Diagnostic and statistical manual of mental disorders (DSM-IV) Criteria
The DSM-IV states that children with enuresis "repeatedly urinate in the bed or into their clothes, usually, but not always involuntarily."
It specifies that patients experiencing enuresis are five-years-old or older. This is because below the age of five, enuresis is very common and is not a disorder. Further, the criteria specify a frequency of symptoms of being at least twice weekly for at least three consecutive months. In the absence of this frequency, the condition may meet the criteria for enuresis if it is causing significant impairment or stress in an area of functioning.
It also specifies that the behaviour is not a result of a substance or general medical condition. It also classifies enuresis into three types- nocturnal only, diurnal only, or nocturnal and diurnal.
It specifies that patients experiencing enuresis are five-years-old or older. This is because below the age of five, enuresis is very common and is not a disorder. Further, the criteria specify a frequency of symptoms of being at least twice weekly for at least three consecutive months. In the absence of this frequency, the condition may meet the criteria for enuresis if it is causing significant impairment or stress in an area of functioning.
It also specifies that the behaviour is not a result of a substance or general medical condition. It also classifies enuresis into three types- nocturnal only, diurnal only, or nocturnal and diurnal.
Prevalence
Over 500,000 Canadian children struggle with nocturnal enuresis. This graph describes the prevalence of nocturnal enuresis in children, from age 1-18. The condition affects these proportions of age groups:
- 16% of five-year-olds
- 13% of six-year-olds
- 10% of seven-year-olds
- 8% of eight-year-olds
- 5% of 10-year-olds
- 2-3% of 12 to 14-year-olds
- 1-2% of adolescents 15-years-old or older
From birth to around 18 months of age, infants have no awareness that their bladder is filling or emptying. At this age, nocturnal enuresis is expected and normal. From ages two to three, children learn to control their urination, and at this time, may stop bedwetting. At age four, a majority of children no longer wet the bed. From age five and up, there is a spontaneous resolution rate of 15% in children; that is to say, 15% of kids who wet the bed will naturally stop wetting the bed each year beginning at age five. At 18-years-old, up to 2% of adolescents will still struggle with nocturnal enuresis, and will likely have this problem through their adult lives.
Causes and Risk Factors
- Developmental delay or delayed toilet training
- Genetics or family history
- Inadequate response to or insufficient secretion of antidiuretic hormone
- Heavy sleeping
- Males are twice as likely to struggle with bedwetting compared to females
References:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association 2000:39–134.
Dopheide JA, Pliszka SR. Chapter 72. Childhood Disorders. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com.proxy.lib.uwaterloo.ca/content.aspx?aID=7986907. Accessed Mar 20, 2013.
Tu ND, Baskin LS, Arnhym AM. Etiology and evaluation of nocturnal enuresis in children. In: Basow DS (ed). UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association 2000:39–134.
Dopheide JA, Pliszka SR. Chapter 72. Childhood Disorders. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com.proxy.lib.uwaterloo.ca/content.aspx?aID=7986907. Accessed Mar 20, 2013.
Tu ND, Baskin LS, Arnhym AM. Etiology and evaluation of nocturnal enuresis in children. In: Basow DS (ed). UpToDate. Waltham, MA: UpToDate; 2013. www.uptodate.com. Updated Dec 4, 2012. Accessed Mar 18, 2013.