or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. Chronological age is at least 5 years of age (or equivalent developmental level). The behavior is not due exclusively to the direct physiological effect of a substance (such as a diuretic) or a general medical condition (such as diabetes, spina bifida, a seizure disorder, etc.). All these criteria must be met in order to diagnose an individual. Generally, healthcare providers may further investigate for bladder control issues if a child is still enuretic in the daytime by age 4, or if they are still enuretic at nighttime by age 5 or 6. Classification The International Children's Continence Society (ICCS) has developed the following standard terminology: Primary enuresis refers to children who have never been successfully trained to control urination. Secondary enuresis refers to children who have been successfully trained and are continent for at least 6 months but revert to wetting in a response to some sort of stressful situation. There are 2 categories of enuresis: Monosymptomatic enuresis (MNE) – Does not include bladder dysfunction during daytime. Nonmonosymptomatic enuresis (NMNE) – Includes bladder dysfunction causing daytime incontinence that is frequent and urgent. Wetting that occurs in the daytime is sometimes referred to as diurnal enuresis. Other conditions, or comorbidities, that commonly accompany enuresis may be expected to be more common with NMNE. Management There are a number of management options for enuresis. Management of enuresis, both nocturnal and daytime, can include behavioral therapy, drug therapy, traditional Chinese medicine (TCM), and other alternative medicine therapies. Treatment of enuresis for children under 5 years old is not recommended. In adults with nocturnal enuresis, use of a bedwetting diary, which keeps track of when enuresis occurs, may be helpful for healthcare providers to figure out the causes of a person's enuresis and their best route for treatment. Behavioral therapy Simple behavioral interventions may prove to be superior in comparison to no ongoing form of treatment and are recommended as initial treatment. Nighttime fluid limitation Enuresis alarm – includes sleeping mats with electrical circuits; alarms with sensors placed in child's underwear; alarms that are wired or wireless and produce noise, vibration, or light; and alarm clocks or mobile phones for older individuals Motivational therapy Bladder training – training the bladder to hold more urine Reward systems – give star charts for dry nights Lifting –