MeSH D053207 | ||
Enuresis is defined as the involuntary voiding of urine beyond the age of anticipated control. Diurnal enuresis is daytime wetting, nocturnal enuresis is nighttime wetting. Both of these conditions can occur at the same time, Many children with nighttime wetting will not have wetting during the day. Children with daytime wetting may have frequent urination, have urgent urination or dribble after urinating.
Contents
The DSM-V classifies enuresis as an elimination disorder and as such it may be defined as the involuntary or voluntary elimination of urine into inappropriate places. A patient must be of at least a developmental level equivalent to the chronological age of a 5 year old in order to be diagnosed with enuresis (in other words it is not abnormal for a child below the age of 5).
The patient must either experience a frequency of inappropriate voiding at least twice a week for a period of at least 3 consecutive months OR experience clinically significant distress or impairment in social, occupational or other important areas of functioning, in order to be diagnosed with enuresis. These symptoms must not be due to any underlying medical condition (e.g. a child who wets the bed because their kidneys produce too much urine, is not suffering from enuresis, they're suffering from kidney disease which is causing the inappropriate urination). As well, these symptoms must not be due exclusively to the direct physiological effect of a substance (such as a diuretic or antipsychotic).
Causes
Common causes include, but not limited to:
Management
Major changes in the management of daytime wetting came about in the 1990s. In most current programs, non-invasive treatments incorporate hydration, timed voiding, correction of constipation and in some cases, computer assisted pelvic floor retraining. These methods have been extremely successful in correcting daytime wetting. Bladder stretching exercises (where the person tries to hold their urine as long as possible) are no longer recommended. In fact, some urologists actually believe that this can be dangerous because the person could develop the long-term habit of tightening the urethral sphincter muscle, which can cause bladder or kidney problems. Urinating on a regular basis is much preferred.
Ruling out infections can also be a part of the differential.
Epidemiology
Daytime wetting is more common in girls than in boys, but bedwetting is three times as prevalent in boys (i.e., around 75% of sufferers are male). At the age of 7 approximately 3% of girls and 2% of boys experience functional daytime wetting at least once a week.