Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care

Knowledge and Awareness of Adults towards Nocturnal Enuresis in Children among the Medina Population

Background: Nocturnal Enuresis (NE) is a common problem among children that is stressful for both the child and adults. There is a lack of adults' knowledge and awareness of the NE condition. Objective: This study aimed to evaluate the adults' knowledge and awareness of NE in Medina City, Saudi Arabia. Method: A cross-sectional observational study was conducted among adults in Medina through September and October 2023, using a questionnaire composed of socio-demographic characteristics and adults' knowledge and awareness of NE. A statistical analysis was performed using SPSS software. Results: The study was conducted among 553 adults in Medina, with a mean (standard deviation [SD]) age of 37.69 (10.775). Most participants (94.8%) were Saudi nationals, of which 84.4% were females, 76.3% were married, and 97.1% were urban residents with university degrees (80.3%). The mean (SD) total score of knowledge and awareness was 4.69 (1.783) out of 9 and 6.49 (2.167) out of 12, respectively. Being female (p < 0.001), with a university degree (p = 0.002), and knowing about enuresis in children (p = 0.011) are significant factors affecting adults' knowledge with higher scores than others. Conclusions: An inadequate knowledge and awareness level of NE in children was revealed among adults living in Medina City, Saudi Arabia. These results emphasize the need for targeted educational campaigns to enhance adults' knowledge and awareness of enuresis.

Parental perception of nocturnal enuresis in a local region of Saudi Arabia

Nocturnal enuresis (NE) has been associated with neurodevelopmental disorders such as autism spectrum disorder, attention deficit or hyperactivity disorder, and intellectual disability. This study aimed to assess parents' perception of NE in children in the eastern region of Saudi Arabia. We conducted a cross-sectional study from May to August 2023, including parents aged ≥18 years living in the area. We administered an online questionnaire to assess parents' knowledge and attitudes toward NE and its treatment. A total of 616 parents completed the questionnaire, 71.4% of which were women, 35% were aged between 25 and 35 years, 75% were married, 65% had a university degree, and 49% had three or more children. In total, 70% demonstrated a good overall knowledge about NE and its treatment, and nearly 60% had a positive attitude toward the condition. Univariate and multivariate ordinal logistic regression analyses revealed that female sex, a higher level of education, and having more than one child were associated with a higher score regarding attitude toward treatment. The level of education and the number of children were predictors of knowledge and a positive attitude toward NE in children.

Parental Beliefs About the Causes, Treatments, and Medical Assistance for Children With Nocturnal Enuresis in the Eastern Region of the Kingdom of Saudi Arabia

OBJECTIVE

To assess parental beliefs about the causes, treatment, and necessity for medical assistance for children with nocturnal enuresis (NE).

METHOD

A self-administered survey questioned parents' beliefs about NE, including causes and at-home behavioral therapy. We evaluated the association between demographic characteristics and the tendency to seek medical advice for NE.

RESULT

The questionnaire received responses from 1232 individuals, 77.1% of whom were female and 82.9% of whom were 30 years of age or older. Psychological issues (53.5%) and laziness to get up (47.6%) were the most often believed causes of NE. Two frequent at-home behavioral therapies chosen by participants were voiding before bedtime and restricting fluid intake at night (73.4% and 70%, respectively). However, only 6.9% of respondents believe that a bedwetting alarm is an effective treatment. The two most frequently reported reasons for not seeking medical attention were parents' belief that their child will eventually outgrow bedwetting (34.1%) and "parents or children's embarrassment" (21.8%). The chi-squared test was used to evaluate the association between demographic characteristics and seeking medical advice. Participants with a single child were more likely than those with more than three children to take their child to the doctor (61.5% vs. 48.6%, respectively). Also, parents who don't have NE-afflicted children were more open to consider seeking medical advice for NE therapy (if their children developed it in the future) compared to parents who already have children with NE.

CONCLUSION

Parents in the Eastern region of Saudi Arabia hold various misconceptions about the causes and treatment of NE. Only 52.1% of parents would take their child to see a doctor if wetting the bed and only 48.1% of parents were aware of effective treatments for NE. These results emphasize that healthcare practitioners need to provide proper information to raise public awareness of NE.

[Enuresis: Perception and attitude in population of our country]

OBJECTIVE

To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan.

