Enuresis

Enuresis
Classification and external resources
ICD-10	F98.0, R32
ICD-9	307.6 788.30 307.6
MeSH	D004775

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 controversial diagnosis 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.