Enuresis

Enuresis is a repeated inability to control urination.[1] Use of the term is usually limited to describing people old enough to be expected to exercise such control.[2] Involuntary urination is also known as urinary incontinence.[3] The term is from the Ancient Greek ἐνούρησις enoúrēsis.

Enuresis
A child may ignore the body's signal of a full bladder in order to engage in a joyous activity, such as playing on a playground.
SpecialtyUrology, pediatrics

Signs and symptoms

Nocturnal enuresis usually presents with voiding of urine during sleep in a child in whom it is difficult to wake. It may be accompanied by bladder dysfunction during the day which is termed non-mono symptomatic enuresis.[4] Day time enuresis, also known as urinary incontinence, may also be accompanied by bladder dysfunction.

The symptoms of bladder dysfunction include:[4]

  1. Urge incontinence - the presence of an overwhelming urge to urinate, frequent urination, attempts to hold the urine and urinary tract infections.
  2. Voiding postponement - delaying urination in certain situations such as school
  3. Stress incontinence - incontinence that occurs in situations when increased intra-abdominal pressure occurs such as coughing.
  4. Giggling incontinence - incontinence that occurs when laughing.

Secondary incontinence usually occurs in the context of a new life event that is stressful such as abuse or parental divorce.[4]

Diagnosis

Clinical definition of enuresis is urinary incontinence beyond age of 4 years for daytime and beyond 6 years for nighttime, or loss of continence after three months of dryness.[5] Current DSM-IV-TR criteria:

  • Repeated voiding of urine into bed or clothes (whether involuntary or intentional)
  • Behavior must be clinically significant as manifested by either a frequency of twice a week for at least three consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
  • Chronological age is at least 5 years of age (or equivalent developmental level).
  • The behavior is not due exclusively to the direct physiological effect of a substance (such as a diuretic) or a general medical condition (such as diabetes, spina bifida, a seizure disorder, etc.).

All these criteria must be met in order to diagnose an individual.

Classification
  • Primary enuresis refers to children who have never been successfully trained to control urination.[6] This represents a fixation.
  • Secondary enuresis refers to children who have been successfully trained and are continent for at least 6 months but revert to wetting in a response to some sort of stressful situation.[6] This represents a regression.

Types of enuresis include:

  • Nocturnal enuresis (bedwetting) which is wetting that occurs in the night while asleep.[6][4]
  • Diurnal enuresis which is wetting that occurs during the day while the child is awake.[6][4]
  • Mixed enuresis - Includes a combination of nocturnal and diurnal type. Therefore, urine is passed during both waking and sleeping hours.

Treatment
See also: Urinary incontinence § Treatment, and Nocturnal enuresis § Treatment

Medications

Nighttime incontinence may be treated by increasing antidiuretic hormone levels. The hormone can be boosted by a synthetic version known as desmopressin, or DDAVP.[6] Desmopressin is approved for use by children. There is good short-term success rate; however, there is difficulty in keeping the bed dry after medication is stopped,[6].

History

Enuresis has been mentioned in Egyptian medical texts as early as 1550 BC.

See also

References
  1. "enuresis - Definition". Merriam-webster.com. Merriam-Webster. Archived from the original on 2009-04-25. Retrieved 2009-06-16.
  2. Enuresis at the US National Library of Medicine Medical Subject Headings (MeSH)
  3. "Managing Urinary Incontinence Archived 2012-06-30 at the Wayback Machine". National Prescribing Service
  4. von Gontard A. Enuresis. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2012.
  5. Ghai, OP; Paul, Vinod; Bagga, Arvind (2009). Essential Pediatrics, 7th Edition. CBS Publishers & Distributors Pvt Ltd. pp. 22-41. ISBN 9788123917771.
  6. Chowdhury SH, Cozma AI, Chowdhury JH. Incontinence - Child. Essentials for the Canadian Medical Liscensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
Classification
External resources
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