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.
Specific Symptoms of Enuresis
- Repeated voiding of urine into bed or clothes (whether involuntary or intentional).
- 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.
- Chronological age is at least 5 years (or equivalent developmental level).
- 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., diabetes, spina bifida, a seizure disorder).
The situation in which the enuresis occurs may be noted by one of the following 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 during waking hours. Diurnal enuresis is more common in females than in males and is uncommon after age 9 years. The enuretic event most commonly occurs in the early afternoon on school days. Diurnal enuresis is sometimes due to a reluctance to use the toilet because of social anxiety or a preoccupation with school or play activity.
- Nocturnal and Diurnal. This subtype is defined as a combination of the two subtypes above.