MATERIAL AND METHODS

A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021.

RESULTS

Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family.

CONCLUSION

Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution.

Can enuresis alarm therapy be managed by the families without the support of a nurse? A prospective study of a real-world sample

AIM

The alarm is the first-line treatment of nocturnal enuresis. However, the therapy is labour-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers.

METHODS

An alarm linked to an application on a parent's smartphone was used. The app recorded enuretic events and gave instructions. Group A were children supported by a nurse. Group B were patients whose families had bought the alarm and downloaded the app independently.

RESULTS

There were 196 children in group A and 202 in group B. The percentages of full responders, partial responders, non-responders and dropouts were 18.4%, 20.4%, 22.4% and 38.8% in group A and 13.4%, 11.4%, 14.9% and 60.4% in group B. The risk for dropping out of therapy was higher in group B (p < 0.001), whereas the chance for adherent children to become dry did not differ between the groups (p = 0.905).

CONCLUSION

For families who are able to adhere to alarm therapy the chance of success is just as good when managed independently as when supported by a nurse. But the latter children will have a greater chance of adhering to the full treatment.

Comparison of the characteristics and factors influencing hospital visits among children with nocturnal enuresis in Japan: The Hirakata-Urayasu population-based cohort study

OBJECTIVES

The aim of this study was to compare the demographic characteristics of school-aged children with nocturnal enuresis and factors influencing hospital visits between two regions in Japan.

METHODS

A cross-sectional survey was conducted in Hirakata City, Osaka Prefecture, and Urayasu City, Chiba Prefecture. An anonymous online questionnaire was administered to all public elementary and junior high school students (aged 6-16 years) or their guardians. Questions included age, gender, perinatal history, frequency of nocturnal enuresis, frequency of bowel movements, comorbidities, and hospital visits for nocturnal enuresis.

RESULTS

The survey response rates were 15.4% in Hirakata City and 37.0% in Urayasu City. In total, 426 children with nocturnal enuresis in Hirakata City and 270 in Urayasu City were included in the final analysis. In both cities, the boy-girl ratio was approximately 2:1, and the prevalence of nocturnal enuresis gradually decreased with age. Multivariate analysis revealed that children aged ≥11 years had a significantly higher proportion of hospital visits (OR, 2.61; 95% CI: 1.49-4.56; p = 0.001; OR, 2.72; 95% CI: 1.12-6.64; p = 0.027, respectively). However, the frequency of nocturnal enuresis did not affect hospital visits.

CONCLUSIONS

The findings of this study suggest that parents with school-aged children have low awareness that nocturnal enuresis is a health problem and therefore subject to medical consultation. Although the proportion of hospital visits increases for children aged ≥11 years, children and families suffering from nocturnal enuresis should be encouraged to see a doctor instead of adopting a "wait and see attitude," even at a young age.

Prevalence of Nocturnal Enuresis Among Children and Its Association With the Mental Health of Mothers in Northern Saudi Arabia

Background

Nocturnal enuresis (NE) is troubling for children and their families. This study aims to investigate the prevalence of NE, its associated health problems, and the outcome of the provided management among children aged 6-18 years and to assess the impact of NE on the mental health of mothers in Northern Saudi Arabia.

Methodology

A retrospective cross-sectional study was conducted in Arar, Northern Saudi Arabia, among children aged 6-18 years old. Data were collected using a structured questionnaire including a Perceived Stress Scale (PSS). Means ± standard deviations (SDs) were used to represent quantitative data, and frequencies and percentages were used to represent qualitative data. Ordinal logistic regression was used to assess the association of NE with perceived stress.

Results

A total of 420 participants were included in this study. Nocturnal enuresis was reported in 24% of the respondents’ children. Around 51% of the mothers know about the causes of NE. Nocturnal enuresis caused embarrassment and social shame to 71% of the mothers. Two-thirds (66%) of the mothers wake up the child at night for urination. Three-quarters (76%) of the participants reported improvement on decreasing fluid intake before sleeping. Of the mothers, 19% perceived low stress, 78% perceived medium stress, and 3% perceived high stress. NE was associated with a higher risk of stress (adjusted odds ratio (OR): 2.14; 95% confidence interval (CI): 1.05-4.37).

