Skip to main content
SpringerLink
Log in

Enuresis

  • Chapter
  • First Online:
Handbook of DSM-5 Disorders in Children and Adolescents

Abstract

This chapter reviews the history of the diagnosis of enuresis in the DSM. The understanding about the cause of urinary incontinence in children has changed over time from a psychopathologic and psychodynamic focus to a multifactorial focus with an emphasis on physiology, psychology, and genetics. The DSM-5 diagnostic criteria were compared with the World Health Organization’s International Classification of Diseases (ICD), the International Classification of Sleep Disorders (ICSD), and the International Children’s Continence Society (ICCS)‘s “Standardization of terminology of lower urinary tract function in children and adolescents.” Although it is now acknowledged that the majority of children with nocturnal enuresis do not have a coexisting mental disorder, the prevalence of coexisting psychological disorders is greater in this population and even greater in children with daytime urinary incontinence and encopresis (fecal incontinence). This chapter includes a discussion about the associated impairments and comorbidities. The chapter concludes with an evidence-based overview of the etiology, symptom presentation, and treatment of enuresis and daytime urinary incontinence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 349.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 449.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 449.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • American Academy of Sleep Medicine. (2005). The international classification of sleep disorders : Diagnostic & coding manual (2nd ed.). Westchester, IL: American Academy of Sleep Medicine.

    Google Scholar 

  • American Psychiatric Association. (1952). Diagnostic and statistical manual, mental disorders. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

    Book  Google Scholar 

  • Austin, P. F., Bauer, S. B., Bower, W., Chase, J., Franco, I., Hoebeke, P., … Wright, A. (2014). The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization Committee of the International Children’s continence society. The Journal of Urology, 191(6), 1863–1865.

    Google Scholar 

  • Bachmann, C., Lehr, D., Janhsen, E., Sambach, H., Muehlan, H., von Gontard, A., & Bachmann, H. (2009). Health related quality of life of a tertiary referral center population with urinary incontinence using the DCGM-10 questionnaire. The Journal of Urology, 182(4), 2000–2006.

    Article  PubMed  Google Scholar 

  • Baeyens, D., Roeyers, H., Demeyere, I., Verte, S., Hoebeke, P., & Vande Walle, J. (2005). Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: A two-year follow-up study. Acta Paediatrica, 94(11), 1619–1625.

    Article  PubMed  Google Scholar 

  • Baeyens, D., Roeyers, H., Hoebeke, P., Verte, S., Van Hoecke, E., & Vande Walle, J. (2004). Attention deficit/hyperactivity disorder in children with nocturnal enuresis. Journal of Urology, 171(6 II), 2576–2579.

    Article  PubMed  Google Scholar 

  • Bower, W. F., Moore, K. H., Shepherd, R. B., & Adams, R. D. (1996). The epidemiology of childhood enuresis in Australia. British Journal of Urology, 78(4), 602–606.

    Article  PubMed  Google Scholar 

  • Brazelton, T. B. (1962). A child-oriented approach to toilet training. Pediatrics, 29(1), 121–128.

    PubMed  Google Scholar 

  • Brooks, L. J., & Topol, H. I. (2003). Enuresis in children with sleep apnea. Journal of Pediatrics, 142(5), 515–518.

    Article  PubMed  Google Scholar 

  • Butler, R., & Heron, J. (2006). Exploring the differences between mono-and polysymptomatic nocturnal enuresis. Scandinavian Journal of Urology and Nephrology, 40(4), 313–319.

    Article  PubMed  Google Scholar 

  • Butler, R. J., & Holland, P. (2000). The three systems approach: A conceptual way of understanding nocturnal enuresis. Scandinavian Journal of Urology and Nephrology, 34(4), 270–277.

    Article  PubMed  Google Scholar 

  • Chase, J., Austin, P., Hoebeke, P., & McKenna, P. (2010). The management of dysfunctional voiding in children: A report from the standardisation Committee of the International Children’s continence Society. The Journal of Urology, 183(4), 1296–1302.

