Nighttime incontinence may be one sign of another condition called obstructive sleep apnea, in which the child's breathing is interrupted during sleep, often because of inflamed or enlarged tonsils or adenoids. Other symptoms of this condition include snoring, mouth breathing, frequent ear and sinus infections, sore throat, choking, and daytime drowsiness. In some cases, successful treatment of this breathing disorder may also resolve the associated nighttime incontinence.

Between the ages of 5 and 10, incontinence may be the result of a small bladder capacity, long sleeping periods, and underdevelopment of the body's alarms in the brain that signal a full or emptying bladder. This form of incontinence will fade away as the bladder grows and the natural alarms become operational.

Enuresis is defined as the involuntary voiding of urine beyond the age of anticipated control. Diurnal enuresis is daytime wetting, nocturnal enuresis is nighttime wetting. Both of these conditions can occur at the same time, Many children with nighttime wetting will not have wetting during the day. Children with daytime wetting may have frequent urination, have urgent urination or dribble after urinating.

The DSM-V classifies enuresis as an elimination disorder and as such it may be defined as the involuntary or voluntary elimination of urine into inappropriate places. A patient must be of at least a developmental level equivalent to the chronological age of a 5 year old in order to be diagnosed with enuresis (in other words it is not abnormal for a child below the age of 5).

The patient must either experience a frequency of inappropriate voiding at least twice a week for a period of at least 3 consecutive months OR experience clinically significant distress or impairment in social, occupational or other important areas of functioning, in order to be diagnosed with enuresis. These symptoms must not be due to any underlying medical condition (e.g. a child who wets the bed because their kidneys produce too much urine, is not suffering from enuresis, they're suffering from kidney disease which is causing the inappropriate urination). As well, these symptoms must not be due exclusively to the direct physiological effect of a substance (such as a diuretic or antipsychotic).

Common causes include, but not limited to:

- Incomplete emptying of the bladder

- Irritable bladder

- Constipation

- Stress

- Urinary tract infection

- Urgency (not “making it” to the bathroom in time)

- Anatomic abnormality

- Poor toileting habits

- Small bladder capacity

- Medical conditions like overactive bladder disorder

Thorough history regarding frequency of bedwetting, any period of dryness in between, associated daytime symptoms, constipation, and encopresis should be sought.

The medical name for bedwetting is "nocturnal enuresis". The condition is divided into 2 types: primary nocturnal enuresis (PNE) and secondary nocturnal enuresis.

In voluntary urination, the bladder's normally relaxed detrusor muscle contracts to squeeze urine from the bladder.

One study, of 109 children diagnosed with giggle incontinence at Schneider Children's Hospital in New York, concluded that the cause of giggle incontinence is involuntary contraction of the detrusor muscle induced by laughter.

Because the complaint is difficult to reproduce under controlled conditions, its triggering mechanism is not clearly understood, but may be related to cataplexy, a sudden transient episode of loss of muscle tone often triggered by strong emotions.

Giggle incontinence, giggle enuresis or enuresis risoria is the involuntary release of urine in response to giggling or laughter. The bladder may empty completely or only partially.

Giggle incontinence is more common in children than adults, typically appearing at ages 5 to 7, and is most common in girls near the onset of puberty. The condition tends to improve with age, with fewer episodes during the teenage years, but may persist into adulthood. A survey of 99 student nurses indicated that about 25% had experienced such a wetting event during their lifetime, and about 10% were still susceptible in their late teens.

Giggle incontinence is a special form of urge incontinence, and is not the same as stress incontinence, which is generally brought on by participating in vigorous sport.

Children with a tic disorder may exhibit the following symptoms:

- overwhelming urge to make movement

- jerking of arms

- clenching of fists

- excessive eye blinking

- shrugging of shoulders

- kicking

- raising eyebrows

- flaring of nostrils

- production of repetitive noises such as grunting, clicking, moaning, snorting, squealing, or throat clearing

Urinary incontinence (UI), also known as involuntary urination, is any leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It is twice as common in women as in men. Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. It has been identified as an important issue in geriatric health care. Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. Enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting).

