Signs & Symptoms
Children with enuresis urinate involuntarily at night or during the day. Many younger children, at about ages 5 and 6, are not especially bothered by their condition. Although they probably dislike waking up on wet sheets and facing their annoyed parents, they don't seem particularly distressed. As they get older, however, and become more interested in a social life, sleepover dates, and camp, enuresis becomes more of an interference in their lives, and secondary problems of avoidance behaviors or low self-esteem can emerge.
Subtypes (according to Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV))
- Nocturnal only. This is the most common subtype and is defined as passage of urine only during nighttime sleep. Typically, the child voids during the rapid eye movement (REM) stage of sleep, and may recall a dream that involves the act of 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 uncommon after age 9 years. The child most commonly wets in the early afternoon on school days. Diurnal enuresis is sometimes due to a reluctance to use the toilet because of social anxiety or a preoccupation with school or play activity.
- Nocturnal and diurnal. A combination of the two subtypes described above.