Pediatric Drugs

, Volume 14, Issue 2, pp 71–77 | Cite as

Medical Management of Nocturnal Enuresis

  • Aniruddh V. Deshpande
  • Patrina H. Y. CaldwellEmail author
Therapy in Practice


Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family.

Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after being successfully dry at night for at least 6 months). Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of the abnormalities mentioned above.

Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine. This group (non-monosymptomatic nocturnal enuresis) requires a different clinical approach, with a focus on treating daytime bladder symptoms, which commonly involves pharmacotherapy with anti-cholinergic medications and urotherapy (including addressing bowel problems).

This review discusses the current management of nocturnal enuresis using the terminologies recommended by the International Children’s Continence Society.


Detrusor Overactivity Oxybutynin Desmopressin Tolterodine Nocturnal Enuresis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors have no potential conflicts of interest and no funding was received by any of the authors involved in the writing of this manuscript.


  1. 1.
    Redsell SA, Collier J. Bedwetting, behaviour and self-esteem: a review of the literature. Child Care Health Dev 2001 Mar; 27(2): 149–62PubMedCrossRefGoogle Scholar
  2. 2.
    Bower WF, Moore KH, Shepherd RB, et al. The epidemiology of childhood enuresis in Australia. Br J Urol 1996; 78(4): 602–6PubMedCrossRefGoogle Scholar
  3. 3.
    Neveus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006; 176(1): 314–24PubMedCrossRefGoogle Scholar
  4. 4.
    Hirasing RA, van Leerdam FJM, Bolk-Bennink L, et al. Enuresis nocturna in adults. Scand J Urol Nephrol 1997; 31(6): 533–6PubMedCrossRefGoogle Scholar
  5. 5.
    Yeung CK, Sihoe JD, Sit FK, et al. Characteristics of primary nocturnal enuresis in adults: an epidemiological study. BJU Int 2004; 93(3): 341–5PubMedCrossRefGoogle Scholar
  6. 6.
    von Gontard A, Schaumburg H, Hollmann E, et al. The genetics of enuresis: a review. J Urol 2001 Dec; 166(6): 2438–43CrossRefGoogle Scholar
  7. 7.
    Rittig S, Knudsen UB, Norgaard JP, et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol 1989 Apr; 256 (4 Pt 2): F664–71PubMedGoogle Scholar
  8. 8.
    Kawauchi A, Imada N, Tanaka Y, et al. Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis. Br J Urol 1998 May; 81Suppl. 3: 72–5PubMedGoogle Scholar
  9. 9.
    Yeung CK, Diao M, Sreedhar B. Cortical arousal in children with severe enuresis. N Engl J Med 2008 May 29; 358(22): 2414–5PubMedCrossRefGoogle Scholar
  10. 10.
    Yeung CK, Sit FK, To LK, et al. Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int 2002 Aug; 90(3): 302–7PubMedCrossRefGoogle Scholar
  11. 11.
    Caldwell PHY, Edgar D, Hodson E, et al. 4. Bedwetting and toileting problems in children. Med J Aust 2005 Feb 21; 182(4): 190–5PubMedGoogle Scholar
  12. 12.
    Sureshkumar P, Caldwell PHY, Craig JC. Diagnosing daytime bladder symptoms in children with nocturnal enuresis: a comparison of brief parental questionnaire with in-depth, physician-elicited, assessment. J Paediatr Child Health 2010; 46(11): 636–41PubMedCrossRefGoogle Scholar
  13. 13.
    Tekgül S, Riedmiller H, Gerharz E, et al. Guidelines on paediatric urology. Pocket guideline [online]. Available from URL: [Accessed 2011 Aug 16]
  14. 14.
    Marschall-Kehrel AD, Murtz G, Kramer G, et al. A suggested treatment algorithm in nocturnal enuresis with emphasis on partial responders. Urologe A 2004 Jul; 43(7): 795–802PubMedCrossRefGoogle Scholar
  15. 15.
    O’Regan S, Yazbeck S, Hamberger B, et al. Constipation a commonly unrecognized cause of enuresis. Am J Dis Child 1986 Mar; 140(3): 260–1PubMedGoogle Scholar
  16. 16.
    McGrath KH, Caldwell PH, Jones MP. The frequency of constipation in children with nocturnal enuresis: a comparison with parental reporting. J Paediatr Child Health 2008 Jan; 44(1-2): 19–27PubMedGoogle Scholar
  17. 17.
    Sureshkumar P, Jones M, Caldwell PHY, et al. Risk factors for nocturnal enuresis in school-age children. J Urol 2009 Dec; 182(6): 2893–9PubMedCrossRefGoogle Scholar