Conclusion

About a quarter of the children suffer from NE, of which a large proportion of mothers face embarrassment and shame. There was a significant association between NE and a higher level of stress. Mothers of children with NE should be provided with counseling and social support to ensure good mental health.

Impact of New vs. Old International Children's Continence Society Standardization on the Classification of Treatment Naïve Enuresis Children at Screening: The Value of Voiding Diaries and Questionnaires

Expert consensus papers recommend differentiating enuresis using questionnaires and voiding diaries into non- (NMNE) and monosymptomatic enuresis (MNE) is crucial at intake to decide the most appropriate workout and treatment. This national, Belgian, prospective study investigates the correlation, consistency, and added value of the two methods, the new against the old International Children's Continence Society (ICCS) definitions, and documents the prevalence of the two enuresis subtypes in our population. Ninety treatment-naïve enuretic children were evaluated with the questionnaire, and the voiding diary and the two clinical management tools were compared. Almost 30% of the children had a different diagnosis with each method, and we observed inconsistencies between them in registering Lower Tract Symptoms (κ = -0.057-0.432 depending on the symptom). Both methods had a high correlation in identifying MNE (rs = 0.612, p = 0.001) but not for NMNE (rs = 0.127, p = 0.248). According to the latest ICCS definitions, the incidence of MNE was significantly lower (7 vs. 48%) with the old standardization.

CONCLUSION

The voiding diary and the questionnaire, as recommended by the ICCS at the screening of treatment-naïve enuretic patients, are considerably inconsistent and have significantly different sensitivities in identifying LUTS and thus differentiating MNE from NMNE. However, the high incidence of LUTS and very low prevalence of MNE suggest that differentiating MNE from NMNE to the maximum might not always correlate with different therapy responses.

The Importance of Understanding Parental Perception When Treating Primary Nocturnal Enuresis: A Topic Review and an Institutional Experience

Primary nocturnal enuresis (PNE) is a common childhood disorder that adversely affects a child’s mental well-being and social life. Our clinical experience showed parents and their child often have significantly different perspective of enuresis, and these differences can affect family dynamics, treatment approaches, and treatment success. Parents’ perception of PNE also influences the likelihood of seeking medical treatment, and we found parents of children with enuresis have markedly different beliefs regarding bedwetting than those of physicians. Because achieving remission for PNE requires parents and their child to actively participate in treatment, assessing their expectancy of success and their beliefs will allow clinicians to adjust treatment goals as necessary. When treating PNE, guidelines consistently recommend incorporating bed alarms as part of the therapy. However, through interviewing parents and treating their children, we found parents preferred medications or other behavioral strategies, such as limiting water intake, because of their convenience. Many parents would complain bed alarms woke them up instead of their child, and they would soon give up on bed alarms. Part of assessing their beliefs includes assessing their confidence in their child being able to wake up to alarms and to persist with treatment. Understanding how they manage and approach setbacks will also determine the treatment modality suited for their child. In this review paper, we detailed our experiences interviewing parents and treating their child with NE with urodynamics and medications at the Changhua Christian Hospital in Taiwan.

Analysing online Twitter discussions of bedwetting via a condition-specific hashtag (#Bedwetting)

AIM

Bedwetting is a common paediatric condition. #Bedwetting has been established as the official hashtag to structure Twitter discussions about the condition. We analysed online Twitter discussions for #Bedwetting.

METHODS

Symplur, a Twitter analytics service was employed to aggregate Twitter activity, users and content including #Bedwetting, between October 2013 and November 2018. Activity was analysed via tweet volume and user adoption. Users were assorted using geographic location, occupation and affiliation data. Content in #Bedwetting Tweets was undertaken by retrieving information about retweets, links, frequently used words and hashtags.

RESULTS

A total of 101 412 tweets and 9957 users utilising #Bedwetting were identified. Most tweets were sent with links (93%). The average ± SD number of tweets using #Bedwetting per month increased from 96 ± 87 in 2013 to 2935 ± 1644 in 2015. Tweet volume decreased to 1960 ± 257 in 2016 and subsequently increased to 2901 ± 1110 in 2017. New users increased from 4 in 2013 to 9957 users in 2018. Users tweeted from 69 countries. Advocacy organisations comprised 35% of the top 100 influencers. Common words in #Bedwetting tweets were 'potty', 'best' and 'training'. Popular associated hashtags were #Pottytraining, #Solutions and #Moms. Hyperlinks in #Bedwetting tweets included advocacy, academic and commercial websites.

