Essential feature of enuresis is repeated voiding of urine during the day or at night in bed or clothes. Most often this is involuntary but occasionally this may be intentional. To receive a diagnosis of enuresis, the voiding of urine must occur at least twice per week for at least three consecutive months or else cause clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. The individual must have reached an age at which continence is expected (that is, the chronological age of the child must be at least five years, or, for children with developmental delays, a mental age of at least 5 years). The urinary incontinence is not due exclusively to the direct physiological effects of a substance (for example, diuretics) or a general medical condition (for example, diabetes, spina bifida, a seizure disorder).
The amount of impairment associated with enuresis is a function of the limitation on the child's social activities (for example, ineligibility for sleep-away camp) or its effect on the child's self-esteem, the degree of the social ostracism by peers, and the anger, punishment, and rejection by caregivers. Although most children with enuresis do not have a coexisting mental disorder, the prevalence of coexisting behavioral symptoms is higher in children with enuresis than in children without enuresis. Developmental delays such as speech and learning delays, encopresis, sleepwalking disorder, and sleep terror disorder may be present. Urinary tract infections are more common in children with enuresis, especially the diurnal type.