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Primary Care Liaison

Continence - Enuresis - Wetting

  • When to refer

    • Night wetting persistent or failed treatment.
    • Day wetting persistent after constipation / UTI treated.
    • Night and day wetting.
    • Complex presentation (Neurodevelopmental)
    • Family distress (punishment, conflict)

    Referral Information needed

    Please collect and include in your referral as much detail as possible. This will assist triage.

    • Previous management and outcome
    • Associated symptoms of constipation or soiling
    • Co-morbidities
    • Social vulnerability

    Initial Work-up

    Night wetting

    • Offer treatment  7 years or older.
    • Use diary to measure and monitor.
    • Explore parenting practices e.g. night fluid restricting, overnight toileting, punitive practices.
    • Urine microscopy not required unless separate symptoms indicative of urinary tract infection.
    • Assess whether constipation is a problem.

    Day wetting

    • Consider overactive bladder, low awareness bladder sensation, poor attention / concentration.
    • Exclude urinary tract infection with urine microscopy.
    • Consider constipation.

    Recommended pre-referral treatment

    Night wetting

    • Explain causes including genetics.
    • Cease night fluid restriction.
    • Ensure parents understand that overnight toileting is not curative.
    • Treat constipation. (see Clinical Practice Guideline Constipation)
    • Enuresis alarm 6-12 weeks.
    • Oral Desmopressin
      • Authority for failed alarm treatment and when alarm not suitable (eg school camp)
      • Also useful for symptom relief and for short periods (school camp).
      • 'Melts' have better bioavailability than tablets.
      • Desmopressin nasal spray not recommended (higher risk of hyponatremia). 
    • NB: Imipramine not recommended (high risk and desmopressin safer alternative).
    • Alarm should be re-tried each year.

    Day wetting

    Resources and links

    Guideline first published Jan 2008. Reviewed August 2018. Please read  Copyright and Disclaimer