CONCLUSIONS

Our analysis of #Bedwetting highlights that Twitter is frequently used to discuss the condition's diagnosis and management. Various stakeholders in health care are utilising the platform to build awareness about bedwetting. We identified that Twitter is being employed to drive web traffic to other internet websites.

Patient Engagement in Medical Device Design: Refining the Essential Attributes of a Wearable, Pre-Void, Ultrasound Alarm for Nocturnal Enuresis

BACKGROUND

To date, no pre-void wearable alarm exists to treat nocturnal enuresis (NE)-night-time bedwetting, and children with NE and their families are disappointed in relation to the post-void moisture alarms and medicine currently available. Development of a safe, comfortable and non-invasive wearable pre-void alarm and associated technology, using advanced mechatronics, is underway (the MyPAD device). Each stage of development includes patient and public involvement (PPI), particularly with respect to human factors, in collaboration with physicians, radiologists, psychologists, nurses, engineers and designers.

OBJECTIVES

The aim of this study was to help us understand the families' experience of the condition of enuresis, and to provide opinion relating to existing NE alarms, designed to detect moisture, and most importantly, the initial design of the MyPAD wearable technology.

METHODS

A PPI workshop in the form of a focus group, made up of children with enuresis and their parents, was conducted during the early stage of the MyPAD product development. The key research questions (RQs) were: (RQ1) What were the families' experiences of using existing post-void enuresis alarms? (RQ2) What do families like about the MyPAD prototype? and (RQ3) What do families not like about the MyPAD prototype? A nurse specialised in terms of NE treatment, including post-void alarms, from the Lancashire Teaching Hospitals NHS Foundation Trust, and two MyPAD design engineers were also present, to explain the MyPAD design concept. Braun and Clarke's six-phase approach to thematic analysis was implemented, which included familiarisation with the data, initial descriptive coding, identifying themes, reviewing themes, defining and labelling themes and producing a report.

RESULTS

Four common themes were identified from the focus group discussions: the importance of sleep; children do not want to feel different; parents feel frustrated and concerned; resilience and perseverance. These themes applied across the research questions; for example, sleep disruption was highlighted as an issue with existing post-void alarms and as an important requirement for the design of MyPAD. The evaluation of the early version of the MyPAD device has prompted the consideration of changes to some existing facets of the device, including providing multiple alarm types, more options for the design of the garment that houses the device, and the need for clear, age-appropriate and informative instructions relating to how the device should be used, in order to maximise its performance/efficiency and acceptance.

CONCLUSIONS

The qualitative data derived from the focus group discussion was incredibly valuable as it enabled the research and design team to experience the perspectives of the families in terms of the challenges and conflicts of managing the condition and the limited utility of existing post-void alarms. This has improved our understanding of the social and environmental challenges that will need to be considered during the design process.

Associations Between Psychiatric Disorders and Enuresis in Taiwanese Children: A National Population-Based Study

BACKGROUND

Psychiatric disorders such as attention-deficit/hyperactivity disorder may negatively impact drug compliance and the prognosis of enuresis. However, existing studies regarding associations between lifetime psychiatric disorders and childhood enuresis are primarily from Western countries, and studies from Taiwan are lacking.

METHODS

We conducted a population-based retrospective cohort analysis using the Taiwan Longitudinal Health Insurance Database 2010. A total of 1,146 children with enuresis (ICD-9-CM code: 307.6) and 4,584 randomly selected sex- and age-matched controls were identified between January 1, 1997 and December 31, 2011. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the development of psychiatric disorders in the children with enuresis.

