DSM-III

In DSM-III, this disorder is called Functional Enuresis

Diagnostic Criteria

A. Repeated involuntary voiding of urine by day or at night.

B. At least two such events per month for children between the ages of five and six, and at least one event per month for older children.

C. Not due to a physical disorder, such as diabetes or a seizure disorder.

Differential Diagnosis

Organic causes of enuresis such as diabetes and seizure disorder should be ruled out by appropriate physical examination.

DSM-IV

Diagnostic Criteria

A. Repeated voiding of urine into bed or clothes (whether involuntary or intentional).

B. The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

C. Chronological age is at least 5 years (or equivalent developmental level).

D. The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Specify type:

  • Nocturnal Only
  • Diurnal Only
  • Nocturnal and Diurnal

Subtypes

The situation in which the Enuresis occurs may be noted by one of the following subtypes:

Nocturnal Only

This is the most common subtype and is defined as passage or urine only during nighttime sleep. The enuretic event typically occurs during the first one-third of the night. Occasionally the voiding takes place during the rapid eye movement (REM) stage of sleep, and the child may recall a dream that involved the act or urinating.

Diurnal Only

This subtype is defined as the passage of urine during waking hours. Diurnal Enuresis is more common in females than in males and is uncommon after age 9 years. The enuretic event most commonly occurs in the early afternoon on school days. Diurnal enuresis is sometimes due to reluctance to use the toilet because of social anxiety or a preoccupation with school or play activity.

Nocturnal and Diurnal

This subtype is defined as a combination of the two subtypes above.

Differential Diagnosis

General medical condition

The diagnosis of Enuresis is not made in the presence of a neurogenic bladder or the presence of a general medical condition that causes polyuria or urgency (e.g., untreated diabetes mellitus or diabetes insipidus) or during an acute urinary tract infection. However, a diagnosis of Enuresis is compatible with such conditions if urinary incontinence was regularly present prior to the development of the general medical condition or if it persists after the institution of appropriate treatment.

DSM-5

Diagnostic Criteria

A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.

B. The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

C. Chronological age is at least 5 years (or equivalent development level).

D. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Specify whether:

  • Nocturnal only: Passage of urine only during nighttime sleep.
  • Diurnal only: Passage of urine during waking hours.
  • Nocturnal and diurnal: A combination of the two subtypes above.

Subtypes

The nocturnal-only subtype of enuresis, sometimes referred to as monosymptomatic enuresis, is the most common subtype and involves incontinence only during nighttime sleep, typically during the first one-third of the night. The diurnal-only subtype occurs in the absence of nocturnal enuresis and may be referred to simply as urinary incontinence. Individuals with this subtype can be divided into two groups. Individuals with "urge incontinence" have sudden urge symptoms and detrusor instability, whereas individuals with "voiding postponement" consciously defer micturition urges until incontinence results. The nocturnal-and-diurnal subtype is also known as nonmonosymptomatic enuresis.

Differential Diagnosis

Neurogenic bladder or another medical condition

The diagnosis of enuresis is not made in the presence of a neurogenic bladder or another medical condition that causes polyuria or urgency (e.g., untreated diabetes mellitus or diabetes insipidus) or during an acute urinary tract infection. However, a diagnosis is compatible with such conditions if urinary incontinence was regularly present prior to the development of another medical condition or if it persists after the institution of appropriate treatment of the medical condition.

Medication side effects

Enuresis may occur during treatment with antipsychotic medications, diuretics, or other medications that may induce incontinence. In this case, the diagnosis should not be made in isolation but may be noted as a medication side effect. However, a diagnosis of enuresis may be made if urinary incontinence was regularly present prior to treatment with the medication.

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