There are four main types of incontinence:

- Urge incontinence due to an overactive bladder

- Stress incontinence due to poor closure of the bladder

- Overflow incontinence due to either poor bladder contraction or blockage of the urethra

- Functional incontinence due to medications or health problems making it difficult to reach the bathroom

Treatments include surgery, pelvic floor muscle training, bladder training, and electrical stimulation. The benefit of medications is small and long term safety is unclear.

Patients with incontinence should be referred to a medical practitioner specializing in this field. Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract. A urogynecologist is a gynecologist who has special training in urological problems in women. Family physicians and internists see patients for all kinds of complaints, and are well trained to diagnose and treat this common problem. These primary care specialists can refer patients to urology specialists if needed.

A careful history taking is essential especially in the pattern of voiding and urine leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.

The physical examination will focus on looking for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles.

Other tests include:

- Stress test – the patient relaxes, then coughs vigorously as the doctor watches for loss of urine.

- Urinalysis – urine is tested for evidence of infection, urinary stones, or other contributing causes.

- Blood tests – blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.

- Ultrasound – sound waves are used to visualize the kidneys, ureters, bladder, and urethra.

- Cystoscopy – a thin tube with a tiny camera is inserted in the urethra and used to see the inside of the urethra and bladder.

- Urodynamics – various techniques measure pressure in the bladder and the flow of urine.

Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, noting times and the amounts of urine produced.

Research projects that assess the efficacy of anti-incontinence therapies often quantify the extent of urinary incontinence. The methods include the 1-h pad test, measuring leakage volume; using a voiding diary, counting the number of incontinence episodes (leakage episodes) per day; and assessing of the strength of pelvic floor muscles, measuring the maximum vaginal squeeze pressure.

Children with Attention Deficit and Disruptive Behavior Disorders may show the following symptoms:

- impulsivity or distractibility

- difficulty socializing

- aggressive behavior

- difficulty following rules or directions

- difficulty completing a task

- problems at school

- frustration

- alcohol or drug use

The most common sleep disorders include:

- Bruxism, involuntarily grinding or clenching of the teeth while sleeping.

- Catathrenia, nocturnal groaning during prolonged exhalation.

- Delayed sleep phase disorder (DSPD), inability to awaken and fall asleep at socially acceptable times but no problem with sleep maintenance, a disorder of circadian rhythms. Other such disorders are advanced sleep phase disorder (ASPD), non-24-hour sleep–wake disorder (non-24) in the sighted or in the blind, and irregular sleep wake rhythm, all much less common than DSPD, as well as the situational shift work sleep disorder.

- Hypopnea syndrome, abnormally shallow breathing or slow respiratory rate while sleeping.

- Idiopathic hypersomnia, a primary, neurologic cause of long-sleeping, sharing many similarities with narcolepsy.

- Insomnia disorder (primary insomnia), chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these symptoms. Insomnia can also be comorbid with or secondary to other disorders.

- Kleine–Levin syndrome, a rare disorder characterized by persistent episodic hypersomnia and cognitive or mood changes.

- Narcolepsy, including excessive daytime sleepiness (EDS), often culminating in falling asleep spontaneously but unwillingly at inappropriate times. About 70% of those who have narcolepsy also have cataplexy, a sudden weakness in the motor muscles that can result in collapse to the floor while retaining full conscious awareness.

- Night terror, "Pavor nocturnus", sleep terror disorder, an abrupt awakening from sleep with behavior consistent with terror.

- Nocturia, a frequent need to get up and urinate at night. It differs from enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.

- Parasomnias, disruptive sleep-related events involving inappropriate actions during sleep, for example sleep walking, night-terrors and catathrenia.

- Periodic limb movement disorder (PLMD), sudden involuntary movement of arms and/or legs during sleep, for example kicking the legs. Also known as nocturnal myoclonus. See also Hypnic jerk, which is not a disorder.

- Rapid eye movement sleep behavior disorder (RBD), acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self (REM sleep disorder or RSD).

