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

The association between primary nonmonosymptomatic nocturnal enuresis and the presence of specific phobia: a case–control study

Background

Nocturnal enuresis (NE) is a common childhood condition characterized by recurrent bedwetting in children with normal bladder control over 5 years old. The pathogenesis of this condition is unknown, but it is believed to have a complex etiology. NE is primary or secondary, monosymptomatic or nonmonosymptomatic (NMNE). MNE children do not have lower urinary tract (LUT) impairment, and their voided volumes are generally normal. NMNE is linked to malfunction of the LUT, with or without daytime incontinence. Several investigations have discovered significant associations between psychiatric problems, especially anxiety disorders and NMNE. Specific phobia is the most common lifelong anxiety disorder, characterized by extreme anxiety when a stimulus is encountered or expected. This study investigated the association between specific phobia and primary NMNE.

Methods

A total of 204 children were studied, including 102 children with primary NMNE and 102 children in the control group. Girls with an FSS-II score greater than 75 and boys with a score greater than 78 were considered to have specific phobia disorder. The groups were compared using SPSS software version 23 and descriptive statistical methods.

Results

The results of the recent study showed that the mean age of the children in the case and control groups was 7.69 and 7.19 years, respectively (p-value = 0.063). The male to female ratio was 49–53 in the case group and 43–59 in the control group (p-value = 0.399). In the study, the frequency of specific phobia in the case group was 12.7% and in the control group was 9.8% (p-value = 0.507).

Conclusions

Despite the strong impacts of anxiety on children's NMNE, there is likely no significant association between specific phobia and primary NMNE.

Problems with enuresis management-A personal view

Much has happened since the end of the era when enuresis was blamed on the parents or the children themselves. Still, there are large gaps in our knowledge and large parts of modern enuresis management guidelines are (still) not based on firm evidence. In this review I will question the following commonly made assumptions regarding enuresis evaluation and treatment: •It is important to subdivide enuresis according to the presence of daytime symptoms•Voiding charts are crucial in the primary evaluation of the enuretic child•All children with enuresis need to be screened for behavioral or psychiatric issues•Concomittant daytime incontinence needs to be successfully treated before addressing the enuresis•Concomittant constipation needs to be successfully treated before addressing the enuresis•Urotherapy is a first-line treatment against enuresis In this review I will argue that much of what we do with these children is based more on experience and well-meant but poorly supported assumptions than on evidence. Some advice and therapies are probably ineffective whereas for other treatments we lack reliable predictors of treatment response. More research is obviously needed, but awaiting new results enuresis management could be substantially simplified.

Enuresis and sleep fellowship education

PURPOSE

Enuresis is a common sleep-related concern in school aged children that gradually decreases into adulthood. We performed a survey of sleep providers in order to assess their comfort level in managing patients with enuresis.

METHODS

Survey participants were recruited via the Pedsleep listserv and sleep medicine program directors in the USA on basecamp application. The Pedsleep list includes a mixture of physicians, psychologists, and other sleep providers/researchers.

RESULTS

Forty-two sleep providers completed the survey. Forty (95%) were board certified in sleep medicine, and 32 (76%) were board certified in pediatrics. Practice patterns for management of enuresis varied among respondents, with 69% who evaluate for possible contributions from other sleep disorders such as obstructive sleep apnea then refer for additional management. Nineteen (45%) respondents felt that they received inadequate or very inadequate training during their sleep fellowship for management of enuresis. While 83% of respondents worked in an academic medical center setting, none of their respective sleep clinics were the primary managing clinic at their own situation. Participants who endorsed their training as adequate/very adequate were significantly more likely to feel comfortable/very comfortable managing enuresis (90% vs 37.5%, p = 0.009).

CONCLUSIONS

A large percentage of sleep providers are lacking essential training to manage enuresis patients. These results suggest the need for additional educational initiatives in this area.