Nocturnal Enuresis: Advice for Referrers

RHC for Health Professionals
NHS GGC

Children are generally expected to be dry by a developmental age of 5 years.

Nocturnal enuresis is a term used for children and young people aged 5-16 years with bedwetting. National guidance indicates treatment options should be made available for children from 5 years of age (NICE 2010).

Children with enuresis can be referred to the Nurse-led continence service, via SCI GatewayThe aim of the paediatric continence service, is to promote continence, by supporting children, young people and their families to improve their symptoms, utilising a holistic assessment to provide options on treatment and intervention, and offering education on behavioural and lifestyle changes that can promote bladder and bowel health.

Who to refer

Referrals are considered for all children with nocturnal enuresis providing they meet the following criteria:

  • Aged 5-16 years with parent/carer/child/young person consent.
  • Reside within the boundary area of NHS Greater Glasgow and Clyde.

NOTE: For children with secondary nocturnal enuresis (i.e. wetting again after at least 6 months of night-time dryness) please ensure that the child does not have a new diagnosis of Type 1 Diabetes Mellitus. All these children should have a urinalysis (to exclude glycosuria) and a random capillary blood glucose, and be referred acutely if this is greater than 11 mmol/L, and discussed with the on call medical team if greater than 8 mmol/L.

Who not to refer

Referrals are not considered for children:

  • For isolated toilet training
  • With predominant daytime wetting symptoms – who should be referred to the Renal Continence Clinic

Information to Include - History

Please include the following points from history in the referral letter

  • On how many nights per week does the child wet?
  • Estimation of volume passed – i.e. a dribble/dampness or large quantities of urine requiring changing of sheets
  • Family history of enuresis in biological parents and any siblings, including age when this resolved
  • How much water/diluting juice does the child drink per day?
  • Does the child have any other issues including neurological issues?
  • Does the child suffer from constipation?
  • Is the child growing appropriately?
  • Does the child have a normal gait?

Information to Include - Examination

Please include the following points from the clinical examination in the referral letter

  • Recent height and weight
  • Examination of spine and lower limb reflexes – to exclude a neurogenic bladder

Suggestions for Management whilst waiting for an Outpatient Appointment

  • If the child is constipated, treat and re-assess nocturnal enuresis after successful treatment.
  • Ensure adequate fluid intake. Approximate volumes per 24 hours by age and sex are:
    • Age 1-2 years: 900mls
    • Age 2-3 years: 1 litre
    • Age 4-8 years: 1.2 litres per day
    • Age 9-13 years:
      • Boys: 1.6 litres
      • Girls: 1.5 litres
    • Age over 13 years:
      • Boys: 2 litres
      • Girls: 1.6 litres
  • Note above about secondary enuresis and referral to medical paediatrics if Type 1 Diabetes Mellitus is suspected

Useful resources for Parents

  • Signpost parents to the ERIC website, and encourage them to read the information and watch the videos

Useful resources and references for Health Professionals

Editorial Information

Last reviewed: 25/11/2024

Next review date: 30/11/2029

Author(s): Sister Ingrid Eckelkamp, Lead of Nurse-led Continence Service, Dr Ruth Bland, Consultant Medical Paediatrics.

Approved By: Medical Paediatrics