# Management of a Complex Case of Primary Enuresis in an Adult With Attention-Deficit Hyperactivity Disorder: A Case Report

## TL;DR

An adult woman with ADHD and primary enuresis showed improvement after being correctly diagnosed and treated with methylphenidate.

## Contribution

Highlights the importance of diagnosing ADHD in adults with enuresis for effective treatment.

## Key findings

- The patient showed significant improvement after being diagnosed with ADHD and treated with methylphenidate.
- Enuresis resolved alongside ADHD symptoms following the treatment adjustment.
- Comprehensive reassessment led to a missed diagnosis and successful management of the patient's conditions.

## Abstract

Enuresis is the inability to maintain voluntary control over urination, which is a relatively uncommon condition in adults. Therefore, there is limited research exploring the management of primary enuresis in adult patients with comorbid attention-deficit hyperactivity disorder (ADHD), particularly in the Middle Eastern region. We report the case of a 28-year-old female patient who has been following up and treated for comorbid bipolar affective disorder (BAD) and borderline personality disorder (BPD) for 12 years, complicated with primary enuresis. She was treated with 10 mg oral escitalopram once daily and a monthly intramuscular injection of 400 mg aripiprazole extended-release, with no reported improvement in her symptoms. Upon recent comprehensive reassessment, the patient was found to have a missed diagnosis of ADHD. Along with her current medications, she was started on 18 mg methylphenidate once daily and lamotrigine, started by 25 mg once daily, titrated to 50 mg. This adjustment led to significant improvement in her symptoms and the resolution of her enuresis. This case report demonstrates the resolution of ADHD symptoms along with the primary enuresis in an adult female patient who was treated with methylphenidate.