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Page: Medical Definitions (Clinical Criteria): Primary vs. Secondary Enuresis
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Primary enuresis is when a child has never been dry at night or would not sleep dry without being taken to the toilet by another person or has some dry nights but continues to average at least two wet nights a week with no long periods of dryness.
Secondary enuresis occurs when a patient goes through an extended period of dryness and begins to experience night-time wetting again. Secondary enuresis can be caused by emotional stress or a medical condition.
Some medical definitions list Primary Nocturnal Enuresis (PNE) as a clinical condition at between 4-5 years old. This type of classification is frequently used by insurance companies. It defines PNE as "Persistent bedwetting in the absence of any urologic, medical or neurological anomaly in a child beyond the age when over 75% of children are normally dry."
Psychologists may use a definition from the American Psychiatric Association’s DSM-IV, defining nocturnal enuresis as repeated urination into bed or clothes, occurring twice per week for at least 3 consecutive months in a child of at least 5 years of age and not due to either a drug side effect or a medical condition. Even if the case does not meet this criteria, the DSM-IV definition allows psychologists to diagnose nocturnal enuresis if the wetting causes the patient clinically significant distress.
Other definitions cast themselves as more “practical” guidance, saying that bedwetting can be considered "clinical problem" if the child is unable to keep the bed dry by age seven.
D'Alessandro refines this to bedwetting more than 2x/month after the age:
* 6 years for females
* 7 years for males.
Secondary enuresis is defined as the onset of bedwetting after having been dry at night for 6 months prior to wetting the bed again.
Doctors consider medical evaluation/intervention when:
* The physician suspects a bladder abnormality
* Lab tests show an infection or other medical condition like diabetes
* The bedwetting is harming the child’s self-esteem or relationships with family/friends
Doctors and parents polled in a medical study reported significantly different attitudes about bedwetting. Parents felt children should stay dry by 2.75 years old, while the physicians average response was 5.13 years.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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