What are the symptoms of Enuresis?

The main sign that a child has Enuresis is regularly peeing in their clothing or bed at age 5 years or older (it is common for younger children to have poor bladder control). The frequency of a child’s urination results in problems in school, at home, and/or in social environments.

  • Enuresis can happen during the day, at night, or both
  • Enuresis can be involuntary or intentional
  • Children who experience Enuresis at night are often very heavy sleepers

How is Enuresis diagnosed?

A medical doctor or child-adolescent psychiatrist will make a diagnosis if a child experiences Enuresis at least twice per week for at least three months, and if it is causing problems for the child in school or with friends. It is also important for a medical doctor to examine the child to rule out medical problems like a urinary tract infection or diabetes.

Enuresis Facts

Worldwide frequency of the condition

Daytime Enuresis occurs in 3.2-9.0% of 7-year-olds, 1.1-4.2% of 11-13-year-olds, and 1.2-3.0% of 15-17-year-olds; and nighttime enuresis frequency ranges from 5%-10% of 5-year-olds, 3%–5% of 10-year-olds, and 1% of those 15 years or older. Recent international cohort studies report somewhat higher frequency rates.

Burden of the condition in Greece

Enuresis accounts for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.

Gender ratio

Enuresis is 1.5 to 2 times more common in boys than girls

Peak age of onset

Although specific data for Enuresis is unavailable, the peak age of onset for mental disorders, in general, is 14.5 years of age. The prevalence of nighttime enuresis decreases as children grow older (e.g., 20% in 4 year olds, 10% in 7 year olds, 1-2% in adolescents, and 0.3-1.7% in adults).

Proportion of the condition that emerges before age 18

Although specific data for Enuresis is unavailable, the proportion that emerges before age 18 years for mental disorders, in general, is 48.4%. This means that 83.2% of individuals with a mental disorder will have been diagnosed by the time they are 18 years old.

What are the associated factors for Enuresis?

Some common factors associated with Enuresis are:

  • Genetic and Familial factors. A child is more likely to have enuresis if their parents had it, especially their father.
  • Environmental factors. These include stress and delayed or inconsistent toilet training.
  • Medical factors. These include small bladder, bladder reactivity, lack of vasopressin release during sleep, and delayed development.

What other disorders co-occur with Enuresis?

Most children with Enuresis do not have a comorbid mental health disorder, although they may be more likely than their same-age peers to experience behavioral difficulties. Also, enuresis may be the sole manifestation of nocturnal seizures. Additionally, children with developmental delays (e.g., speech, language, language, motor development), encopresis, sleepwalking, or night terrors may experience enuresis.

How is Enuresis treated?

Most cases of enuresis are treated through a type of therapy called cognitive-behavioral therapy (CBT), although in some cases medication may be prescribed.

A cognitive-behavioral therapist will work with the child’s family to create a behavioral approach to help the child control his or her bladder. Several behavioral approaches include:

  • Moisture alarms that wake the child when they begin to wet the bed
  • Limiting fluid and caffeine intake in the evening hours
  • Encouraging the child to go to the bathroom more often
  • Rewarding the child when he or she has a dry night

Getting frustrated with the child when an episode happens and/or embarrassing the child in front of others not only increases stress but will not decrease the number of episodes.

A medical professional may opt to treat a child’s Enuresis with medicine, although when the child stops taking the medicine, wetting may resume.

  • Desmopressin leads to less urine to be produced at night
  • Oxybutynin increases bladder capacity and decreases bladder contractions

Medications can have side effects, but they are safe for children to use with proper care from their doctor. A child or teen who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

Where to find more information

If you need more information on bladder control, enuresis, and reasons for concerns, you can also go to "Difficulties with bladder control" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list here:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Enuresis or bedwetting: A quick guide. (2021, September 10). https://childmind.org/guide/enuresis-bedwetting-quick-guide/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C00 Enuresis. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1157749237

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Ferrara, P., Franceschini, G., Bianchi Di Castelbianco, F., Bombace, R., Villani, A., & Corsello, G. (2020). Epidemiology of enuresis: A large number of children at risk of low regard. Italian Journal of Pediatrics, 46(1), 128. https://doi.org/10.1186/s13052-020-00896-3
  • De Sousa, A., Kapoor, H., Jagtap, J., & Sen, M. (2007). Prevalence and factors affecting enuresis amongst primary school children. Indian Journal of Urology, 23(4), 354. https://doi.org/10.4103/0970-1591.36703
  • Mohammadi, M., Vaisi Raiegani, A. A., Jalali, R., Ghobadi, A., & Salari, N. (2019). The Prevalence of Nocturnal Enuresis among Iranian Children: A Systematic Review and Meta-Analysis. Urology Journal, 2019: Instant. https://doi.org/10.22037/uj.v0i0.5194
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
  • von Gontard A. Enuresis (2012). In Rey J.M. (ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • von Gontard A. Enuresis (2012). In Rey J.M. (ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

Interventions

  • Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E. G., Zangani, C., Fornaro, M., Estradé, A., Fusar‐Poli, P., Carvalho, A. F., & Solmi, M. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. https://doi.org/10.1002/wps.20881
  • Peng, C. C.-H., Yang, S. S.-D., Austin, P. F., & Chang, S.-J. (2018). Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis. Scientific Reports, 8(1), 16755. https://doi.org/10.1038/s41598-018-34935-1
  • Ramakrishnan, K. (2008). Evaluation and treatment of enuresis. American Family Physician, 78(4), 489–496.

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