Enuresis

In enuresis (synonyms: Enuresis diurna; enuresis nocturna; enuresis nocturna neurotica; functional enuresis; incontinentia urinae of nonorganic origin; nervous enuresis; nonorganic enuresis; nonorganic enuresis nocturna; nonorganic urinary incontinence; nonorganic primary enuresis; nonorganic secondary enuresis; psychogenic enuresis; psychogenic enuresis nocturna; urinary incontinence of nonorganic origin; ICD-10-GM F98. 0: Non-organic enuresis) is the involuntary enuresis of the child. During the 3rd to 6th year of life, stable bladder control develops, first during the day and later at night. By the fifth year of life, nocturnal enuresis is considered physiological. Primary incontinence (urinary incontinence; inability to retain urine) is said to exist from early childhood. Enuresis is one of the most common disorders in childhood. ICCS criteria and definitions

A distinction is made between continuous and intermittent urinary incontinence. The intermittent form is divided into:

• Enuresis nocturna (nocturnal enuresis; bedwetting; bedwetting, enuresis during sleep/including naps).
• Enuresis diurna (daytime wetting; daytime wetting (while awake)); it is a daytime non-organic (functional) urinary incontinence* ; usually combined with other symptoms of bladder dysfunction (see below).
• Wetting both asleep and awake – 2 diagnoses: subform of enuresis and daytime urinary incontinence.

Criteria

• * Exclusion of organic causes (neurogenic, structural or other medical causes).
• Chronological minimum age of 5.0 years
• Duration of at least 3 months
• Frequency at least one episode per month
  • ≥ 4 episodes/week: frequent wetting.
  • < 4 episodes/week: infrequent bedwetting
  • < 1 episode/month: symptoms but no disorder

Distinguish between a primary and a secondary form of enuresis:

• Primary enuresis – enuresis present from birth or never dry for more than 6 months.
• Secondary enuresis – renewed enuresis after a dry phase lasting at least six months.

Adult enuresis is said to occur when enuresis persists beyond the age of eighteen. The incidence in young adults is 2-6%. Enuresis is divided by cause into:

• Nonorganic (functional) enuresis:
  • Purely nocturnal enuresis (monosymptomatic enuresis nocturna, NEM).
  • Nocturnal enuresis with additional daytime symptoms (non-monosymptomatic enuresis nocturna, Non-MEN).
  • Bladder dysfunction with isolated daytime symptoms:
    • Overactive bladder (OAB) and urge incontinence (imperative urination/sudden, very strong, unmanageable urge to urinate followed by involuntary urination).
    • Micturition postponement (refusal syndrome in which urine is withheld and urination is delayed in certain situations (going to school, school, game situations, television, etc.)).
    • Dyscoordinated micturition (emptying the bladder) (detrusor sphincter dyscoordination).
    • Underactive bladder (Engl. underactive bladder).
• Organic enuresis (rarely occurs); enuresis due to:
  • Anatomical disorders/diseases – malformation of the urinary tract (often associated with malformations of the kidney).
  • Neurological disorders/diseases:
    • Congenital (congenital).
    • Acquired tumorous or inflammatory diseases of the nervous system that affect bladder innervation
  • Polyuric kidney disease

As a rule, it is a functional disorder. Only rarely are psychological causes such as increased stress (eg, divorce / separation of parents) trigger of wetting. The prevalence of nocturnal enuresis (enuresis nocturna) is 7-13% in the 7-year-old group and 1-2% in the adolescent group. During the day (enuresis diurna), 2-3% of 7-year-olds wet the bed. Course and prognosis: Wetting children experience high levels of distress. They are reluctant to stay overnight with friends or are afraid of school trips.Against this background, it is not advisable to wait until the enuresis resolves spontaneously (on its own). In most cases, simple measures (standard durotherapy: e.g. micturition/ toilet training) are sufficient to stop the enuresis. Note: If other excretory disorders are present in addition to enuresis, fecal incontinence (inability to control bowel movements) or constipation is treated first, followed by daytime urinary incontinence (bladder weakness), and finally enuresis. Comorbidities (concomitant disorders): child psychiatric (hyperkinetic disorders (ADHD); anxiety disorders, depressive disorders) and gastroenterological disorders (fecal retention and constipation/constipation) are associated with enuresis.