DSM-5 Diagnostic Criteria
Enuresis 307.6 (F98.0)
A. Repeated emission of urine in bed or on clothing, whether involuntary or voluntary.
B. The behavior is clinically significant when it occurs with a frequency of at least twice a week for a minimum of three consecutive months or due to the presence of clinically significant distress or impairment in social, academic (work) or other important areas of life. functioning.
C. Chronological age is at least 5 years (or an equivalent level of development).
D. The behavior cannot be attributed to the physiological effects of a substance (e.g., a diuretic, antipsychotic) or another medical condition (e.g., diabetes, spina bifida, epilepsy).
Specify if:
Nocturnal only: Emission of urine only during nocturnal sleep.
Daytime only: Emission of urine during waking hours.
Nocturnal and daytime: A combination of the two previous subtypes.
The essential characteristic of enuresis is the repeated emission of urine during the day or night in bed or on clothes. In most cases this is usually involuntary, but sometimes it is intentional.
To establish a diagnosis of enuresis, the emission of urine must occur at least twice a week for a minimum of 3 months, or it must cause clinically significant discomfort or impairment in social, academic (occupational) or other important areas of functioning. child. An age at which continence can be expected must have been reached (i.e. the child’s chronological age must be at least 5 years). Urinary incontinence is not due exclusively to the direct physiological effects of a substance (e.g. ., diuretic), or a medical illness (e.g., diabetes, spina bifida, seizure disorder).
Symptoms
The magnitude of the alterations associated with enuresis depends on the limitation exerted on the child’s social activities (e.g., inability to sleep outside the home) or its effect on his or her self-esteem, the degree of social ostracism to which he or she is subjected. their peers and the anger, punishment and rejection exercised by their caregivers.
Treatment:
The treatment will consist of teaching the child the appropriate guidelines to control the reflex to urinate during the day and at night, as well as advising parents on the behavior they should adopt in response to the problem. Some of the most effective and frequent interventions used in psychological treatment are:
Alarm method:
It is an extremely effective method. It consists of placing a device called pipi-stop when the child goes to sleep. The device is sensitive to humidity and will activate with an intense sound at the first drops of urine. This sound will cause urination to stop and the child to wake up. The repetition of this sequence will cause the child to associate the body signals of the beginning of urination with the action of waking up and at the end of the night the child will wake up before the device rings, thus avoiding wetting the bed and acquiring the habit of controlling the urination reflex.
Voluntary retention training:
It consists of exercising the sphincter muscles that control urine retention.
Dry bed training:
It consists of teaching the child the correct guidelines during the night: waking up, holding urine, getting out of bed, going to the bathroom, etc.