Nocturnal enuresis in children

The Prevalence and Sociodemographic Risk Factors of Enuresis Nocturna among Elementary School-age Children

Introduction and Aim:

Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to research prevalence and severity of EN among elementary school-age children and sociodemographic risk factors related to it.

Materials and Methods:

The study was performed in three elementary schools in Ankara, Turkey between January and May 2011. It was planned to have 2500 students of 6–14 ages in the study. The questionnaire, which consisted of questions, aiming to evaluate the EN condition of participants and their characteristics, were distributed to the parents. It was observed that 2314 participants’ questionnaires (92.56%) were in accordance with evaluation criteria.

Statistical Analysis:

The relation between EN and the sociodemographic factors was evaluated through Chi-square test and logistic regression analysis.

Results:

The mean age of 2314 participants was 9.21 ± 2.08. 48.5% (n = 1123) of the students were male and 51.5% (n = 1191) were female. While the general EN prevalence was 9.9% (n = 230); 10.7% (n = 120) for males, as 9.2% (n = 110) for females. Statistical significant difference was determined between the two groups, with EN and without EN, regarding age groups (P < 0.001), education level of parents (P < 0.001, P < 0.001), and the number of sibling (P = 0.002), income level (P < 0.001), and positive family history (P < 0.001). However, logistic regression analysis revealed that there was a significant difference only between EN and age groups (odds ratio [OR] =4.42, P < 0.001), education level of mother (OR = 2.13, P = 0.017) and family history (OR = 0.12, P < 0.001).

Conclusions:

As a consequence, such factors as age groups, education level of parents, positive family history could be accepted as a risk of concerning EN. It is important to perform a detailed evaluation on population, carrying risk of having EN.

Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going

BACKGROUND

Nocturnal enuresis (NE) is a very common pediatric disorder. The aim of this study was to evaluate the characteristics of patients with NE or urinary incontinence (UI) during a period of 5 years to increase the knowledge on these conditions and optimize their diagnosis and treatment.

METHODS

We enrolled 278 children with NE or UI referred to the pediatric nephrology ambulatory, 'A. Gemelli' University Hospital of Rome, from December 2006 to December 2011.

RESULTS

We observed that heredity, parasomnias, left-handedness, polythelia and constipation are correlated to NE and UI.

CONCLUSIONS

We wanted to clarify the definition of NE and UI and describe our experience on the main characteristics of these conditions by referring to the latest knowledge reported in the literature.

Efficacy of the bell and pad alarm therapy for nocturnal enuresis

AIM

(i) To determine the efficacy of bell and pad alarm therapy as an initial and relapse treatment for nocturnal enuresis; (ii) to explore risk factors for treatment failure; and (iii) to explore risk factors for relapse within 12 months of successful bell and pad alarm therapy.

METHODS

A 22-item questionnaire was sent to 240 children who received bell and pad alarm therapy in a 6-year period via a community centre. The questionnaire recorded demographic characteristics of the child, length of the first bell and pad alarm therapy, outcome of initial treatment and relapse information.

RESULTS

The initial response and relapse rates of bell and pad alarm therapy were 84 and 30%, respectively. Female gender, absence of diurnal symptoms and willingness to use alarm therapy were associated with better treatment outcomes. Treatment success was associated with shorter treatment length. The success rate of repeating alarm therapy after relapse was 78%, with an average length of treatment of 10 weeks.

CONCLUSION

The bell and pad alarm therapy is an effective treatment for nocturnal enuresis both as initial therapy and after relapse. The association between patient characteristics and treatment response found in our study may help inform clinicians of likely treatment outcomes, and identify those who may need a different approach.

Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran

AIM

To estimate the prevalence of enuresis in school-age children in Iran and determine associated factors.

MATERIALS AND METHODS

A total of 7562 children, aged 5-18 years, enrolled in this cross-sectional study. Using a standard questionnaire, data on demographic characteristics, and familial and physical conditions were obtained from the parents by interview. The ICD-10 definition of enuresis was used. In the case of enuretics, a detailed history was taken, and physical and ultrasonographic examinations, urinalysis and urine culture were performed.

RESULTS

The overall prevalence of enuresis was 6.8%. A significant relationship was found between the prevalence of enuresis and age (P=0.001), educational level of parents (P=0.001), number of family members (P=0.028), positive family history of enuresis (P=0.001), parenting methods (P=0.001), and deep sleep (P=0.001). Birth weight (P=0.07), monthly income (P=0.322), employment status of parents (P=0.08), ethnic differences (P=0.09), delayed development (P=0.062), drinking (P=0.072) or urination habit before sleep (P=0.06), and stool incontinence (P=0.062) were not significantly associated with enuresis. Prevalence of urinary tract pathology was 2.9% in enuretics.

CONCLUSIONS

This study provides a quantitative estimate of the prevalence and main risk factors for enuresis in Iranian children.

Breastfeeding during infancy may protect against bed-wetting during childhood

OBJECTIVE

Our goal was to test the hypothesis that children who exhibit bed-wetting during childhood were less likely to be breastfed during infancy compared with normal controls.