RESULTS

Enuresis was more common in the younger children, and the rate was significantly higher in boys (58.7%) than in girls (41.3%). A total of 171 patients (14.9%) in the enuresis group had at least one psychiatric diagnosis vs 259 (5.7%) in the control group (p<0.001). Multivariate analysis showed that the presence of enuresis increased the odds of developing major depressive/dysthymic disorder (OR=2.841, 95% CI: 1.619, 4.987), attention-deficit/hyperactivity disorder (OR=3.156, 95% CI: 2.446, 4.073), autism spectrum disorder (OR=2.468, 95% CI: 1.264, 4.822), anxiety disorders (OR=3.113, 95% CI: 2.063, 4.699), intelligence disability (OR=3.989, 95% CI: 2.476, 6.426), disruptive behavior disorders (OR=3.749, 95% CI: 1.756, 8.004), and tic disorder (OR=2.660, 95% CI: 1.642, 4.308).

CONCLUSION

Children with enuresis are likely to have psychiatric disorders, and physicians should consider this during their evaluation.

Prevalence of Nocturnal Enuresis among Saudi Children Population

Background Nocturnal enuresis (NE) is the involuntary urination that occurs while asleep after an age when bladder control at night is expected. It has a global incidence of 1.4%-28% among 6-12 years old children. The aim of this study is to show the prevalence, risk factors, types of provided treatment of enuresis among studied children in Kingdom of Saudi Arabia (KSA). Methods A cross-sectional descriptive study was carried out among Saudi children, 3-12 years of age, from different cities in Saudi Arabia, during the period from 20 October to 20 November 2019. Data was collected by using a pre-designed questionnaire that was distributed online and included questions designed to fulfill the study objectives. Results This study reported that 31.2% of Saudi children of the chosen ages are suffered from enuresis, the majority occurred at day and night by 55.1% while 43.9% occurred only at night. Participants described types of provided treatment as follows: behavioral modification was the most commonly used by 31.6% followed by pharmacological intervention (29.6%), bed-wetting alarm (6.8%), exercises to strengthen the bladder muscles (6.2%) and surgical intervention reported by 1.5% only. It was found that the improvement of enuresis on treatment occurred in 43.6% of cases. There was a significant reduction of the prevalence of NE with age (peak is 63.6% in 5-7 years old) but no significant correlation was found with gender (p = 0.104). However, there was a significant correlation with parent having history of NE (p = 0.001). Conclusion The study reported that 31.2% of children found to have nocturnal enuresis; 43.9% of those had nocturnal enuresis alone. There were no significant correlations between nocturnal enuresis and child gender while it significantly correlated with child's age and having a family history of NE. Behavioral modification therapy was the most commonly provided treatment followed by pharmacological intervention; improvement occurred in less than half of the cases with treatment.

Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting

BACKGROUND AND AIMS

The objective of this update of the EAU-ESPU guidelines recommendations for nocturnal enuresis was to review the recent published literature of studies, reviews, guidelines regarding the etiology, diagnosis and treatment options of nocturnal enuresis and transform the information into a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist and urologist.

MATERIAL AND METHODS

Since 2012 a monthly literature search using Scopus® was performed and the relevant literature was reviewed and prospectively registered on the European Urology bedwetting enuresis resource center (http://bedwetting.europeanurology.com/). In addition, guideline papers and statements of the European Society for Paediatric Urology (ESPU), the European Association of Urology (EAU), the National Institute for Health and Care Excellence (NICE) and the International Children Continence Society (ICCS) were used to update the knowledge and evidence resulting in this practical recommendation strategy. Recommendations have been discussed and agreed within the working group of the EAU-ESPU guidelines committee members.

RESULTS

The recommendations focus to place the child and his family in a control position. Pragmatic analysis is made of the bedwetting problem by collecting voiding and drinking habits during the day, measuring nighttime urine production and identification of possible risk factors such as high-volume evening drinking, nighttime overactive bladder, behavioral or psychological problems or sleep disordered breathing. A questionnaire will help to identify those risk factors.

CONCLUSION

Motivation of the child is important for success. Continuous involvement of the child and the family in the treatment will improve treatment compliance, success and patient satisfaction.

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

BACKGROUND

Nocturnal enuresis (NE), or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE.

METHODS

This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion.

DISCUSSION

This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registration Number: 12618000288224.

PROTOCOL

23 February 2018, version 1.1.

Enuresis Management in the Primary Care Pediatrics Clinic

Enuresis is a frequent complaint not always volunteered by parents or patients. The pediatric clinician has to inquire about enuresis to break the secrecy surrounding this symptom that could be related to a more serious underlying renal, endocrine, or psychosocial disease. Determining the type of enuresis is crucial to offer optimal treatment. We present a review for the pediatric clinician to optimize their care of the child with monosymptomatic enuresis. [Pediatr Ann. 2018;47(10):e390-e395.].

