enuresis

Last reviewed 04/2022

Enuresis is uncontrolled or involuntary discharge of urine in a child, 5 years or older in the absence of a physical disease. It may be nocturnal, during the day - or both (1).

The terminology used to describe nighttime wetting has been the subject of much confusion with the terms nocturnal enuresis, enuresis, bedwetting and incontinence of urine when sleeping being used synonymously (2).

• The Diagnostic & Statistical Manual of Mental Disorders (DSM- IV) defines nocturnal enuresis as an involuntary voiding of urine during sleep, present at least twice a week, in children aged more than 5 years without any congenital or acquired defects of the central nervous system (2) 
• The International Children’s Continence Society (ICCS) which uses the term “incontinence” when describing uncontrollable leakage of urine defines enuresis as incontinence in discrete episodes while asleep in children who are at least 5 years or older
• enuresis can be termed nocturnal enuresis to add greater clarity when needed
• the symptom of bedwetting is termed as enuresis or intermittent nocturnal incontinence regardless of whether concurrent daytime symptoms are present or not (3)                                                                                              
  

Day time wetting is rare but is considered to be a significant problem and investigations should be carried out to identify any physical (organic) causes such as urinary tract dysfunction, congenital malformation and neurogenic disorders (4).

• Jarvelin et al found that structural abnormalities and functional disorders of the urinary tract (such as unstable bladder contractions or urinary tract infections) was more often seen in children with day time wetting than in children who had night- time wetting alone (4).

Reference:

1. Watson L. Enuresis. InnovAiT2010;3(2):91-94   
2. NICE (October 2010).Nocturnal enuresis - The management of bedwetting in children and young people
3. Nevéus T et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. 2006;176(1):314-24.   
4. Glazener CM, Evans JH. Simple behavioural and physical interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2004;(2)