Epidemiology Certainly enuresis is not an entity unique to urbanization and to the 20th century, having been alluded to as early as 1550 BC in the Ebers Papyrus. No culture or society is immune from the problem of bed-wetting. There are no data to suggest that diurnal enuresis or secondary enuresis is more commonly associated with organic disorders than is primary or nocturnal enuresis. It is interesting to note that only slightly more than a third of children with enuresis are brought to the attention of a physician. This perhaps is related to embarrassment on the part of parents, or to the self-limiting nature and the high spontaneous cure rate associated with enuresis.
Most studies point to a slightly higher prevalence of enuresis in boys than in girls.
Studies in twins show that if one twin is an enuretic, there is a strong likelihood that the other will be one as well. Perhaps the most important point regarding the etiology of nocturnal enuresis is the fact that rarely is it a manifestation of a significant underlying urologic or neurologic disorder. In all likelihood, a multitude of factors contribute to cause enuresis, including a variation in maturation of the central neural influence on bladder control. A delay in such a central control mechanism may prolong the duration of enuresis. Motivational therapy promotes active participation of the child, who is encouraged to assume responsibility for his or her enuresis and who is rewarded as a means of stepwise response shaping.