Prevalence, patient and consultation characteristics of enuresis in Australian paediatric practice

AIM

To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years.

METHODS

Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013.

RESULTS

Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008; 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008; 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001).

CONCLUSION

The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups.

Examining the effectiveness of parental strategies to overcome bedwetting: an observational cohort study

OBJECTIVE

To examine whether a range of common strategies used by parents to overcome bedwetting in 7½-year-old children (including lifting, restricting drinks before bedtime, regular daytime toilet trips, rewards, showing displeasure and using protection pants) are effective in reducing the risk of bedwetting at 9½ years.

DESIGN

Prospective cohort study.

SETTING

General community.

PARTICIPANTS

The starting sample included 1258 children (66.7% boys and 33.2% girls) who were still bedwetting at 7½ years.

OUTCOME MEASURE

Risk of bedwetting at 9½ years.

RESULTS

Using propensity score-based methods, we found that two of the parental strategies used at 7½ years were associated with an increased risk of bedwetting at 9½ years, after adjusting the model for child and family variables and other parental strategies: lifting (risk difference=0.106 (95% CI 0.009 to 0.202), ie, there is a 10.6% (0.9% to 20.2%) increase in risk of bedwetting at 9½ years among children whose parents used lifting compared with children whose parents did not use this strategy) and restricting drinks before bedtime (0.123 (0.021 to 0.226)). The effect of using the other parental strategies was in either direction (an increase or decrease in the risk of bedwetting at 9½ years), for example, showing displeasure (-0.052 (-0.214 to 0.110)). When we re-analysed the data using multivariable regression analysis, the results were mostly consistent with the propensity score-based methods.

CONCLUSION

These findings provide evidence that common strategies used to overcome bedwetting in 7½-year-olds are not effective in reducing the risk of bedwetting at 9½ years. Parents should be encouraged to seek professional advice for their child's bedwetting rather than persisting with strategies that may be ineffective.

Parental perception and factors associated with treatment strategies for primary nocturnal enuresis

OBJECTIVE

The aim was to investigate the factors influencing parents seeking reasonable managements for their child and their overall outlook toward primary nocturnal enuresis (PNE).

STUDY DESIGN

We recruited 93 children with PNE from enuresis clinics and requested their parents to complete questionnaires regarding their child's medical history and behavior, their methods for coping with PNE, and their perception of enuresis. Logistic regression models were applied to investigate factors influencing the parents to adopt a positive approach toward enuresis and to subsequently seek a medical consultation.

RESULTS

One-third of the parents had an encouraging attitude toward children with PNE, whereas slightly less than half reacted with anger. The more educated the father or the younger the child with NE, the larger the possibility of the parents utilizing a positive approach, such as encouragement, for coping with NE. Factors that influenced parents to seek medical consultation for NE were socioeconomic status, maternal educational level, and the age and birth order of their child.

DISCUSSION

From our results, angry and frustrated parents (43.0%) were significantly more likely to punish their child for bedwetting than were parents who approached NE positively (comfort and encouragement; 33.3%). A lack of encouragement may negatively affect the self-esteem of children with NE. Moreover, an individual's self-esteem or confidence, both of which can help them eliminate NE, determines the person's behavioral response to bedwetting. In our study, approximately 50% of the parents who approached NE positively (comfort and encouragement) or inconsistently (ambivalence) reported that they comforted their child after bedwetting.

CONCLUSIONS

Nearly half the parents reacted angrily to children with NE, and some parents even punished their child. The parents' socioeconomic background, education, and the age and birth order of the child were the factors associated with their seeking active treatment for NE. A father's education and young age of the child were factors that influenced parents who preferred positive approaches, such as encouragement, for coping with NE.

Nigerian parents can harbour harmful views about the causes and treatment of childhood enuresis that result in child abuse

AIM

The aim of this study was to determine Nigerian parents' views about the causes and treatment of childhood enuresis.

METHODS

Parents of children aged 5-17 years were individually interviewed in an urban community in Nigeria using a pretested questionnaire. Their responses about the causes and treatment of enuresis were grouped under common themes.