    Article  PubMed  Google Scholar 

  • Crimmins, C., Rathbun, S., & Husmann, D. (2003). Management of urinary incontinence and nocturnal enuresis in attention-deficit hyperactivity disorder. The Journal of Urology, 170(4), 1347–1350.

    Article  PubMed  Google Scholar 

  • Deshpande, A. V., Caldwell, H. Y. P., & Sureshkumar, P. (2012). Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database of Systematic Reviews, 12, CD002238. doi:10.1002/14651858.CD002238.pub2.

    PubMed  Google Scholar 

  • Deshpande, A. V., Craig, J. C., Smith, G. H. H., & Caldwell, P. H. Y. (2011). Factors influencing quality of life in children with urinary incontinence. Journal of Urology, 186(3), 1048–1052.

    Article  PubMed  Google Scholar 

  • Eiberg, H., Shaumburg, H., von Gontard, A., & Rittig, S. (2001). Linkage study of a large Danish 4-generation family with urge incontinence and nocturnal enuresis. The Journal of Urology, 166(6), 2401–2403.

    Article  PubMed  Google Scholar 

  • Elzinga-Plomp, A., Boemers, T., Messer, A., Vijverberg, M., Jong, T., & Gool, J. (1995). Treatment of enuresis risoria in children by self-administered electric and imaginary shock. British Journal of Urology, 76(6), 775–778.

    Article  PubMed  Google Scholar 

  • Equit, M., Sambach, H., Niemczyk, J., & von Gontard, A. (2014). Urinary and fecal incontinence: A training program for children and adolescents. Toronto: Hogrefe Publishing.

    Google Scholar 

  • Feehan, M., McGee, R., Stanton, W., & Silva, P. (1990). A 6 year follow-up of childhood enuresis: Prevalence in adolescence and consequences for mental health. Journal of Paediatrics & Child Health, 26(2), 75–79.

    Article  Google Scholar 

  • Fergusson, D., Horwood, L., & Shannon, F. (1986). Factors related to the age of attainment of nocturnal bladder control: An 8-year longitudinal study. Pediatrics, 78(5), 884–890.

    PubMed  Google Scholar 

  • Fergusson, D. M., Horwood, L., & Shannon, F. (1990). Secondary enuresis in a birth cohort of New Zealand children. Paediatric and Perinatal Epidemiology, 4(1), 53–63.

    Article  PubMed  Google Scholar 

  • Forsythe, W. I., & Redmond, A. (1974). Enuresis and spontaneous cure rate: Study of 1129 patients. Archives of Diseases Child, 49, 259–263. doi:10.1136/adc.49.4.259.

    Article  Google Scholar 

  • Franco, I. (2007a). Overactive bladder in children. Part 1: Pathophysiology. The Journal of Urology, 178(3), 761–768.

    Article  PubMed  Google Scholar 

  • Franco, I. (2007b). Overactive bladder in children. Part 2: Management. The Journal of Urology, 178(3), 769–774.

    Article  PubMed  Google Scholar 

  • Franco, I., von Gontard, A., & De Gennaro, M. (2013). Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: A standardization document from the international Children’s continence Society. Journal of Pediatric Urology, 9(2), 234–243.

    Article  PubMed  Google Scholar 

  • Gim, C. S. Y., Lillystone, D., & Caldwell, P. H. Y. (2009). Efficacy of the bell and pad alarm therapy for nocturnal enuresis. Journal of Paediatrics & Child Health, 45(7–8), 405–408.

    Article  Google Scholar 

  • Glazener, C. M., & Evans, J. H. (2002). Desmopressin for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 3, CD002112.

    Google Scholar 

  • Glazener, C. M., Evans, J. H., & Peto, R. E. (2003). Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 3, CD002117.

    Google Scholar 

  • Glazener, C. M., Evans, J. H., & Peto, R. E. (2005). Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 2, CD002911.

    Google Scholar 

  • Hagglof, B., Andren, O., Bergstrom, E., Marklund, L., & Wendelius, M. (1998). Self-esteem in children with nocturnal enuresis and urinary incontinence: Improvement of self-esteem after treatment. European Urology, 33(Suppl 3), 16–19.

