Based on lecture by Sandra Sexson, M.D.

Definition: involuntary or inappropriate passage of urine in a child beyond the gage he should be toilet trained.

"primary" = never dry for any 3-6 month period; probably a developmental issue.

"secondary" = relapses; usually self-limiting; often associated with stress.

3 million children in U.S. have primary nocturnal enuresis

male: female = 2:1

15% of 5-6 year olds

3% of adolescents

Consider medical causes of enuresis (but "don't go overboard" in your evaluation):

Organic causes

Diabetes (either insipidus or juvenile onset) - maybe first symptom.

Urinary tract infection, especially in girls if relapse in bed-wetting

Check urinalysis +/- urine culture

Neurological problems such as spinal bifida <= relatively rare

Maturational delay

Tends to be familial; fathers who were bed-wetters more likely to have bed-wetting offspring. May also be true for mothers.

Psychological delays (especially of secondary enuresis)

Stress may be causative, but bed-wetting more often a cause of than a symptom of psychological distress

Night terrors, sleep walking - associated with waking up from stage IV sleep

Spontaneous resolution peaks at ages 6-7, and at age 11-12.

Management of Primary Nocturnal Enuresis

Encopresis = inappropriate passing of feces at developmentally inappropriate age (> 5 usually).


    1. Evacuate child's colon
    2. Use laxatives and enemas in combination.

      Get KUB radiograph before initiating to insure colon isn't obstructed by huge mass of hardened feces.

      May require manual disimpaction.

    3. Keep stool movable
    4. Attempt bowel movement 2 times / day - have child sit on toilet after breakfast and dinner.
    5. Keep child's feet on something firm, so may need small toilet.

      May need to sit for as long as half an hour, so may need some other activity to make it a more pleasant experience.

    6. Increase positive reinforcement
    7. Decrease negative reinforcement


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