Evidence-based assessment and management of childhood enuresis

Mild or moderate enuresis (night-time wetting twice/week or less) in children is common and often spontaneously resolves, whereas severe enuresis (wetting every night) is uncommon and resolution rates are poor particularly after 10 years of age. Accurate and informed assessment along with classification of enuresis by a health professional will inform prognosis and management. Monosymptomatic enuresis can be caused by nocturnal polyuria, inability to wake and a constitutionally small bladder with appropriate treatment being desmopressin or an alarm or a combination of both. Non-monosymptomatic enuresis is contributed to by bladder overactivity with appropriate treatment being bladder training and anticholinergics plus or minus desmopressin. Complications such as constipation, recurrent urinary tract infections, bladder dysfunction or obstructive sleep apnoea warrant early, independent management. Knowledge of comorbidities, such as motor disorders or attention deficit hyperactivity disorder, along with understanding of child and family factors, further refine and tailor management strategies. Current evidence-based strategies provide effective treatment for a condition that can impact on the self-esteem of children and the well-being of families.