Nocturnal enuresis in children.

Millions of children nationwide are affected by nocturnal enuresis. Despite the numbers of children affected, enuresis continues to be poorly understood is and often poorly managed. Because enuresis is a symptom and not a disease, it is difficult to discern a cause or an effective treatment. Although less than 5% of children with nocturnal enuresis have an organic basis for their wetting, the physical examination and history should carefully rule out any physical causes. Factors that have been observed to be associated with the occurrence of nocturnal enuresis include developmental delay, introduction of negative factors, heredity, small bladder capacity, and reduced nocturnal secretion of antidiuretic hormone. The cornerstone of therapy for all children with nocturnal enuresis should be behavioral management. Medical management should be initiated only after behavioral management has failed. No one therapy guarantees success, and multiple therapies may be attempted before dryness is obtained.