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Causes of nocturnal enuresis in children

Causes of nocturnal enuresis in children
Condition Associated clinical features from history, examination, or urinalysis
Underlying renal/urologic abnormalities
Bladder dysfunction
  • Daytime wetting
  • Lower urinary tract symptoms (eg, urgency, holding maneuvers, interrupted micturition)
  • Wetness in the undergarments
Urinary tract infection
  • Abnormal urinalysis (pyuria, bacteriuria)
Chronic kidney disease
  • Poor growth or weight loss
  • Hypertension
  • Abnormal urinalysis (proteinuria, hematuria)
  • Edema
  • With progressive deterioration of kidney function:
    • Anorexia
    • Vomiting
    • Weakness
    • Fatigue
Posterior urethral valves
  • Incomplete bladder emptying (by percussion and/or palpation of bladder)
  • Straining to void
  • Large volumes of voided urine
  • Slow or intermittent urinary stream
  • Dribbling of urine
  • Urinary tract infections
  • Poor weight gain
Ectopic ureter (only in females)
  • Persistent dampness in underwear
  • Absence of dry episodes
Other underlying medical conditions
Fecal incontinence or constipation
  • History of soiling
  • History of infrequent stooling
  • Palpation of stool in the abdomen
Sickle cell disease
  • Family history of sickle cell disease
  • Abnormal urinalysis (decreased specific gravity, hematuria, proteinuria)
Seizures
  • Paroxysmal, stereotyped behaviors (eg, staring, limb movements, loss of tone)
Diabetes mellitus
  • Polyuria
  • Polydipsia
  • Weight loss
  • Glucosuria
Diabetes insipidus
  • Polyuria
  • Polydipsia
  • Decreased specific gravity on first morning void
Spinal dysraphism
  • Abnormalities in the lumbosacral spine (eg, hair tuft, dermal sinus tract, dimple, or pit)
  • Lower extremity weakness, sensory loss, abnormal tone
  • Abnormal gait
  • Abnormal plantar response
Obstructive sleep apnea
  • Snoring
  • Signs of adenotonsillar hypertrophy (eg, mouth breathing, adenoid facies)
Pinworms
  • Perianal excoriation
  • Vulvovaginitis
Primary polydipsia
  • History of increased water intake
  • Polyuria
This table is intended for use with UpToDate content related to nocturnal enuresis in children. Refer to UpToDate content for additional details.
Graphic 121684 Version 2.0