Nocturnal enuresis is defined as the repeated involuntary discharge of urine during sleep after a child is developmentally expected to attain bladder control. It is diagnosed when a child voids twice a week for at least 3 months and experiences distress. Nocturnal enuresis is more common in boys than girls and affects around 15-20% of 5 year old children, with 90% experiencing the persistent type. Causes include genetic factors, physiological immaturity, psychological stress, and organic issues like urinary tract infections. Treatment begins with behavioral modifications like rewards, scheduled voiding, and alarms, with medication options if unsuccessful.

1. NOCTURNAL
ENURESIS
Fahad Al Hulaibi

2. Definition
 defined as:
the voluntary or involuntary repeated discharge of
urine into clothes or bed after a developmental age
when bladder control should be established.
When ?

3.  The diagnosis of enuresis is made when urine is
voided:
- Twice a week for at least 3 consecutive months
-When clinically significant distress occurs in areas of
the child's life as a result of the wetting.

4. prevalence
Female Male
3% 7%
All child
90%
5 y/o childs

5. Types
 Persistent (primary) type: 90%
in which the child has never been dry at night
 Regressive (secondary) type:
in which a child who has been continent for 6 mo or
longer then begins to wet the bed.

6. Further classifications:
 Nocturnal enuresis: Common in girl
Rarely happened after 9y/o
voiding urine at night
Most common causes is: micturition deferral
Other causes:
is urinary tract infection, chemical urethritis, associated
constipation, diabetes, and giggle or stress incontinence
 Diurnal enuresis :
voiding urine while awake

7. ETIOLOGY
 Genetic factors.
 physiologic factors:
 psychologic factors:
Increase age , hyperactive children
stress and/or traumatic experiences
Organic causes:
DM, UTI, Small bladder or Neurological problems

8. Investigations
 Ultrasonography
 Uroflowmetry
 Urinalysis
 urine culture

9. TREATMENT
 should begin with behavioral treatment.
1. Rewarding the child for being dry at night is a
useful step.

10. 2. The child should void before retiring.
3. using an alarm clock to wake the child once 2–3
hr after he or she falls asleep is indicated.
4. No Punishment of the child.

11.  Use of conditioning devices
(an alarm that rings when the child wets a special sheet)

12.  Pharmacotherapy:
If behavioral treatment is not working
Imipramine (DDAVP)

14. References
Kliegman R, Stanton B, Behrman
R, Jenson H. Nelson Textbook
of Pediatrics. 18th ed. 2007.
Saunders Elseveir.