and around 1% among individuals 15 years or older.
Development and Course
Two types of course of enuresis have been de scribed: a “primary” type, in which the indi-
vidual has never established urinary continence, and a “secondary” type, in which the dis-
turbance develops after a period of establis hed urinary continence. There are no differences
in prevalence of comorbid me ntal disorders between the two types. By definition, primary
enuresis begins at age 5 years. The most co mmon time for the onset of secondary enuresis
is between ages 5 and 8 years, but it may occur at any time. After age 5 years, the rate of spon-
taneous remission is 5%–10% per year. Most ch ildren with the disord er become continent
by adolescence, but in approximately 1% of cases the disorder continues into adulthood.
Diurnal enuresis is uncommon after age 9 year s. While occasional diurnal incontinence is
not uncommon in middle childhood, it is substantially more common in those who also
have persistent nocturnal enures is. When enuresis persists in to late childhood or adoles-
cence, the frequency of incontinence may in crease, whereas continence in early childhood
is usually associated with a dec lining frequency of wet nights.
Risk and Prognostic Factors
Environmental. A number of predisposing factors for enuresis have been suggested, in-
cluding delayed or lax toilet training and psychosocial stress.
Genetic and physiological. Enuresis has been associated with delays in the develop-
ment of normal circadian rhyt hms of urine production, with resulting nocturnal polyuria
or abnormalities of central v asopressin receptor sensitivity, and reduced functional blad-