RESULTS

We included 448 respondents in the study: 75.5% were mothers, 44.2% had at least one child with enuresis and only 1.3% had spoken to a doctor about it. Enuresis was thought to be due to playing too much and drinking too much fluid at night by 69.7% and 21.2% of the respondents, respectively. The two most common treatment methods that parents were aware of for enuresis were waking to void (23.7%) and urinating on hot charcoal (20.8%). The most common methods that parents actually employed included waking to void (49.0%), punishing the child (36.9%) and doing nothing (28.8%).

CONCLUSION

Most of the respondents believed that playing too much and drinking or eating too much were responsible for childhood enuresis. Parents rarely discussed childhood enuresis with their doctors and some of the self-help measures that were employed may be harmful and could constitute child abuse.

Psychosocial and respiratory disease related to severe bladder dysfunction and non-monosymptomatic enuresis

OBJECTIVE

Complicated bladder dysfunctions (BD) (associated with infections/urological complications or irresponsive to treatment) are a small proportion of all cases, but are highly morbid, clinically and psychosocially. Our aim is to describe a cohort of complicated pediatric BD, using subgroup analysis to compare presentations and responses to treatment among genders, age groups, and patients with or without non-monosymptomatic enuresis (NME). We also relate severe BD to other health conditions or to social/behavioral problems and report treatment results.

METHOD

Thirty-five cases of complicated BD were reviewed. Neurogenic bladders and anatomical urological problems were excluded. Justifications for referral, comorbidities, and social aspects/familial dynamics were studied. Overactive bladders were primarily treated with oxybutynin. Transcutaneous parasacral neuromodulation was used in case of insufficient response or unbearable side effects. For infrequent voiders, timed voiding and transcutaneous neuromodulation were counseled.

RESULTS

Incontinence/enuresis were the motives for referral in only a third of the cases. UTI (42.9%) was the main reason for referral. Hydronephrosis was observed in 8.6% of the children. Respiratory/ENT problems, obesity, and precocious puberty were highly prevalent. Schooling problems and neuropsychiatric disease were common. Social problems were common. Five patients presented urological problems secondary to BD (hydroureteronephrosis, VUR, trabeculated bladder). Twenty percent of cases required high anticholinergic doses and 37.1% transcutaneous electrostimulation. Eight (22.9%) patients abandoned but later resumed therapy, and 14.6% did not follow treatment. Boys tended to be older than girls and presented NME, respiratory, and behavioral problems more often, with a significant difference for asthma and anxiety/depression. Associated health problems and neuropsychiatric treatment tended to be more frequent among those presenting NME. Non-enuretic children tended to show better results from treatment (see Table).

CONCLUSION

The social characteristics of our population (severe cases, socially deprived, very poor, not well educated, and with limited access to health care) determine a very specific sampling. Our research demonstrated that even severe cases of BD affecting socially deprived children may be treated, with adhesion to treatment and results comparable with other cohorts of BD, although the children need multidisciplinary attention and close follow-up. Boys, older children, and NME are more difficult to treat and often have other associated health and behavioral problems. Stress-related conditions were common in severe BD. A relatively high occurrence of precocious puberty was an unexpected finding in our research.

Early childhood psychological factors and risk for bedwetting at school age in a UK cohort

There is evidence for a link between psychological factors and bedwetting, but the direction of this association is unclear. Using data on 8769 children from the Avon Longitudinal Study of Parents and Children, we examined whether difficult temperament (Toddler Temperament Scale at 24 months; Emotionality Activity Sociability Questionnaire at 38 months) and psychological problems (Revised Rutter Parent Scale for Preschool Children at 42 months) are linked to bedwetting at school age. We examined the association between these risk factors and different patterns of bedwetting from 4 to 9 years using multinomial regression. Difficult temperament and psychological problems in early childhood were associated with increased odds of bedwetting at 4-9 years. The strongest associations were most often found for the pattern of bedwetting that was both frequent (at least twice a week) and persistent (up to age 9) e.g. the temperament traits of 'adaptability' and 'mood' were associated with a 33 % increase (95 % confidence interval = 1.14-1.55) and a 27 % increase (1.10-1.47) respectively in the odds of persistent and frequent bedwetting per one standard deviation increase in risk score. Early behaviour problems (e.g. conduct problems [1.43 (1.25, 1.63)] and hyperactivity [1.29 (1.11, 1.50), p < 0.001]) were also associated with frequent and persistent bedwetting, but there was less evidence that early emotional difficulties were risk factors for bedwetting. Adjustment for confounders did not alter these conclusions. The presence of difficult temperament and behaviour problems in early childhood might help to identify children who will continue to experience bedwetting at school age.

