356 Elimination Disorders
be intentional. To qualify for a diagnosis of  enuresis, the voiding of urine must occur at
least twice a week for at least 3 consecutive months or must cause clinically significant dis-
tress or impairment in social, academic (occu pational), or other im portant areas of func-
tioning (Criterion B). The indi vidual must have reached an age at which continence is
expected (i.e., a chronological age of at leas t 5 years or, for childre n with developmental
delays, a mental age of at least 5 years) (Cri terion C). The urinary incontinence is not at-
tributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic med-
ication) or another medical co ndition (e.g., diabetes, spina bifida, a seizure disorder)
(Criterion D).
Associated Features Supporting Diagnosis
During nocturnal enuresis, occasionally the voiding takes place during rapid eye movement
(REM) sleep, and the child may recall a dream that involved the act of urinating. During day-
time (diurnal) enuresis, the child defers voiding until incontinence occurs, sometimes because
of a reluctance to use the toilet as a result of social anxiety or  a preoccupation with school or
play activity. The enuretic event most commonly occurs in the early afternoon on school days
and may be associated with symptoms of disr uptive behavior. The enuresis commonly per-
sists after appropriate treatment of an associat ed infection. 
Prevalence
The prevalence of enuresis is 5%–10% am ong 5-year-olds, 3%–5%  among 10-year-olds,