- Restless legs syndrome (RLS), an irresistible urge to move legs. RLS sufferers often also have PLMD.

- Shift work sleep disorder (SWSD), a situational circadian rhythm sleep disorder. (Jet lag was previously included as a situational circadian rhythm sleep disorder, but it doesn't appear in DSM-5 (see Diagnostic and Statistical Manual of Mental Disorders)).

- Sleep apnea, obstructive sleep apnea, obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring. Other forms of sleep apnea are less common. When air is blocked from entering into the lungs, the individual unconsciously gasps for air and sleep is disturbed. Stops of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea. Other forms of sleep apnea include central sleep apnea and sleep-related hypoventilation.

- Sleep paralysis, characterized by temporary paralysis of the body shortly before or after sleep. Sleep paralysis may be accompanied by visual, auditory or tactile hallucinations. Not a disorder unless severe. Often seen as part of narcolepsy.

- Sleepwalking or "somnambulism", engaging in activities normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.

- Somniphobia, one cause of sleep deprivation, a dread/ fear of falling asleep or going to bed. Signs of the illness include anxiety and panic attacks before and during attempts to sleep.

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty falling asleep and/or staying asleep with no obvious cause, it is referred to as insomnia.

Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions and sleeping sickness.

Some common sleep disorders include sleep apnea (stops in breathing during sleep), narcolepsy and hypersomnia (excessive sleepiness at inappropriate times), cataplexy (sudden and transient loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to infection). Other disorders include sleepwalking, night terrors and bed wetting. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Patients with PANS may present with a new onset or acute flare and follow a relapsing-remitting course, chronic-static course, or a chronic-progressive course.

PANS Criteria include the following:

I. Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake

II. Concurrent presence of additional neuropsychiatric symptoms, (with similarly severe and acute onset), from at least two of the following seven categories:

1. Anxiety

2. Emotional lability and/or depression

3. Irritability, aggression, and/or severely oppositional behaviors

4. Behavioral (developmental) regression

5. Deterioration in school performance (related to attention deficit/hyperactivity disorder ADHD-like symptoms, memory deficits, cognitive changes)

6. Sensory or motor abnormalities

7. Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency.

While not often volunteered as a complaint, upon questioning, it has been found that pain is a common co-morbidity. Pains may include joint pain, muscle aches, headaches and stomachaches. Clinical experience has shown that after the OC and other psychiatric symptoms have improved, some children report pain for the first time. When widespread pain is present, patients often report other forms of sensory amplification and poor sleep. Physical exam may reveal areas of tenderness to palpation in the classic distribution for fibromyalgia. Patients who report both pain and stiffness upon awakening or after prolonged stationary positions should be assessed for arthritis. A small fraction of patients with PANS have been afflicted by an arthritis condition (inflammatory back pain, reactive arthritis, psoriatic arthritis, and juvenile idiopathic arthritis). Reactive arthritis (most commonly in the ankles, knees, and hips) has been reported before PANS onset. Involvement of the pediatrician, pediatric rheumatologist, pain specialist, occupational therapist, and physical therapist may help the course of the illness, alleviate pain and likely, improve emotional functioning.

Signs and symptoms of psychogenic polydipsia include:

- Excessive thirst and xerostomia, leading to overconsumption of water

- Hyponatraemia, causing headache, muscular weakness, twitching, confusion, vomiting, irritability etc., although this is only seen in 20% - 30% of cases.

- Hypervoelemia, leading to oedema, hypertension and weight gain (due to the kidneys being unable to filter the excess blood) in extreme episodes

- Tonic-clonic seizure

- Behavioural changes, including fluid-seeking behaviour; patients have been known to seek fluids from any available source, such as toilets and shower rooms.

The most common presenting symptom is tonic-clonic seizure, found in 80% of patients. Psychogenic polydipsia should be considered a life-threatening condition, since it has been known to cause severe hyponatraemia, leading to cardiac arrest, coma and cerebral oedema. It can also cause central pontine myelinolysis.