    PubMed  Google Scholar 

  • Hellstrom, A., Hanson, E., Hansson, S., Hjalmas, K., & Jodal, U. (1995). Micturition habits and incontinence at age 17--reinvestigation of a cohort studied at age 7. British Journal of Urology, 76(2), 231–234.

    Article  PubMed  Google Scholar 

  • Heron, J., Joinson, C., Croudace, T., & von Gontard, A. (2008). Trajectories of daytime wetting and soiling in a United Kingdom 4 to 9-year-old population birth cohort study. The Journal of Urology, 179(5), 1970–1975.

    Article  PubMed  Google Scholar 

  • Hooton, T. M. (2001). Recurrent urinary tract infection in women. International Journal of Antimicrobial Agents, 17(4), 259–268.

    Article  PubMed  Google Scholar 

  • Hublin, C., Kaprio, J., Partinen, M., & Koskenvuo, M. (1998). Nocturnal enuresis in a nationwide twin cohort. Sleep, 21(6), 579–585.

    Article  PubMed  Google Scholar 

  • Hunskaar, S., & Vinsnes, A. (1991). The quality of life in women with urinary incontinence as measured by the sickness impact profile. Journal of the American Geriatrics Society, 38(4), 378–382.

    Article  Google Scholar 

  • Järvelin, M. R. (1989). Developmental history and neurological findings in enuretic children. Developmental Medicine & Child Neurology, 31(6), 728–736.

    Article  Google Scholar 

  • Järvelin, M. R., Moilanen, I., Vikeväinen-Tervonen, L., & Huttunen, N. P. (1990). Life changes and protective capacities in Enuretic and non-Enuretic children. Journal of Child Psychology and Psychiatry, 31(5), 763–774.

    Article  PubMed  Google Scholar 

  • Joinson, C., Heron, J., Emond, A., & Butler, R. (2007). Psychological problems in children with bedwetting and combined (day and night) wetting: A UK population-based study. Journal of Pediatric Psychology, 32(5), 605–616.

    Article  PubMed  Google Scholar 

  • Joinson, C., Heron, J., von Gontard, A., Butler, U., Emond, A., & Golding, J. (2009). A prospective study of age at initiation of toilet training and subsequent daytime bladder control in school-age children. Journal of Developmental & Behavioral Pediatrics, 30(5), 385–393.

    Article  Google Scholar 

  • Joinson, C., Heron, J., von Gontard, A., Butler, U., Golding, J., & Emond, A. (2008). Early childhood risk factors associated with daytime wetting and soiling in school-age children. Journal of Pediatric Psychology, 33(7), 739–750.

    Article  PubMed  Google Scholar 

  • Koff, S. A. (1996). Cure of nocturnal enuresis: Why isn’t desmopressin very effective? Pediatric Nephrology, 10(5), 667–670.

    Article  PubMed  Google Scholar 

  • Kuh, D., Cardozo, L., & Hardy, R. (1999). Urinary incontinence in middle aged women: Childhood enuresis and other lifetime risk factors in a British prospective cohort. Journal of Epidemiological Community Health, 53(8), 453–458.

    Article  Google Scholar 

  • Kuhn, S., Natale, N., Siemer, S., Stoeckle, M., & von Gontard, A. (2009). Clinical differences in daytime wetting subtypes: Urge incontinence and postponed voiding. The Journal of Urology, 182(4), 1967–1972.

    Article  PubMed  Google Scholar 

  • Largo, R. H., Molinari, L., Siebenthal, K., & Wolfensberger, U. (1996). Does a profound change in toilet-training affect development of bowel and bladder control? Developmental Medicine & Child Neurology, 38(12), 1106–1116.

    Article  Google Scholar 

  • Loening-Baucke, V. (1997). Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics, 100(2 (Pt 1)), 228–232.

    Article  PubMed  Google Scholar 

  • Longstaffe, S., Moffatt, M. E., & Whalen, J. C. (2000). Behavioral and self-concept changes after six months of enuresis treatment: A randomized, controlled trial. Pediatrics, 105(Supplement 3), 935–940.

