Tips from Other Journals

Primary and Secondary Enuresis Have Same Causes


Am Fam Physician. 2006 Jan 15;73(2):333.

Primary nocturnal enuresis and secondary nocturnal enuresis have been considered separate entities with different causes. Robson and colleagues sought characteristics that would distinguish primary from secondary enuresis.

Children who presented at a tertiary care center for enuresis evaluation were enrolled in the study. Enuresis was defined as bed-wetting occurring at least once per month; patients with secondary enuresis had a history of nighttime dryness for at least six consecutive months. The minimum age of participants was 3.5 years. Patients were evaluated for factors such as daytime voiding habits, urinary tract infection, constipation, the age at which the child was able to void on his or her own, squatting behavior (in girls), and attention-deficit/hyperactivity disorder. Children also underwent uroflow and postvoid ultrasound studies.

A total of 170 patients were enrolled. In these patients, primary analysis showed no differences in characteristics between the children with secondary enuresis (27.6 percent) and those with primary enuresis (72.4 percent) except constipation, which was more prevalent in the primary enuresis group. Once constipation had been adjusted for, the only remaining significant difference between the two groups was the age at which the children had begun voiding on their own: patients with primary enuresis started an average of 0.22 years later than patients with secondary enuresis (2.35 versus 2.13 years, respectively). There was a high prevalence of daytime voiding disturbances in both groups.

The authors conclude that primary and secondary nocturnal enuresis have a common etiology. The causes of primary enuresis have been thought to be sleep arousal problems, small bladder capacity, and nocturnal overproduction of urine. Secondary enuresis has been thought to be caused by urge and voiding dysfunction, stress, constipation, diabetes, and sleep apnea. Relief of constipation and addressing daytime voiding disturbances may be effective in treating both conditions, obviating the need for medications or enuresis alarms.

Robson WL, et al. Primary and secondary nocturnal enuresis: similarities in presentation. Pediatrics. April 2005;115:956–9.



Copyright © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Jan 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article