Enuresis

The essential feature of Enuresis is repeated voiding of urine during the day or at night into bed or clothes.

Most often this is involuntary but occasionally may be intentional. To qualify for a diagnosis of Enuresis, the voiding of urine must occur at least twice per week for at least 3 months or else must cause clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. The individual must have reached an age at which continence is expected (i.e., the chronological age of the child must be at least 5 years, or, for children with developmental delays, a mental age of at least 5 years). The urinary incontinence is not due exclusively to the direct physiological effects of a substance (e.g., diuretics) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder). .

Subtypes

• Nocturnal Only. This is the most common subtype and is defined as passage of urine only during nighttime sleep. The enuretic event typically occurs during the first one-third of the night. Occasionally the voiding takes place during the rapid eye movement (REM) stage of sleep, and the child may recall a dream that involved the act of urinating.

• Diurnal Only. This subtype is defined as the passage of urine only during waking hours. Diurnal Enuresis is more common in females than in males and is uncommon after age 9 years. Individuals with diurnal Enuresis can be divided into two groups. One group with "urge incontinence" has Enuresis characterized by sudden urge symptoms and detrusor instability on cystometry. Another group with "voiding postponement" consciously defer micturition urges until incontinence results, with the deferral sometimes due to a reluctance to use the toilet because of social anxiety or a preoccupation with school or play activity. This latter group has a high rate of symptoms of disruptive behavior. The enuretic event most commonly occurs in the early afternoon on school days.

• Nocturnal and Diurnal. This subtype is defined as a combination of the two subtypes above.

Once constipation has developed, it may be complicated by an anal fissure, painful defecation, and further fecal retention. The consistency of the stool may vary. In some individuals it may be of normal or near-normal consistency. It may be liquid in other individuals who have overflow incontinence secondary to fecal retention.

Prevalence

The prevalence of Enuresis is around 5%–10% among 5-year-olds, 3%–5% among 10-year-olds, and around 1% among individuals age 15 years or older.

Course & Family Pattern

The most common time for the onset of secondary Enuresis is between the ages of 5 and 8 years, but it may occur at any time. After age 5 years, the rate of spontaneous remission is between 5% and 10% per year. Most children with the disorder become continent by adolescence, but in approximately 1% of cases the disorder continues into adulthood.

Approximately 75% of all children with Enuresis have a first-degree biological relative who has had the disorder. The risk of Enuresis is five- to sevenfold greater in the offspring of a parent who had a history of Enuresis.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.