Nocturnal Enuresis: A Review and Focus on The Treatment Modalities of Monosymptomatic Nocturnal EnuresisN octurnal Enuresis (Bedwetting) significantly impacts children and families, especially emotional well-being, self-esteem, interpersonal relationships, and socialization. 1,2 However, both domestic and international studies have found only a minority of caregivers have brought this problem to consult a physician. 3 Therefore, physicians play a key role in finding the problem to provide advice and help children receive appropriate treatment at an early stage, resulting in a better quality of life for children and families. 4
DefinitionsThe definition of enuresis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) refers to repeated voiding of urine into bed or clothes, occurring at least twice a week for at least 3 consecutive months in children older than 5 years of age (or the developmental equivalent). Enuresis is divided into nocturnal enuresis (wetting while asleep at night) and diurnal enuresis (daytime wetting while awake). 5 The International Children's Continence Society (ICCS), 6 however, uses the term intermittent urinary incontinence, which refers to involuntary wetting, and classifies it into two categories. First, enuresis, also known as nocturnal enuresis, is defined as nighttime wetting at least once a week for at least 3 consecutive months in a child 5 years of age or older. Another is daytime urinary incontinence, which includes daytime wetting at least once every 2 weeks. Furthermore, enuresis is classified as monosymptomatic (MNE) or non-monosymptomatic (NMNE), with the latter correlating with lower urinary tract symptoms such as severe frequency, urgency, urine leaking, abnormalities of urine stream, or daytime incontinence. 7 In addition, enuresis can be categorized into primary and secondary forms. Primary enuresis is defined as the child who has never obtained continence, whereas secondary enuresis is the one that has been continent for at least 6 months and become incontinent. 5