In diagnosis, primary polydipsia is usually categorised as:

- Psychogenic (PPD) - caused by underlying psychiatric symptoms, including those caused by psychoses and rarely by affective disorders

- Non-psychogenic - another non-psychological cause, including idiopathic (unknown cause)

The terms primary polydipsia and psychogenic polydipsia are sometimes incorrectly used interchangeably - to be considered psychogenic, the patient needs to have some other psychiatric symptoms, such as delusions involving fluid intake or other unusual behaviours. Primary polydipsia may have physiological causes, such as autoimmune hepatitis.

Since primary polydipsia is a diagnosis of exclusion, the diagnosis may be made for patients who have medically unexplained excessive thirst, and this is sometimes incorrectly referred to as "psychogenic" rather than "primary" polydipsia.

Sensory-based motor disorder shows motor output that is disorganized as a result of incorrect processing of sensory information affecting postural control challenges, resulting in postural disorder, or developmental coordination disorder.

The SBMD subtypes are:

1. Dyspraxia

2. Postural disorder

Symptoms may vary according to the disorder's type and subtype present. SPD can affect one sense or multiple senses. While many people can present one or two symptoms, sensory processing disorder has to have a clear functional impact on the person's life.

Infants with the disorder exhibit an inverted smile; they appear to be crying when they are actually smiling, in conjunction with uropathy. They also may be affected by hydronephrosis. Symptoms of this disease can start at very young ages. Many people with this syndrome will die in their teens to early 20s because of the renal failure (uropathy) if not diagnosed and treated. Children with the syndrome have abnormal facial development that cause an inverted smile, nerve connections are however normal. When attempting to smile, the child will appear to cry. Urinary problems arise as a result of a neurogenic bladder. Most patients older than the age of toilet training, present with enuresis, urinary-tract infection, hydronephrosis, and a spectrum of radiological abnormalities typical of obstructive or neurogenic bladders. Radiological abnormalities include things such as: trabeculated bladder, vesicoureteral reflex, external sphincter spasm, pyelonephritis, hyperreflexic bladder, noninhibited detrusor contraction, etc.. Urinary abnormalities might result in renal deterioration and failure. This can be prevented by taking proper measures to restore normal micturition and by taking antibiotics to prevent infections. In some cases, the affected patients become hypertensive and progress to end-stage renal disease, while others become uremic. Additionally, most patients suffer from constipation.

Early detection of this syndrome is possible through the peculiar faces that children present.

Urofacial syndrome ( or hydronephrosis with peculiar facial expression), is an autosomal recessive congenital disorder characterized by inverted facial expressions in association with obstructive disease of the urinary tract. The inverted facial expression presented by children with this syndrome allows for early detection of the syndrome, this inverted smile is easy to see when the child is smiling and laughing. Early detection is vital for establishing a better prognosis as urinary related problems associated with this disease can cause harm if left untreated. Incontinence is another easily detectable symptom of the syndrome that is due to detrusor-sphincter discoordination, although it can easily be mistaken for pyelonephritis.

It may be associated with "HPSE2".

Amputation of the penis can be either partial or complete. Often self-inflicted by people with psychiatric disorders, it may be occur with other trauma, such as in an assault or a mechanical accident. These injuries are treated by re-implantation if possible, with or without anastomosis of the vasculature to restore erectile function; skin necrosis and loss of sensation are common complications after treatment. Microsurgery on the vasculature decreases the risk of necrosis significantly. Klingsor syndrome is a psychiatric disorder that causes self-harm, which can involve the penis. Paranoid schizophrenia, eating disorders, and psychotic breaks can also be associated with penile injury. In some cases, transgender people who are not able to access genital surgery may self-amputate their penis. Favorable prognostic factors for replantation of amputated penises include short ischemic time and a clean incision (as opposed to a crush injury or ragged incision).

Replantation of an amputated penis can be done up to 24 hours after the injury, though fewer than 16 hours of cold ischemia or 6 hours of warm ischemia leads to the best outcomes. If replantation is not possible or desired, a penile stump can be closed and phalloplasty could be performed later.