Diagnosis

The term ‘enuresis’ is used when a child, beyond the age of anticipated bladder control and socially correct toileting behaviour, urinates into clothing or other inappropriate places. The defining age is usually considered to be five years. Whether the urinating is intentional or involuntary is not relevant to the general diagnosis. However, involuntary urination during the night, in a child who has never ceased to wet the bed (or has lost a previously acquired skill) is referred to as ‘nocturnal enuresis’, and colloquially as ‘bedwetting’. Nocturnal enuresis is one of the commonest reasons for families seeking help from primary care physicians. The problem was referred to as early as the sixteenth century in The boke of chyldren by Thomas Phaire, in a chapter entitled ‘Of pissing in the bedde’.

‘Diurnal enuresis’ is the term for involuntary daytime urination. It occurs in approximately 1 in 10 of the children with nocturnal enuresis. A distinction is also made between children who are ‘regular’ and those who are ‘intermittent’ bedwetters. Most enuretic children have what is called ‘primary’ nocturnal enuresis, meaning that they have wet their beds since toddlerhood. ‘Secondary’ enuresis is the term applied to children who revert to bedwetting after a sustained period of dry beds. Although urinary tract infections or diabetes may play a role in secondary enuresis, it is often impossible to identify any specific medical cause.