METHODS

A case-control study was conducted in a pediatric continence center and a general pediatric practice. Cases (n = 55) were recruited from the continence center and defined as children 5 to 13 years of age who experienced lifetime involuntary voiding of urine during nighttime sleep at least 2 times a week in the absence of defects of the central nervous system or urinary tract. Age- and gender-matched controls (n = 117) who did not exhibit bed-wetting were enrolled from a general pediatric practice. Infant feeding practices were measured as breastfeeding (yes/no) and, for those who were breastfeed, by the duration of breastfeeding and the time of formula supplementation.

RESULTS

Among the case subjects, 45.5% were breastfed, whereas among the controls 81.2% were breastfed. The controls reported higher household incomes than the case subjects, and their mean family size (number of children) was slightly lower. After adjusting for race, income, and family size, the odds ratio was 0.283, indicating that case subjects were significantly less likely than controls to be breastfeed. Among all the study subjects who were breastfed, controls were breastfed for a significantly longer period than case subjects (an average of 3 months longer). Although breastfed controls were less likely to be supplemented with formula than breastfed case subjects, this difference was not statistically significant.

CONCLUSIONS

Breastfeeding longer than 3 months may protect against bed-wetting during childhood. Breast milk supplemented with formula did not make a difference in the rate of enuresis.

Enuresis in children and young people: a public health nurse approach in New Zealand

The involuntary passing of urine at age six and older is called enuresis. Wetting during the day is called diurnal enuresis and wetting at night while asleep is called nocturnal enuresis. Nocturnal enuresis is second only to allergy as the commonest chronic disorder in childhood. Many children (adolescents are included in the term 'children') who are nocturnal enuretics exhibit behaviours such as low self-esteem, withdrawal, less ambition and increased anxiety. These children are often low achievers within the school system and become a problem for their family and school. In this article the author discusses a child/adolescent-centred primary nocturnal enuresis program and service that is administered by a group of public health nurses in South Auckland, New Zealand.

Enuresis: prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey

BACKGROUND

Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances. The aim of the present study was to establish the prevalence of enuresis among school children and determine the risk factors associated with this disorder.

METHODS

A cross sectional population-based study was conducted in 1576 children. The pupils enrolled in the study were chosen randomly from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire completed by parents. Enuretic children were invited to the pediatric nephrology outpatient clinic of Cerrahpasa Medical School, Istanbul, Turkey. A detailed history was taken, physical and ultrasonographic examinations, urinalysis and urine culture were performed. The relationship between the prevalence of enuresis and the patients' age, gender, region, the parental educational level and employment status, number of family members, and the family's monthly income were tested by means of chi(2 ) and logistic regression analysis. The comparison between the two enuretic groups (monosymptomatic nocturnal enuresis group vs diurnal enuresis only and diurnal-nocturnal enuresis group) regarding the sociodemographic factors were tested with the chi(2) test and P < 0.05 was accepted as statistically significant.

RESULTS

The study group was composed of 1576 school children aged between 6 and 16 years. The overall prevalence of enuresis was 12.4%. When the chi(2) test was used, a significant relationship was found between the prevalence of enuresis and age, educational level of the father, the family's monthly income, and number of family members. However, when logistic regression analysis was applied, there was a statistically significant relationship only between enuresis, and age and number of family members. In the whole group, monosymptomatic enuresis nocturna was found to be more common in boys. When the two enuretic children groups (monosymptomatic nocturnal, diurnal only and nocturnal-diurnal enuretics) were compared with each other regarding gender, parental educational and employment status, and number of family members, statistically significant differences were found. Both maternal and the paternal low educational status were found to be associated with monosymptomatic enuresis nocturna. Likewise, monosymptomatic enuresis nocturna was found to be more common in the children of the unemployed mothers, while diurnal enuresis was more common in the children of unemployed fathers. Nocturnal enuresis was found to be associated with large families. No statistically significant difference was demonstrated between the two groups of enuretics regarding age and family income levels. The rate of urinary abnormalities in the whole group was 7.1%.

CONCLUSIONS

Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Identification of children at risk is an essential first step before choosing the individualized management for each enuretic child.

Enuresis in children with sleep apnea

OBJECTIVES

To test the hypothesis that the presence of nocturnal enuresis is related to the severity of sleep apnea, we examined the relation between the Respiratory Disturbance Index (RDI, apneas plus hypopneas per hour of sleep) and the presence and severity of enuresis.

STUDY DESIGN

All children 4 years of age and older who were referred to our sleep center for suspected sleep disordered breathing (SDB) were asked whether and how frequently they currently wet the bed. All patients underwent full overnight polysomnography (PSG). The relation between RDI and enuresis was examined by chi(2) analysis. A value of P <.05 was considered statistically significant.

RESULTS

Ninety boys and 70 girls were studied; 66 children (41%) described current enuresis. At all ages, enuresis was more prevalent in our patients than control patients in the literature. Children with an RDI of < or =1 had a significantly lower prevalence of enuresis (17%) than did children with an RDI >1 (47%) (P <.05). Fourteen percent of children with an RDI < or =1 had frequent enuresis, compared with 32% of children with an RDI >1 (P <.05). There was no significant difference in the prevalence of enuresis in children with an RDI 1 to 5, 5 to 15, or >15 (P =.92).

CONCLUSIONS

There is a high prevalence of enuresis in children with suspected sleep-disordered breathing. Children with an RDI >1 were at higher risk for enuresis than children with an RDI < or =1. This may be due to the effects of obstructive sleep apnea on arousal response, bladder pressure, or urinary hormone secretion.