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Nocturnal enuresis — DCH MCQ

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ModerateBehavioural and emotionalNocturnal enuresisDCH

A developmentally typical 6-year-old boy wets the bed on 4 or 5 nights each week and has never remained dry at night for 6 months. He has no daytime urinary symptoms, dysuria, constipation or polydipsia, and urinalysis is normal. Three months of adequate daytime fluid intake, regular toileting including before sleep, and positive rewards for agreed behaviours have not helped. He understands how a bedwetting alarm works, and the family is motivated to use one and prioritises sustained improvement. What is the most appropriate next management?

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Correct answer: A — Offer an enuresis alarm with structured family support

This is frequent primary monosymptomatic nocturnal enuresis without features suggesting diabetes, urinary infection, constipation or daytime bladder dysfunction. As appropriate advice on fluids, toileting and behavioural rewards has been unsuccessful, an enuresis alarm is the preferred next treatment when the child and family understand it and can sustain the required effort. NICE permits alarms in children under 7 according to maturity and motivation. Treatment need not be deferred until age 7. Daytime fluid restriction is inappropriate; adequate daytime intake should be encouraged. Normal examination and urinalysis with no daytime symptoms provide no indication for renal ultrasonography. Desmopressin can be considered at this age when rapid or short-term dryness is important or an alarm is unsuitable, but it is not the preferred durable treatment in this motivated family.

Reference: National Institute for Health and Care Excellence. Bedwetting in under 19s (CG111), sections 1.5, 1.7 and 1.8: initial treatment and bedwetting alarms. 2010. https://www.nice.org.uk/guidance/cg111/chapter/recommendations