Family compliance with the use of alarm devices in the treatment of monosymptomatic nocturnal enuresis

OBJECTIVE

In the treatment of monosymptomatic nocturnal enuresis (MNE), enuretic alarm devices (EADs) are the first recommended treatment option. This study aimed to evaluate parental and child compliance with EAD treatment.

MATERIAL AND METHODS

Fifty patients for whom EAD therapy was recommended were included in this study. The mean age of the patients was 10.4 years (5-16). All the patients were nursery or school children. Patients who did not return for their follow-up visits were called by phone, and verbal information were gathered about the use and performance success of the device. We documented the patients who used, and did not use the EAD with their reasons.

RESULTS

Nineteen (36%) patients were able to use the EAD without any problems. Eight of the remaining 31 patients didn't return for control, and they could not be get in touch with, either. Of the 23 (46%) families whom we could get a contact, 4 families did not purchase EAD due to a decrease in the number of wet nights, 4 families due to compensatory payment, and 3 families due to reluctance of one of the parents. One family reported that they gave up the EAD treatment because of the disturbing loud volume of the device. Four families reported that their children refused to use the EAD. Four families said that they could not use the EAD regularly because the device frequently did not work properly. In this study, we could not keep in touch with 16% of the patients, and 46% of the patients stopped using or did not receive this therapy.

CONCLUSION

Although EAD has been the priorly recommended alternative with its relatively higher success, and lower recurrence rates, our study demonstrated that the compliance of families with this treatment is below the expected level.

Mono-symptomatic nocturnal enuresis in lebanese children: prevalence, relation with obesity, and psychological effect

INTRODUCTION

Nocturnal enuresis is involuntary urination while sleeping after a certain age, usually five years, when children should have established bladder control. The prevalence has been found to be up to 20% in five year old children, and it is considered the most common urological childhood complication.

MATERIAL AND METHODS

This study was conducted on Makassed School children aged 5–18 years. This was a two-step study, the first step was a questionnaire distributed to the children to be answered by their parents. The second step included individually meeting with every child who met the inclusion criteria and his/her parents and physically examining the child.

RESULTS

11,440 questionnaires were distributed to school children aged 5–18 years, to be answered by their parents. Of the 7270 parents who responded back, 6620 reported no enuresis, 90 (1.25%) reported only diurnal enuresis, 107 (1.5%) reported diurnal and nocturnal enuresis, and 453 parents reported their child having nocturnal enuresis only. The data collected was analyzed according to age, sex, area, body mass index (BMI), and the PMQOL-SF score. The prevalence of mono-symptomatic nocturnal enuresis (MNE) in Lebanon was found to be 5.3%. The results showed that the prevalence of MNE is inversely proportional to age. The prevalence of male to female ratio was 1.4:1. As for the prevalence according to different geographic areas, the results have shown that the North had the majority of cases with 7.6% prevalence. Results showed that 82.4% of children had a score more than 50, and only 28% of parents had a score above 50.

DISCUSSION

The prevalence of nocturnal enuresis in Lebanon is lower than that in neighboring countries such as Turkey8 and Saudi Arabia,9 but higher than that in Italy10 and Hong Kong. Our study has managed to show the same results, with a peak in incidence at seven years then dropping back to 0% at the age of 16. Our study has shown a male to female predominance but the male to female ratio was 1.4:1, a value lower than that described in earlier studies. Our study has shown that more than 80% of children were psychologically affected whereas only less than 30% of parents were affected.

CONCLUSION

To our knowledge, this was the first study in Lebanon conducted to determine the prevalence of MNE. The relatively low prevalence rate found may be because of differences in genetic predisposition, psychosocial or environmental conditions, and traditional and cultural backgrounds. No relation was found between obesity and nocturnal enuresis. The psychological impact on children is significant but that on the parents is minimal.