Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Defined as repeated urination into the clothing during the day and into the bed at night by a child who is chronologically and developmentally older than 5 years Must occur at least twice a week for 3 months Has been categorized by the International Children's Continence Society as monosymptomatic or non-monosymptomatic Monosymptomatic enuresis is uncomplicated nocturnal enuresis (NE; must never have been dry at night for over 6 months with no daytime accidents); it is a reflection of a maturational disorder and there is no underlying organic problem Complicated or non-monosymptomatic enuresis often involves NE and daytime incontinence and often reflects an underlying disorder +++ Clinical Findings ++ Child does not achieve urine continence by 5–6 years of age and generally has no underlying pathology to which the incontinence can be attributed Child does not respond to a full bladder or rectum More common in boys than in girls +++ Diagnosis ++ Involves a complete history and physical examination to rule out any anatomic abnormalities or underlying pathology Urinalysis should be obtained, including a specific gravity Urine culture should be obtained, especially in girls +++ Treatment ++ Involves education and the avoidance of being judgmental and shaming the child A variety of behavioral strategies have been used such as limiting liquids before sleep and waking the child at night so that he or she can go to the toilet If this simple approach is unsuccessful, the use of bedwetting alarms is suggested A form of cognitive-behavioral therapy Has been found to cure two-thirds of affected children Desmopressin acetate (DDAVP), an antidiuretic hormone analog Has been used successfully when nonpharmacologic strategies fail Decreases urine production Imipramine, a tricyclic antidepressant, also has been used successfully but should be used only as last resort due to risk of death from overdose When such medications are stopped, there is a very high relapse rate Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth