Daytime and nighttime wetting in children: a review of management

Left behind and left out: The impact of the school environment on young people with continence problems

Objectives

To explore the impact of the secondary school environment on young people with continence problems.

Design

In‐depth qualitative semi‐structured interviews.

Methods

We interviewed 20 young people aged 11–19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis.

Results

We generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning.

Conclusion

Disclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self‐management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential.

Enhanced response using a multicomponent urine alarm treatment for nocturnal enuresis

PURPOSE

The current study investigated the effects of using the combination of a urine alarm and simple reward system to treat nocturnal enuresis (NE) for three children who failed to fully respond to the urine alarm alone.

DESIGN AND METHODS

A withdrawal design (i.e., ABACA) embedded within a delayed multiple baseline design across participants was used to evaluate the effects of the urine alarm alone and in combination with a reward system on participants' frequency of wet nights per week. Results were analyzed through visual and descriptive methods.

RESULTS

The urine alarm in combination with a reward system resulted in improvements in all three participants' NE. These results are contrasted with the urine alarm alone, which produced less frequent dry nights.

PRACTICE IMPLICATIONS

Nursing professionals in primary care settings are positioned to provide evidence-based treatment recommendations to families with children with NE. Findings from the current study provide a promising approach to the treatment of NE for those children who fail to respond fully to the urine alarm.

Urinary incontinence and quality of life in children

OBJECTIVE

Urinary incontinence (UI) negatively affects children's quality of life (QOL). It is not known if parents are reliable informants on impact and QOL nor if lower urinary tract symptoms (LUTS) are related to QOL. We wished to determine the association between LUTS measured by the Dysfunctional Voiding Symptom Score (DVSS) and QOL measured by the Pediatric Urinary Incontinence QOL tool (PIN-Q), and to test the relationship between parent and patient's responses.

SUBJECTS AND METHOD

Forty children (10 males, 30 females), aged 5-11 years with non-neurogenic daytime wetting, and their parents completed DVSS and PIN-Q as well as responding to open-ended questions about the effect of incontinence.

RESULTS

Child DVSS: mean 12.6 (3 (very mild) to 21 (severe)); parent DVSS: mean 12.8 (3-20). Child PIN-Q: mean 37.6 (8 (no effect) to 70 (severe effect)); parent PIN-Q: mean 38.7 (15-61). Parents indicated a major effect of UI on family function and dynamics, as well as on the child.

CONCLUSIONS

UI has a major effect on the child and the family. The PIN-Q and DVSS are complementary and provide a clinically appropriate picture of LUTS and impact on QOL. Parents understood the effect of incontinence and could act as proxy for the child.