# Nocturnal Enuresis (Bedwetting) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Guideline CG111 Nocturnal Enuresis in Children 2010 · Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) · Egyptian National Drug Formulary, endocrine 2024, desmopressin acetate monograph, primary nocturnal enuresis (printed pp. 242-243) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary, endocrine 2024, desmopressin acetate monograph, primary nocturnal enuresis (printed pp. 242-243) - Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) ## Treatment metadata - Desmopressin — 0.1 mg — oral.solid - Oxybutynin — 5 mg — oral.solid ## Complete treatment card ```text NOCTURNAL ENURESIS (BEDWETTING) Sources: NICE Guideline CG111 Nocturnal Enuresis in Children 2010 · Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) · Egyptian National Drug Formulary, endocrine 2024, desmopressin acetate monograph, primary nocturnal enuresis (printed pp. 242-243) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Monosymptomatic bedwetting means wetting at night alone, with no urinary symptoms and no bladder problem [urinary incontinence] - The non-monosymptomatic form adds nocturia, urgency, daytime wetting, hesitancy, weak stream, straining, dribbling, holding manoeuvres, pain [drooling · nocturia · poor urinary stream · urinary incontinence] - A family history of bedwetting turns up often - Constipation runs alongside in 33% to 56% of children [constipation] - Constipation clues: recurring belly pain, soiling, painful or bulky stools, fewer than 2 motions a week, stools that block the toilet [abdominal pain · constipation · faecal incontinence] - Short of formal constipation: missed motions, needing to push, stools hard to pass [constipation] - Drinking heavily late in the day, having drunk too little at school, is common - Straining to start or a weak stream hints at urethral blockage; bowel trouble with an odd gait hints at a neurogenic bladder [poor urinary stream] - Noises or muscle movements during sleep raise a seizure disorder [seizures] - Shame, low self-worth and withdrawal from others are common in these children - Restless sleep, snoring or sleepwalking point to a sleep disorder; stinging, cloudy or bloody urine to cystitis [snoring] - New bedwetting on its own in a teenager has preceded sudden death in sleep, raising long QT or another cardiac problem [sudden cardiac arrest] SIGNS - what you find (5) - Examination is usually normal in the simple form - Findings pointing to a cause: big tonsils, stool felt in the abdomen, wet underwear from daytime leaking - Vulvovaginitis or scratched anal skin suggests threadworm; abnormal leg neurology suggests a spinal cord problem - Genital findings: hypospadias, phimosis, labial adhesions, and soiling of the underwear [faecal incontinence] - Sacral dimples, extra hair, naevi, pigment change or haemangiomas, with leg or gait signs, mean MRI of the lower spine TESTS (12) - History, examination and urinalysis usually separate the simple form from the complicated one - Urinalysis is needed in every child, screening for diabetes, kidney disease, vasopressin disorders, water intoxication and cystitis - In the primary form the child has never managed 6 unbroken months dry at night - It arises when bladder capacity does not match the urine made overnight - Ask about daytime leaking and keep a voiding diary of the timing and volume of daytime passes - Count the wet nights each week or month - Ask about snoring, odd gait, sleepwalking, night terrors, passing lots of urine or heavy thirst - Renal ultrasound and voiding cystourethrogram are kept for past urine infection, daytime symptoms or urological abnormality - Snoring, mouth breathing, pauses, choking, restless sleep or night sweats warrant a sleep study - No snoring does not rule out obstructive sleep apnoea - Where dryness was achieved and then lost, consider an ECG and a family cardiac history - Sickle cell disease brings a family history and poor urine concentration with a low specific