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- Involuntary, urinary incontinence after age of expected bladder control; term generally reserved for children ≥5 years of age; may be
- Primary: has never been “dry” for 6 months (80%)
- Secondary: patient previously “dry” for 6 months or longer
- Classified as
- Monosymptomatic nocturnal enuresis (MNE)
- Non-monosymptomatic nocturnal enuresis (NMNE) if there is evidence of lower urinary tract malfunction (e.g., delayed voiding, frequency, urgency, holding maneuvers)
- Male > female, although some recent reports state that nocturnal enuresis is more common in girls than in boys
- 10–15% of children at age 5 years
- 7–15% of children at 7 years
- 5% of children at 10 years
- 0.5–1% in teenagers and adults
- Lower urinary tract dysfunction
- Sleep disorders (e.g., obstructive sleep apnea [OSA])
- Neuropsychiatric disorders
- 60–70% have a positive family history of enuresis.
- Risk of severe enuresis is greater with maternal enuresis history compared with paternal history (odds ratio 3.6 vs. 1.8).
- Autosomal dominant pattern seen in 50%, whereas 30% of cases are sporadic
- Risk is twice as high in monozygotic twin of a child with enuresis compared with a dizygotic twin.
- Several loci on chromosomes 8q, 12q, 13q, and 22q associated with a nocturnal enuresis phenotype; candidate genes include ENUR1 and ENUR2.
- Primary nocturnal enuresis: results from interplay of one or more of the following:
- Nocturnal polyuria
- Decreased functional bladder volume
- Increased detrusor activity
- Increased arousal threshold when asleep
- Inadequate secretion of antidiuretic hormone
- Daytime incontinence and enuresis, day and night
- As above
- More concerning for underlying urologic and neurologic disorder
- Urinary reflux into vagina with seepage after conclusion of voiding
- Insertion of ureter into urethra or vagina
- Stress incontinence with increased abdominal pressure (laughing, coughing, increased intravesicular pressure)
- Secondary enuresis can result from:
- Any condition causing polyuria (including diabetes, hypercalcemia)
- Urinary tract infection (UTI)
- Emotional stress or trauma including physical and sexual abuse, parental divorce, depression, new sibling, household moving, new school
Commonly Associated Conditions
Neuropsychiatric comorbidities: ADHD, anxiety, and oppositional behavior are more commonly associated with secondary nocturnal enuresis.