Enuresis

Enuresis refers to a repeated inability to control urination. Use of the term is usually limited to describing individuals old enough to be expected to exercise such control.

History: Found evidence of mention in Egyptian medical texts as early as 1550 B.C.

Types of enuresis include:

  • Nocturnal enuresis (bedwetting)
  • Diurnal enuresis
  • Mixed enuresis - Includes a combination of nocturnal and diurnal type. Therefore, urine is passed during both waking and sleeping hours.

Classification: 1. Primary enuresis refers to children who have never been successfully trained to control urination. This represents a fixation. 2. Secondary enuresis refers to children who have been successfully trained but revert to wetting in a response to some sort of stressful situation. This represents a regression.

Current DSM-IV-TR Criteria: a. Repeated voiding of urine into bed or clothes (whether involuntary or intentional) b. Behavior must be clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. c. Chronological age is at least 5 years of age (or equivalent developmental level). d. 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.

Overall Prevalence and Characteristics: In the United States, approximately 15 to 20 percent of 5 year old children will develop symptoms related to disorder. Prevalence changes significantly with age. To be more specific, about 33 percent of 5 year-olds, 25 percent of 7 year olds, 15 percent of 9 year olds, 8 percent of 11 year olds, 4 percent of 13 year-olds, and 3 percent of 15 to 17 year-olds. Numbers show that diurnal enuresis is much less common. Overall, about 60 percent of those suffering are male. However, this too depends on age. From ages 4 to 6, the number of boys and girls is about equal. However, the ratio changes so that by 11 years of age there are twice as many boys as girls. Incidence varies with social class with more incidences among those with low socioeconomic status. No evidence has been found related to ethnic differences.

The proposed condition PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been used to describe a set of children who have a rapid onset of OCD and/or tic disorders following a streptococcal infection, with a link to other symptoms such as enuresis. A broader classification of this hypothesis, PANS, has been proposed which states that some patients suffer these symptoms in response to mycoplasma or lyme disease or even viruses rather than streptococcal. PANS is an acronym for Pediatric acute-onset neuropsychiatric syndrome. This hypothesis describes children who have abrupt, dramatic onset of obsessive-compulsive disorder (OCD) or anorexia nervosa coincident with the presence of two or more neuropsychiatric symptoms. It is believed that these children experience a rise in dopamine levels as a result of a of cross-reactive anti-neuronal antibodies. The rise in dopamine can cause such side effects as enuresis, bed-wetting, and urinary urgency.

Other articles related to "enuresis":

Diurnal Enuresis
... Enuresis is defined as involuntary voiding of urine beyond the age of anticipated control ... Diurnal enuresis is daytime wetting, nocturnal enuresis is nighttime wetting ...
Macdonald Triad - Enuresis
... Enuresis is the "unintentional bed-wetting during sleep, persistent after the age of five" ... However, some authors continue to speculate that enuresis may be related to firesetting and animal cruelty in some way ... Enuresis is an "unconscious, involuntary, and nonviolent act and therefore linking it to violent crime is more problematic than doing so with animal cruelty or firesetting" ...
Nocturnal Enuresis
... Nocturnal enuresis, commonly called bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs ... Nocturnal enuresis is considered primary (PNE) when a child has not yet had a prolonged period of being dry ... Secondary nocturnal enuresis (SNE) is when a child or adult begins wetting again after having stayed dry ...
Medical Definitions: Primary Vs. Secondary Enuresis - Secondary Nocturnal Enuresis
... Secondary enuresis occurs after a patient goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting ... Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection ...