF, Genest J, Nowaczynski W, Kuchel O, Rojo-Ortega M (1975) Diurnal variation of plasma vasopressin in man. J Clin Endocrinol Metab 41: 332–338

    PubMed  Google Scholar 

  65. Norgaard JP, Pedersen EB, Djurhuus JC (1985) Diurnal antidiuretic-hormone levels in enuretics. J Urol 134: 1029–1031

    PubMed  Google Scholar 

  66. Fefferman RA (1994) DDAVP approval question. Pediatrics 93: 1022–1023

    PubMed  Google Scholar 

  67. Rittig S, Knudsen UB, Norgaard JP, Pedersen EB, Djurhuus JC (1989) Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol 256: F664-F671

    PubMed  Google Scholar 

  68. Puri VN (1980) Urinary levels of antidiuretic hormone in nocturnal enuresis. Indian Pediatr 17: 675–676

    PubMed  Google Scholar 

  69. Dimson (1977) Desmopressin as a treatment for enuresis. Lancet I: 1260

    Google Scholar 

  70. Dimson SB (1986) DDAVP and urine osmolality in refractory enuresis. Arch Dis Child 61: 1104–1107

    PubMed  Google Scholar 

  71. Tuvemo T (1978) DDAVP in childhood nocturnal enuresis. Acta Paediatr Scand 67: 753–755

    PubMed  Google Scholar 

  72. Birkasova M, Birkas O, Flynn JM, Cort HJ (1978) Desmopressin in the management of nocturnal enuresis in children: a doubleblind study. Pediatrics 62: 970–974

    PubMed  Google Scholar 

  73. Aladjem M, Wohl R, Boichis H, Orda S, Lotan D, Freedman S (1982) Desmopressin in nocturnal enuresis. Arch Dis Child 57: 137–140

    PubMed  Google Scholar 

  74. Legros JJ, Gilot P, Seron X (1978) Influence of vasopressin on learning and memory. Lancet I: 41–42

    Google Scholar 

  75. Post ME, Richmond AR, Blackett RP, Duncan PK, Miller K (1983) Desmopressin response of enuretic children. Am J Dis Child 137: 962–963

    PubMed  Google Scholar 

  76. Hogg JR, Husmann D (1983) The role of family history in predicting response to desmopressin in nocturnal enuresis. J Urol 150: 444–445

    Google Scholar 

  77. Miller K, Goldberg S, Atkin B (1989) Nocturnal enuresis: experience with long-term use of intranasally administered desmopressin. J Pediatr 114: 723–726

    PubMed  Google Scholar 

  78. Key DW, Bloom DA, Sanvordenker J (1992) Low-dose DDAVP in nocturnal enuresis. Clin Pediatr (Phila) 31: 299–301

    Google Scholar 

  79. Evans JHC, Meadow SR (1992) Desmopressin for bed wetting: length of treatment, vasopressin secretion, and response. Arch Dis Child 67: 184–188

    PubMed  Google Scholar 

  80. Moffatt MEK, Harlos S, Kirshen AJ, Burd L (1993) Desmopressin acetate and nocturnal enuresis: how much do we know? Pediatrics 92: 420–425

    PubMed  Google Scholar 

  81. Rappaport L (1993) The treatment of nocturnal enuresis — where are we now. Pediatrics 92: 465–466

    PubMed  Google Scholar 

  82. Kallio J, Rautava P, Huupponen R, Korvenranta H (1993) Severe hyponatremia caused by intranasal desmopressin for nocturnal enuresis. Acta Paediatr Scand 82: 881–882

    Google Scholar 

  83. Muglia L, Goodman E, Peters C, Majzoub J (1992) Symptomatic hyponatremia secondary to DDAVP treatment for primary enuresis. Pediatr Res 31: 81A

    Google Scholar 

  84. There is no author (1990) Desmopressin for nocturnal enuresis. Med Lett 32: 38–39

    Google Scholar 

  85. Simmonds EJ, Madony MJ, Littlewood JM (1988) Convulsion and coma after intranasal desmopressin in cystic fibrosis. BMJ 297: 1614

    Google Scholar 

  86. Wille S (1986) Comparison of desmopressin and enuresis alarm for nocturnal enuresis. Arch Dis Child 61: 30–33

    PubMed  Google Scholar 

  87. Sukhai RN, Mol J, Harris AS (1989) Combined therapy of enuresis alarm and desmopressin in the treatment of nocturnal enuresis. Eur J Pediatr 148: 465–467

    PubMed  Google Scholar 

  88. Weider JD, Sateia JM, West PR (1991) Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg 105: 427–432

    PubMed  Google Scholar 

  89. Egger J, Carter CH, Soothill JF, Wilson J (1992) Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. Clin Pediatr (Phila) 31: 302–307

    Google Scholar 

  90. Poole CJM, Lightman SL (1988) Inhibition of vasopressin secretion during migraine. J Neurol Neruosurg Psychiatry 51: 1441–1444

    Google Scholar 

  91. O'Regan S, Yazbeck S, Hamberger B, Schick E (1986) Constipation a commonly unrecognized cause of enuresis. Am J Dis Child 140: 260–261

    PubMed  Google Scholar 

  92. Long BC (1991) A drug free program for nocturnal enuresis. Urol Nurs, March pp 15–16

  93. Steward MA (1975) Treatment of bedwetting. JAMA 232: 281–283

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, The Children's Mercy Hospital, University of Missouri at Kansas City, 2401 Gillham Road, 64108, Kansas City, Missouri, USA

    Uri S. Alon

Authors
  1. Uri S. Alon
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alon, U.S. Nocturnal enuresis. Pediatr Nephrol 9, 94–103 (1995). https://doi.org/10.1007/BF00858985

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00858985

Key words

Search

Navigation