Isolated Enuresis in Children

Monosymptomatic (isolated) enuresis


  • Involuntary voiding of urine, in children of age 5 years and above
  • at least twice a week for at least 3 months with no underlying medical problem
Boys with family history of delayed bladder control are predisposed to prolonged bedwetting
The most common causes of diurnal enuresis are diabetes insipidus, UTI, seizure, constipation, and abuse.


  • best initial – Urinalysis (to rule out UTI, DM, DI)
  • Urologic imaging for children with significant daytime symptoms & history of recurrent UTI


  • Behavior modifications

    • Avoid sugary/caffeinated beverages
    • Void regularly during the day & immediately before bedtime
    • Drink ample fluids in the morning & early afternoon; minimize fluid intake before bedtime
    • Reward system (eg, “gold star” chart)
  • Enuresis alarm:
    • 1st-line intervention when Behavior modifications fail; the best long-term outcome
  • Pharmacotherapy: Best for short-term improvement; but there is a high risk of relapse
    • 1st-line: Desmopressin; risk of relapse (up to 70%) and hyponatremia
    • 2nd-line: Tricyclic antidepressants (imipramine); SE: increased suicidality, cardiotoxicity

It is important to rule out the secondary causes and treat accordingly.

Causes of secondary enuresis

  • Psychological stress – presents with behavior regression, mood lability
  • UTI – presents with dysuria, hesitancy, urgency, abdominal pain
  • Diabetes mellitus –  polyuria, polydipsia, polyphagia, weight loss, lethargy, candidiasis
  • Diabetes insipidus – polyuria, polydipsia
  • Obstructive sleep apnea – snoring, dry mouth, fatigue, hyperactivity, irritability

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