Encopresis 357
Culture-Related Diagnostic Issues 
Enuresis has been reported in a variety of Eu ropean, African, and Asian countries as well
as in the United States. At a national level,  prevalence rates are remarkably similar, and
there is great similarity in the developmenta l trajectories found in different countries.
There are very high rates of enuresis in orphanages and other residential institutions,
likely related to the mode and environment in which toilet training occurs. 
Gender-Related Diagnostic Issues
Nocturnal enuresis is more common in males. Diurnal incontinence is more common in fe-
males. The relative risk of having a child who develops enuresis is greater for previously
enuretic fathers than for pr eviously enuretic mothers. 
Functional Consequences of Enuresis
The amount of impairment associated with enur esis is a function of the limitation on the
child’s social activities (e.g., ineligibility fo r sleep-away camp) or its effect on the child’s
self-esteem, the degree of social ostracism by peers, and the anger, punishment, and rejec-
tion on the part of caregivers.
Differential Diagnosis
Neurogenic bladder or another medical condition. The diagnosis of enuresis is not made
in the presence of a neurogenic bladder or an other medical condition that causes polyuria or
urgency (e.g., untreated diabetes mellitus or diabetes insipidus) or during an acute urinary
tract infection. However, a diagnosis is compat ible with such conditions if urinary inconti-
nence was regularly present prior to the development of another me dical condition or if it per-
sists after the institution of appropriate treatment of the medical condition.
Medication side effects. Enuresis may occur during treatment with antipsychotic med-