Nocturnal enuresis: The management of bedwetting in children and young people

NICE guidelines [CG111] Published date:

Introduction

Introduction

Bedwetting is a widespread and distressing condition that can have a deep impact on a child or young person's behaviour, emotional wellbeing and social life. It is also very stressful for the parents or carers. The prevalence of bedwetting decreases with age. Bedwetting less than 2 nights a week has a prevalence of 21% at about 4 and a half years and 8% at 9 and a half years. More frequent bedwetting is less common and has a prevalence of 8% at 4 and a half years and 1.5% at 9 and a half years[1].

The causes of bedwetting are not fully understood. Bedwetting can be considered to be a symptom that may result from a combination of different predisposing factors. There are a number of different disturbances of physiology that may be associated with bedwetting. These disturbances may be categorised as sleep arousal difficulties, polyuria and bladder dysfunction. Bedwetting also often runs in families.

Experts and expert bodies differ in their definitions of 'nocturnal enuresis' (see the full guideline for a discussion). The term 'bedwetting' is used in this guideline to describe the symptom of involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology.

This guideline makes recommendations on the assessment and management of bedwetting in children and young people. The guidance applies to children and young people up to 19 years with the symptom of bedwetting. Children are generally expected to be dry by a developmental age of 5 years, and historically it has been common practice to consider children for treatment only when they reach 7 years. The guideline scope did not specify a minimum age limit to allow consideration of whether there are interventions of benefit to younger children previously excluded from advice and services due to their age. We have included specific advice for children under 5 years, and indicated treatment options for children between 5 and 7 years.

Children and young people with bedwetting may also have symptoms related to the urinary tract during the day. A history of daytime urinary symptoms may be important in determining the approach to management of bedwetting and so the assessment sections include questions about daytime urinary symptoms and how the answers to these may influence the approach to managing bedwetting. However, the management of daytime urinary symptoms is outside the scope of this guideline.

The treatment of bedwetting has a positive effect on the self-esteem of children and young people. Healthcare professionals should persist in offering different treatments and treatment combinations if the first-choice treatment is not successful. Children and young people with bedwetting are cared for by a number of different healthcare professionals in a variety of settings. All healthcare professionals should be aware of and work within legal and professional codes and competency frameworks.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.



[1] Butler RJ, Heron J (2008) The prevalence of infrequent bedwetting and nocturnal enuresis
in childhood: A large British cohort. Scandinavian Journal of Urology and Nephrology 42:
257–64

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