Findings from history | Possible interpretation |
---|---|
Large volume of urine in the first few hours of night | Typical pattern for bedwetting only |
Variable volume of urine, often more than once a night | Typical pattern for children and young people who have bedwetting and daytime symptoms with possible underlying overactive bladder |
Bedwetting every night | Severe bedwetting, which is less likely to resolve spontaneously than infrequent bedwetting |
Previously dry for >6 months | Bedwetting is defined as secondary |
Daytime frequency/urgency/wetting; abdominal straining or poor urinary stream; pain passing urine | Any of these may indicate the presence of a bladder disorder such as an overactive bladder or, more rarely (when symptoms are very severe and persistent), an underlying urological disease |
Constipation | A common comorbidity that can cause bedwetting and requires treatment (see Constipation in Children and Young People, NICE clinical guideline 99) |
Soiling | Frequent soiling is usually secondary to underlying faecal impaction and constipation, which may have been unrecognised |
Inadequate fluid intake | May mask an underlying bladder problem, such as overactive bladder disorder, and may impede the development of an adequate bladder capacity |
Behavioural and emotional problems | These may be a cause or a consequence of bedwetting. Treatment may need to be tailored to the specific requirements of each child or young person and family |
Family problems | A difficult or ‘stressful’ environment may be a trigger for bedwetting. These factors should be addressed alongside the management of bedwetting |
Practical issues | Easy access to a toilet at night, sharing a bedroom or bed, and proximity of parents to provide support are important issues to take into account and address when considering treatment, especially that with an alarm |
↵a Taken from NICE guideline CG111 on nocturnal enuresis.2