Causes of Enuresis - Differential Diagnosis Algorithm

Primary Nocturnal Enuresis (Urinary Control Never Achieved)

 • Delayed Maturation (Familial)

 • Idiopathic

 • Sleep Disorders (Obstructive Sleep Apnea)

 • Anatomic Abnormality

Secondary Nocturnal Enuresis (Red Flag) (>6 Month Continence Prior):

 • Urinary Tract Infection

 • Idiopathic

 • Behavioural/Psychogenic (Child Abuse)

 • Cystitis

 • Diabetes Mellitus

 • Other (Diabetes Insipidus, Urethral Obstruction, Cerebral Palsy, Neurogenic Bladder, Seizure Disorder)

Diurnal Enuresis:

 • Pediatric Unstable Bladder

 • Infrequent Voiding (Urinary Tract Infection)

 • Cystitis

 • Behavioural/Psychogenic

 • Idiopathic

 • Non-neurogenic (Hinman Syndrome)

 • Vaginal Voiding (Labial Adhesion)



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