gravity IF NOT THIS - what else fits (11) - Urine infection, chronic kidney disease, ectopic ureter in girls, posterior urethral valves - Constipation, diabetes, vasopressin disorders, obstructive sleep apnoea - Spinal dysraphism, threadworm, primary polydipsia, sickle cell disease - Bladder dysfunction, physical or sexual abuse, behavioural or developmental disorder - Drug side effects, urethral obstruction, overactive bladder, long QT or another cardiac condition - Constant dampness in a girl may be an ectopic ureter - Diabetes: passing lots of urine, heavy thirst, weight loss despite a normal or bigger appetite - Vasopressin disorders also give polyuria and thirst, with a dilute first morning urine - Chronic kidney disease: poor growth, high blood pressure, weight loss, oedema, no appetite, tiredness, protein and blood in urine - Depression, anxiety, conduct disorder and ADHD occur more at 9 to 12 with daytime wetting or secondary enuresis - Behavioural problems are seldom tied to the primary form Source disease-level clinical article (daytime-urinary-incontinence-child-full.txt) Status traced to the source above 1. DESMOPRESSIN [1st line] Adult Initially: 120 mcg at bedtime. If no sufficient effectiveness, the dose may be increased up to 240 mcg. x 3 months (then 1 week trial withdrawal) Peds 5 years and over: 120 micrograms at bedtime; may be raised to 240 micrograms if not effective (Children (from 5 years of age): Initially: 120 mcg at bedtime. If no sufficient effectiveness, the dose may be increased up to 240 mcg.) Source Egyptian National Drug Formulary, endocrine 2024, desmopressin acetate monograph, primary nocturnal enuresis (printed pp. 242-243) Why Synthetic vasopressin analogue that reduces nighttime urine output by increasing renal water reabsorption; first-line when rapid control of bedwetting is needed or an alarm device is unsuitable. Caution FLUID RESTRICTION MANDATORY: Restrict fluid 1 hour before and 8 hours after the dose. There is a risk of severe hyponatraemic convulsions if fluid restriction is ignored. Desmopressin is first line for children >= 5 years when rapid control is needed or an alarm is unsuitable. The melt and the tablet are not interchangeable milligram for milligram: 120 mcg of the sublingual melt is roughly 200 mcg of the swallowed tablet. Egypt sells the 0.1 mg tablet, so this dose is two of them. Egypt DESMODJUST 0.1 MG 30 TABS. MARCYRL PHARM... 210.00 EGP (7.00/unit) OMEGAPRESS 0.1 MG 30 TABS. ATCO PHARMA >... 288.00 EGP (9.60/unit) 2. OXYBUTYNIN [add-on - not a substitute] Adult 5 mg 2-3 times daily, max 20 mg daily Peds 5 years and over: 2.5 mg twice daily initially, may increase to 5 mg two or three times daily (last dose before bedtime) (Children 5 years of age and over: 2.5 mg twice a day, may be increased to 5 mg two or three times daily (last dose before bedtime)) Source Oxybutynin Hydrochloride 5 mg Tablets SmPC section 4.2 (eMC product 11470) Why Antimuscarinic that reduces detrusor overactivity, added to desmopressin rather than replacing it, for children with daytime urgency or enuresis that persists on desmopressin alone. Caution Used for daytime urgency or enuresis resistant to desmopressin monotherapy. Anticholinergic side effects include dry mouth, constipation, and blurred vision. Rule out urinary tract infection, diabetes mellitus, or spinal pathology. In the elderly the half-life is longer: start 2.5 mg twice daily, more so if the patient is frail, and go no higher than 5 mg twice daily unless it is tolerated. Oxybutynin is strongly anticholinergic - confusion, dry mouth, constipation and falls. Egypt DRY TROPAN 5MG MR 10 CAPS. BORG 11.00 EGP (1.10/unit) DETRONIN 5 MG 20 TABS. PHAROPHARMA 26.00 EGP (1.30/unit) OXYBIN 5 MG 20 TAB. EIPICO 26.00 EGP (1.30/unit) URIPAN 5 MG 30 TABS. ADWIA 54.00 EGP (1.80/unit) OXURATE 1MG/ML SYRUP 120ML SIGMA 6.50 EGP -> ? strength differs, ? different route - not oral solid DRY TROPAN 2.5MG/5ML ELIXIR 120 ML BORG 7.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)