94 Enuresis (307.6)

The term enuresis comes from the Greek word meaning “I make water” and refers to the involuntary voiding of urine, after an age at which toilet training is expected to have been completed.

DSM-IV-TR criteria

• A. Repeated voiding of urine into bed or clothes (whether involuntary or intentional).
• B. The behavior is 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 (or equivalent developmental level).
• D. The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetics, spina bifida, a seizure disorder).
• Specify type:
  • Nocturnal (Nighttime urination) Only
  • Diurnal (Daytime urination) Only
  • Nocturnal and Diurnal (a mixture of both)

Associated features

An associated feature of Enuresis is a function of the limitation on the child’s social activities, it has effects on the child’s self-esteem, the degree of social ostracism by peers, and the anger, punishment, and rejection on the part of caregivers. Motor skills delays, language, speech delays, and learning delays are present in children with Enuresis. Along with having Enuresis, some children/adults may exhibit Sleepwalking Disorder and/or Sleep Terror Disorder. Urinary tract infections are more common in children with Enuresis, most common in the one’s with Diurnal Type than those who are continent.

Child vs. adult presentation

There are not many differences in the presentation among children and adults. Usually, adults that have this condition also had it when they were children and it carried on throughout their lives. Adults will usually have wetting during the day, as well as the night.

Gender and cultural differences in presentation

Studies have shown that enuresis tends to appear significantly greater in males than females. Enuresis can be found more among African American population than any other ethnicities studied. Reports show that boys aged 7 to 10 years old have about an 8% prevalence, while the average for girls is about 4.5%.

Epidemiology

The prevalence of Enuresis is around 5-10% among 5 years old, 3-5% among 10 years old, and around 1% among individuals of the age of 15 and older.

Etiology

• There can be an organic cause of Enuresis, however it is highly unlikely. Some examples of organic causes are a urinary tract infection, constipation, and food allergies. Most agree that there are a number of factors that contribute to Enuresis. One is genetic factors. If a parent had this, then it is very likely that their child will develop this as well. If both parents had Enuresis, there is about a 75% chance that their child will have it too. The rate significantly goes down if neither parents had it. Another factor is sleep patterns. There are differences between children with Enuresis and without in their sleeping patterns.
• One common belief is that Enuresis is caused by psychological factors. However, many studies show that children with this disorder behave in the same way as children without this disorder. For the most part, it has been found that because of the Enuresis, secondary psycho-social problems develop in children. Some researchers have found that low bladder capacity is related to nocturnal Enuresis. However, some question this because they feel that the child would have symptoms throughout the day if they had a low bladder capacity.
• Another common factor that many researchers have found is delayed development of the central nervous system. This causes the child not to realize that they need to empty their bladder during the night.

Empirically supported treatments

There are a number of behavioral treatments that can be used to help children with Enuresis. A few examples are a pad or a buzzer/alarm. Medication is also an option. One option is a nasal spray that is anti-diuretic. Also, an anti-depressant called imipramine is useful in treatment. If these do not work, the condition could be more serious and may result in the child and family needing to see a psychiatrist.