Nocturnal Enuresis in Children

Etiology and Risk Factors

Children have a 44% risk of enuresis when one parent was enuretic, and 77% risk when both parents were affected, compared to only 15% in children from non-enuretic families 1
The American Academy of Child and Adolescent Psychiatry suggests that genetic data have identified specific chromosomal loci linked to enuresis, confirming the hereditary basis 1
Primary monosymptomatic nocturnal enuresis represents the most common presentation, involving three major pathophysiological mechanisms: nocturnal polyuria, detrusor overactivity, and increased arousal threshold 2

The American Academy of Child and Adolescent Psychiatry recommends that family history is critical: Ask specifically about parental history of bedwetting, as this strongly suggests hereditary primary enuresis 1
Sleep-related symptoms to screen for OSA include habitual snoring, witnessed apneas or gasping during sleep, restless sleep or unusual sleeping positions, and daytime sleepiness or behavioral problems 3
The pattern of enuresis, including primary versus secondary and monosymptomatic versus non-monosymptomatic, should be assessed 1, 2, 4

The American Academy of Child and Adolescent Psychiatry suggests that first-line behavioral interventions for hereditary/primary enuresis include regular daytime voiding schedule, evening fluid restriction, and treatment of constipation if present 6
Enuresis alarm therapy has approximately 66% success rate with long-term effectiveness 6
Desmopressin is effective for children with nocturnal polyuria, with a 30% full response and 40% partial response rate 5, 6
Surgical correction of upper airway obstruction should be pursued when OSA is identified, as this can lead to improvement or cure of the enuresis 1, 3