Diurnal enuresis is daytime wetting. Nocturnal enuresis is nighttime wetting. Enuresis is defined as the involuntary voiding of urine beyond the age of anticipated control. Both of these conditions can occur at the same time, Many children with nighttime wetting will not have wetting during the day. Children with daytime wetting may have frequent urination, have urgent urination or dribble after urinating. The DSM-V classifies enuresis as an elimination disorder and as such it may be defined as the involuntary or voluntary elimination of urine into inappropriate places. A patient must be of at least a developmental level equivalent to the chronological age of a 5 year old in order to be diagnosed with enuresis. The patient must either experience a frequency of inappropriate voiding at least twice a week for a period of at least 3 consecutive months OR experience clinically significant distress or impairment in social, occupational or other important areas of functioning, in order to be diagnosed with enuresis. These symptoms must not be due to any underlying medical condition. As well, these symptoms must not be due exclusively to the direct physiological effect of a substance.
Management approaches include reassuring families that the child is not wetting their pants on purpose and treatment should include positive reinforcement. Non-invasive treatments include keeping a diary to track when the child does not make it to the bathroom on time, ruling out and treating urinary tract infections, ensuring the child is not constipated, hydration, timed voiding, correction of constipation, and in some cases, computer assisted pelvic floor retraining. The effectiveness of non-surgical and non-pharmaceutical interventions for treating children with daytime urinary incontinence is not clear. Bladderstretching exercises are no longer recommended. Bladder stretching exercises can be dangerous because the person could develop the long-term habit of tightening the urethral sphincter muscle, which can cause bladder or kidney problems. Urinating on a regular basis is suggested.
Epidemiology
Daytime wetting is more common in girls, but bedwetting is three times as prevalent in boys. At the age of 7 approximately 3% of girls and 2% of boys experience functional daytime wetting at least once a week.