  18. 18.
    Nicholson L, Smith DP. Dysfunctional elimination syndrome: where constipation, daytime urinary problems and bedwetting merge. Adv Nurse Pract 2007 Mar; 15(3): 26–31PubMedGoogle Scholar
  19. 19.
    O’Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol 1985; 23(3): 152–4PubMedGoogle Scholar
  20. 20.
    Halachmi S, Farhat WA. The impact of constipation on the urinary tract system. Int J Adolesc Med Health 2008; 20(1): 17–22PubMedCrossRefGoogle Scholar
  21. 21.
    Mowrer OH, Mowrer WM. Enuresis: a method for its study and treatment. Am J Orthopsychiatry 1938; 8: 436–59CrossRefGoogle Scholar
  22. 22.
    Glazener CMA, Evans JHC, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005; (2): CD002911Google Scholar
  23. 23.
    Glazener CMA, Evans JHC, Peto RE. Complex behavioural and educational interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2004; (1): CD004668Google Scholar
  24. 24.
    Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev 2005; (2): CD005230Google Scholar
  25. 25.
    Rushton HG. Older pharmacologic therapy for nocturnal enuresis. Clin Pediatr (Phila) 1993 Jul; Spec No: 10–3Google Scholar
  26. 26.
    Glazener CM, Evans JH, Peto RE. Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev 2003; (4): CD002238Google Scholar
  27. 27.
    Glazener CM, Evans JH. Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 2002; (3): CD002112Google Scholar
  28. 28.
    Vande Walle J, Stockner M, Raes A, et al. Desmopressin 30 years in clinical use: a safety review. Curr Drug Saf 2007 Sep; 2(3): 232–8CrossRefGoogle Scholar
  29. 29.
    Eggert P, Fritz A, Stecker B, et al. Desmopressin has an influence on the arousability of children with primary nocturnal enuresis. J Urol 2004 Jun; 171 (6 Pt 2): 2586–8PubMedCrossRefGoogle Scholar
  30. 30.
    Rahm C, Schulz-Juergensen S, Eggert P. Effects of desmopressin on the sleep of children suffering from enuresis. Acta Paediatr 2010 Jul; 99(7): 1037–41PubMedCrossRefGoogle Scholar
  31. 31.
    Gepertz S, Neveus T. Imipramine for therapy resistant enuresis: a retrospective evaluation. J Urol 2004 Jun; 171 (6 Pt 2): 2607–10PubMedCrossRefGoogle Scholar
  32. 32.
    Glazener CMA, Evans JHC, Peto RE. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev 2003; (3): CD002117Google Scholar
  33. 33.
    Nijman RJ. Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Urology 2004; 63 (3 Suppl. 1): 45–50PubMedCrossRefGoogle Scholar
  34. 34.
    Jonville AP, Dutertre JP, Barbellion M, et al. Adverse effects of oxybutynin chloride (Ditropan) in pediatrics. Arch Fr Pediatr 1993 Jan; 50(1): 27–9PubMedGoogle Scholar
  35. 35.
    Humphreys MR, Reinberg YE. Contemporary and emerging drug treatments for urinary incontinence in children. Paediatr Drugs 2005; 7(3): 151–62PubMedCrossRefGoogle Scholar
  36. 36.
    Bolduc S, Upadhyay J, Payton J, et al. The use of tolterodine in children after oxybutynin failure. BJU Int 2003 Mar; 91(4): 398–401PubMedCrossRefGoogle Scholar
  37. 37.
    Reinberg Y, Crocker J, Wolpert J, et al. Therapeutic efficacy of extended release oxybutynin chloride, and immediate release and long acting tolterodine tartrate in children with diurnal urinary incontinence. J Urol 2003 Jan; 169(1): 317–9PubMedCrossRefGoogle Scholar
  38. 38.
    Bolduc S, Moore K, Nadeau G, et al. Prospective open label study of solifenacin for overactive bladder in children. J Urol 2010 Oct; 184(4 Suppl.): 1668–73PubMedCrossRefGoogle Scholar
  39. 39.
    Austin PF, Ferguson G, Yan Y, et al. Combination therapy with desmopressin and an anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial. Pediatrics 2008 Nov; 122(5): 1027–32PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  • Aniruddh V. Deshpande
    • 1
    • 2
    • 3
  • Patrina H. Y. Caldwell
    • 2
    • 4
    Email author
  1. 1.Department of UrologyThe Children’s Hospital at WestmeadWestmeadAustralia
  2. 2.Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadAustralia
  3. 3.School of Public Health, Sydney Medical SchoolUniversity of SydneyAustralia
  4. 4.Discipline of Paediatrics and Child Health, Sydney Medical SchoolUniversity of SydneyAustralia

Personalised recommendations