Enuresis is when it goes wrong
after it’s already been achieved.
So generally, this is a voluntary
or involuntary release of urine
after the age when control should be achieved
or after it’s already been achieved.
So primary enuresis is when
they never achieve their goal
and secondary enuresis is
when the goal is achieved.
They’re peeing on the potty for at least
six months, and then the control is lost.
When we have patients with enuresis,
it’s important to distinguish between
nighttime and daytime enuresis.
Nighttime enuresis is when patients have
an inability to wake up and then go pee.
So this isn’t a voluntary inability
to go to the toilet and urinate,
it’s that their sleeping
through the experience
and they wake up after
they’ve already peed.
There are some genetic influences here
in that a family history is
fairly common for this problem.
And generally, continence is achieved
normally at ages three to five.
So if it’s later than this,
we’re having a problem.
This is to be distinguished
from daytime enuresis.
Daytime enuresis is more common in girls.
It relates to waiting too
long to go to the bathroom.
Children are distracted,
don’t want to waste their time going
pee, wants to do something else.
And generally, continence in
daytime should be achieved
normally in children
ages two to four.
So if they’re not accomplishing
this, now we have a problem.
In children with either day or
night control by the age of five,.
there’s usually an
So we should consider things like chronic
recurrent urinary tract infections,
the presence of diabetes, especially if it’s
gotten much worse in the last few weeks,
a spinal cord lesion,
such as tethered cord,
may present as a difficulty
with controlling urine.
An overactive bladder
is a possible diagnosis
or maybe the patient has a
chemical urethritis or vaginitis
such as with bubble baths.
This can result in voluntary withholding
because it hurts a little bit to pee,
they get backed up and then
they have an accident.
Or rarely, there could be some
physical trauma or hopefully not,
but sometimes sexual abuse, which
is causing that child to withhold
either because of pain with urination
or because of unpleasant feelings
around their genital area.
If patients have a behavioral reason
why they are having enuresis,
we generally give parents reassurance.
Most children outgrow this.
Generally, we should try to wake the
child at night to go to the bathroom
if they’re having nighttime problems.
Voiding alarms aren’t particularly
helpful but the can be tried.
Basically what this is is a
sensor that’s in the panties
that can go off when things
become just a little bit moist.
Then, it triggers a loud alarm
and the child wakes up.
The problem with these is they have peed
already a little bit by the time they wake up.
So they aren’t always
but sometimes they will work
and it’s pretty harmless to try.
Another thing you can do
in very recalcitrant cases
where the child simply can’t
control their urination,
is we can provide
something like DDAVP.
Generally, we’ll give a dose of
nasal DDAVP before they go to bed
and they will have less likelihood
of urination throughout the night.
Keep an eye on them though and make
sure that their sodium levels are okay.
We don’t want a
low sodium level.
Rarely patients will get
Though that is very unusual.