    PubMed  Google Scholar 

  • Macaulay, A. J., Stern, R. S., & Stanton, S. L. (1991). Psychological aspects of 211 female patients attending a urodynamic unit. Journal of Psychosomatic Research, 35(1), 1–10.

    Article  PubMed  Google Scholar 

  • Nunes, V. D., O’Flynn, N., Evans, J., & Sawyer, L. (2010). Management of enuresis in children and adolescents: Summary of the NICE guideline. British Medical Journal, 341(2), c5399. doi:10.1136/bmj.c5399.

    Article  PubMed  Google Scholar 

  • McGrath, K. H., Caldwell, P. H., & Jones, M. P. (2008). The frequency of constipation in children with nocturnal enuresis: A comparison with parental reporting. Journal of Paediatrics andChild Health, 44(1–2), 19–27.

    Google Scholar 

  • Neveus, T., Eggert, P., Evans, J., Macedo, A., Rittig, S., Tekgul, S., … International Children’s Continence Society, International Children’s Continence Society. (2010). Evaluation of and treatment for monosymptomatic enuresis: A standardization document from the international Children’s continence Society. Journal of Urology, 183(2), 441–447. doi:10.1016/j.juro.2009.10.043.

  • Nørgaard, J. P. (1991). Pathophysiology of nocturnal enuresis. Scandinavian Journal of Urology and Nephrology. Supplementum, 140, 1–35.

    PubMed  Google Scholar 

  • Nygaard, I., Turvey, C., Burns, T. L., Crischilles, E., & Wallace, R. (2003). Urinary incontinence and depression in middle-aged United States women. Obstetrics & Gynecology, 101(1), 149–156.

    Google Scholar 

  • O’Regan, S., Yazbeck, S., Hamberger, B., & Schick, E. (1986). Constipation a commonly unrecognized cause of enuresis. American Journal of Diseases of Children, 140(3), 260–261.

    PubMed  Google Scholar 

  • Rittig, S., Knudsen, U. B., Norgaard, J. P., Pedersen, E. B., & Djurhuus, J. C. (1989). Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. American Journal of Physiology, 256(4 Pt 2), F664–F671.

    PubMed  Google Scholar 

  • Robson, W. L. M., Leung, A. K., & Van Howe, R. (2005). Primary and secondary nocturnal enuresis: Similarities in presentation. Pediatrics, 115(4), 956–959.

    Article  PubMed  Google Scholar 

  • Roijen, L., Postema, K., Limbeek, V., & Kuppevelt, V. (2001). Development of bladder control in children and adolescents with cerebral palsy. Developmental Medicine & Child Neurology, 43(2), 103–107.

    Article  Google Scholar 

  • Salonia, A., Zanni, G., Nappi, R. E., Briganti, A., Dehò, F., Fabbri, F., … Rigatti, P. (2004). Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: Results of a cross-sectional study. European Urology, 45(5), 642–648.

    Google Scholar 

  • Sher, P. K., & Reinberg, Y. (1996). Successful treatment of giggle incontinence with methylphenidate. The Journal of Urology, 156(2), 656–658.

    Article  PubMed  Google Scholar 

  • Temml, C., Haidinger, G., Schmidbauer, J., Schatzl, G., & Madersbacher, S. (2000). Urinary incontinence in both sexes: Prevalence rates and impact on quality of life and sexual life. Neurourology and Urodynamics, 19(3), 259–271.

    Article  PubMed  Google Scholar 

  • Vijverberg, M., Elzinga-Plomp, A., Messer, A., Van Gool, J., & De Jong, T. (1996). Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence. European Urology, 31(1), 68–72.

    Article  Google Scholar 

  • von Gontard, A. (2013a). The impact of DSM-5 and guidelines for assessment and treatment of elimination disorders. European Child & Adolescent Psychiatry, 22(1), 61–67.

