Editing Enuresis (section)

== Signs and symptoms ==

Nocturnal enuresis usually presents with voiding of urine during sleep in a child for whom it is difficult to wake.<ref name=":9">{{cite journal | vauthors = Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, von Gontard A, Wright A, Yang SS, Nevéus T | display-authors = 6 | title = 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 | journal = The Journal of Urology | volume = 191 | issue = 6 | pages = 1863–1865.e13 | date = June 2014 | pmid = 24508614 | doi = 10.1016/j.juro.2014.01.110 }}</ref><ref>{{cite journal | vauthors = Ramakrishnan K | title = Evaluation and treatment of enuresis | journal = American Family Physician | volume = 78 | issue = 4 | pages = 489–96 | date = August 2008 | pmid = 18756657 | url = https://www.aafp.org/afp/2008/0815/p489.html }}</ref> It may be accompanied by bladder dysfunction during the day which is termed non-mono symptomatic enuresis.<ref name="auto">von Gontard A. Enuresis. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2012.</ref> Day time enuresis, also known as urinary incontinence, may also be accompanied by bladder dysfunction.

The symptoms of bladder dysfunction include:<ref name="auto" />

# Urge incontinence – the presence of an overwhelming urge to urinate, frequent urination, attempts to hold the urine and urinary tract infections.
# Voiding postponement – delaying urination in certain situations such as school.
# Stress incontinence – incontinence that occurs in situations when increased intra-abdominal pressure occurs such as coughing.
# Giggling incontinence – incontinence that occurs when laughing.

Secondary incontinence usually occurs in the context of a new life event that is stressful such as abuse or parental divorce.<ref name="auto" />

Signs indicating a child has a daytime wetting condition may include:<ref name=":6" />
* urgency to urinate with leakage of urine
* urinating 8 times a day or more
* urinating less than a regular amount of 4-7 times a day (infrequent urination)
* inability to fully empty the bladder when urinating (incomplete urination)
* avoiding urine leakage through physical compensation, like squatting, squirming, leg crossing, or heel sitting.

Signs indicating a child has a nighttime wetting condition, if they are at least 5 years old, may include:<ref name=":6" />
* bedwetting that occurs at least 2 times a week over at least 3 months
* reoccurrence of bedwetting after 6 months of no bedwetting.

=== Impact ===
It is recommended that children are made aware that bedwetting is not their fault, especially due to preconceived notions of inadequate parenting or psychiatric issues leading to enuresis.<ref name=":3" /> Untreated enuresis may lead to a lack of self-esteem or avoidance of social activities.<ref name=":3" /> Children with nocturnal enuresis are found to have lower quality of life, but it is not clear which aspects are most affected.<ref name=":4" /> More studies are needed to understand the impact of nocturnal enuresis on parents.<ref name=":4">{{cite journal | vauthors = Collis D, Kennedy-Behr A, Kearney L | title = The impact of bowel and bladder problems on children's quality of life and their parents: A scoping review | journal = Child | volume = 45 | issue = 1 | pages = 1–14 | date = January 2019 | pmid = 30328126 | doi = 10.1111/cch.12620 | s2cid = 53525241 | doi-access = free }}</ref>