What is the definition of enuresis?

Definition of Enuresis

Enuresis is defined as the repeated voiding of urine into the bed or clothes at least twice per week for at least three consecutive months in a child who is at least 5 years of age. 1

Types of Enuresis

• Nocturnal enuresis: Voiding during sleep
• Diurnal enuresis: Wetting while awake
• Primary enuresis: Occurs in children who have never been consistently dry through the night
• Secondary enuresis: Refers to the resumption of wetting after at least 6 months of dryness
• Monosymptomatic enuresis: The only symptom is nocturnal bed-wetting in a child who has never been dry 2
• Nonmonosymptomatic enuresis: Children have both daytime and nighttime symptoms 3

Diagnostic Criteria

According to the DSM-IV-TR definition 1:

• Repeated voiding of urine into bed or clothes
• At least twice weekly
• For at least three consecutive months
• Child must be at least 5 years of age
• Can include both voluntary and involuntary voiding (though most research studies exclude voluntary wetting)
• A child can still be considered enuretic with less frequency or duration if there is associated distress or functional impairment

Epidemiology

• Nocturnal incontinence occurs in 12-25% of 4-year-old children
• 7-10% of 8-year-old children
• 2-3% of 12-year-old children
• 1-3% of teenagers may still wet the bed 1
• Primary enuresis is twice as common as secondary enuresis
• Boys are affected twice as often as girls
• More common in lower socioeconomic groups and institutionalized children
• Spontaneous cure rate is approximately 14-16% annually 1

Etiology

Several factors contribute to enuresis:

1. Genetic factors: 44% of children with one enuretic parent and 77% with both parents having history of enuresis will develop the condition 1

2. Sleep disorders:

   • Dysfunctional arousal system during sleep
   • Sleep apnea from upper airway obstruction 1

3. Developmental factors:

   • Developmental immaturity in motor and language milestones 1

4. Psychological factors:

   • More common in secondary enuresis
   • Associated with stressors like parental divorce, school trauma, sexual abuse, or hospitalization
   • Family disorganization or neglect resulting in inadequate toilet training 1

5. Pathophysiological factors:

   • Sleep arousal disorder
   • Overproduction of urine
   • Small bladder storage capacity
   • Detrusor overactivity 3

Clinical Significance

Enuresis can have significant psychological impacts on children, including:

• Chronic anxiety
• Impaired self-esteem
• Delayed developmental steps (attending camp, sleeping at friends' houses)
• Family embarrassment and parental anger
• Risk of physical or emotional abuse from frustrated caregivers 1

The psychological and developmental damage from enuresis can often be more devastating than the symptom itself, highlighting the importance of proper diagnosis and treatment to improve quality of life and prevent long-term psychological consequences.

Enuresis should be considered a clinical problem after age 4-5 years; before that age, it is essentially a normal developmental variant unless specific causes are identified 1.

AI: I've provided a comprehensive definition of enuresis based on the DSM-IV-TR criteria as outlined in the American Academy of Child and Adolescent Psychiatry guidelines. I've included the different types of enuresis, epidemiology, etiology, and clinical significance to give a complete understanding of this condition.