    Article  Google Scholar 

  • von Gontard, A. (2013b). Urinary incontinence in children with special needs. Nature Reviews Urology, 10, 667–674. doi:10.1038/nrurol.2013.213.

    Article  Google Scholar 

  • von Gontard, A., Baeyens, D., Van Hoecke, E., Warzak, W. J., & Bachmann, C. (2011a). Psychological and psychiatric issues in urinary and fecal incontinence. The Journal of Urology, 185(4), 1432–1437.

    Article  Google Scholar 

  • von Gontard, A., & Equit, M. (2014). Comorbidity of ADHD and incontinence in children. European Child & Adolescent Psychiatry, 24, 1–14.

    Google Scholar 

  • von Gontard, A., Heron, J., & Joinson, C. (2011b). Family history of nocturnal enuresis and urinary incontinence: Results from a large epidemiological study. The Journal of Urology, 185(6), 2303–2307.

    Article  Google Scholar 

  • von Gontard, A., Mauer-Mucke, K., Plück, J., Berner, W., & Lehmkuhl, G. (1999). Clinical behavioral problems in day-and night-wetting children. Pediatric Nephrology, 13(8), 662–667.

    Article  Google Scholar 

  • von Gontard, A., Moritz, A., Thome-Granz, S., & Freitag, C. (2011c). Association of attention deficit and elimination disorders at school entry: A population based study. The Journal of Urology, 186(5), 2027–2032.

    Article  Google Scholar 

  • von Gontard, A., & Neveus, T. (Eds.). (2006). Management of disorders of bladder and bowel control in childhood. Cambridge: Cambridge University Press.

    Google Scholar 

  • von Gontard, A., Schaumburg, H., Hollmann, E., Eiberg, H., & Rittig, S. (2001). The genetics of enuresis: A review. The Journal of Urology, 166(6), 2438–2443.

    Article  Google Scholar 

  • Wolfish, N., Pivik, R., & Busby, K. (1997). Elevated sleep arousal thresholds in enuretic boys: Clinical implications. Acta Paediatrica, 86(4), 381–384.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2008). International classification of diseases (ICD) 10th retrieved January 9, 2015 from http://apps.who.int/classifications/apps/icd/icd10online/

  • Yeung, C. K., Sihoe, J. D., Sit, F. K., Bower, W., Sreedhar, B., & Lau, J. (2004). Characteristics of primary nocturnal enuresis in adults: An epidemiological study. BJU International, 93(3), 341–345.

    Article  PubMed  Google Scholar 

  • Yeung, C. K., Sreedhar, B., Sihoe, J. D., Sit, F. K., & Lau, J. (2006). Differences in characteristics of nocturnal enuresis between children and adolescents: A critical appraisal from a large epidemiological study. BJU International, 97(5), 1069–1073. doi:10.1111/j.1464-410X.2006.06074.x.

    Article  PubMed  Google Scholar 

  • Young, G. C., & Morgan, R. T. (1972). Overlearning in the conditioning treatment of enuresis: A long-term follow-up study. Behaviour Research & Therapy, 10(4), 419–420.

    Article  Google Scholar 

  • Zink, S., Freitag, C. M., & von Gontard, A. (2008). Behavioral comorbidity differs in subtypes of enuresis and urinary incontinence. The Journal of Urology, 179(1), 295–298.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Kidney Research, Discipline of Paediatrics and Child Health, The Children’s Hospital of Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Patrina Caldwell

  2. Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie Universitätsklinikum des Saarlandes, 66421, Homburg, Germany

    Alexander von Gontard

Authors
  1. Patrina Caldwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander von Gontard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrina Caldwell .

Editor information

Editors and Affiliations

  1. Neurology, Learning and Behavior Center, Salt Lake City, Utah, USA

    Sam Goldstein

  2. Intermountain Healthcare, Salt Lake City, Utah, USA

    Melissa DeVries

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Caldwell, P., von Gontard, A. (2017). Enuresis. In: Goldstein, S., DeVries, M. (eds) Handbook of DSM-5 Disorders in Children and Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-319-57196-6_23

Download citation

Publish with us

Policies and ethics

Search

Navigation