Enuresis in Children.

Enuresis, also known as nocturnal enuresis or bedwetting, refers to intermittent incontinence during sleep. It warrants medical attention, in children older than five years of age, or earlier if desired by the child or family, due to its significant emotional and psychological impact on quality of life. Children who have never achieved nighttime continence are diagnosed with primary enuresis, while those who begin bedwetting after at least six months of being dry, with secondary enuresis. The condition is further classified as monosymptomatic (MNE) or non-monosymptomatic (NMNE), depending on the absence or presence of lower urinary tract symptoms. Assessment, thus, focuses on ruling out underlying pathological causes and determining the phenotype as mentioned above. Comorbid conditions such as sleep-disordered breathing, behavioral or psychiatric disorders, and constipation should be identified. A frequency-volume chart is a valuable tool in both diagnosis and management. All families in select cases should receive basic urotherapy. The mainstays of MNE treatment are an enuresis alarm and desmopressin. Anticholinergic or β3-adrenergic agents may be added to desmopressin. Imipramine is considered a third-line agent. Management of NMNE requires targeted treatment of the associated lower urinary tract condition. Comorbidities must also be addressed appropriately. Therapy-resistant and treatment-refractory enuresis should be diagnosed only after ensuring adherence to prescribed therapies. A range of alternative therapies may be explored and individualized based on the patient's needs.