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Enuresis: practical guidelines for primary care

Vande Walle et al 2017

British Journal of General Practice 22 May 2017;

Commentary by Charlotte van Herzeele
Enuresis, or bedwetting, is a common but under-reported and under-prioritised problem affecting many children and families. Diagnostic and treatment guidelines are available but are frequently complex and targeted towards specialists, while accessible and practical recommendations for the primary care physician are lacking. However, treatment in primary care is both possible and desirable for many patients, in order to limit the patient’s burden and to avoid unnecessary investigations. The steering committee of World Bedwetting Day 2017, who represent major professional societies engaged in the treatment of enuresis, have therefore developed a simplified set of guidelines for the management of enuresis in primary care.  A two-step diagnostic process is recommended, and first-line treatment options are discussed.

Depending on aetiology, different treatment options are available in primary care. Nocturnal polyuria can be treated using the vasopressin analogue, desmopressin, which reduces the amount of urine during the night. Small bladder capacity at night and arousal problems in children with monosymptomatic nocturnal enuresis are treated using a bedwetting alarm. Enuresis caused by nocturnal polyuria and small bladder capacity at night can benefit from combination treatment with alarm and desmopressin.

Whatever the choice of treatment, family doctors should recognise that enuresis can be a heavy burden for families and offer basic advice on how to tackle the condition. Box 1 presents tips for parents of children with enuresis. Supportive advice and tips for children are shown in Box 2.

Box 1. Tips for parents of children with enuresis

  • Do not blame your child. Bedwetting is not your child’s fault.
  • Be supportive of your child. Reward your child by giving compliments for the effort your child makes, not for the result.
  • Understand that bedwetting is a problem that can be solved in most patients.
  • If your child is at least 5 years old, do not wait to discuss the bedwetting problem with your family doctor.
  • Waking up your child would not treat the condition.
  • Encourage your child to drink fluid during the day
  • Let your child use diapers/pull-ups to increase comfort and to decrease stress

Box 2. Tips for children suffering from enuresis

  • It is not your fault!
  • Drink more during the daytime
  • Limit your drinking during the last two hours before bedtime
  • No drinking at night
  • Pee before bedtime
  • Use diapers to give you more comfort and to decrease worry of wetting the bed
  • Talk to your parents about the bedwetting
  • Go to your family doctor - bedwetting is almost always treatable

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

Download the CMT


Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.