Prevalence of nocturnal enuresis among children in Primary Health Care Centers of Family and Community Medicine, PSMMC, Riyadh City, KSA

Prevalence of nocturnal enuresis among children and adults in Saudi Arabia: a systematic review and meta-analysis

BACKGROUND

Nocturnal enuresis (NE) is defined as any intermittent incontinence while sleeping in a child over the age of 5. This disorder can have emotional and psychological implications. Here, we performed the first meta-analysis to provide an overall assessment of the prevalence of NE and the factors associated with it in Saudi Arabia. We also examined its psychological impact and mothers' behavior in dealing with this disorder.

PATIENTS AND METHODS

A thorough search was conducted on PubMed, Scopus, Cochrane, and Web of Science databases for studies assessing the prevalence of NE. Comprehensive Meta-Analysis Version 3.3 was used to conduct the analysis. We evaluated NE prevalence, NE frequencies, NE by time, social shame and embarrassment in children with NE, and mothers seeking medical advice. A meta-regression analysis was performed to determine the correlation between the frequency of NE and NE in parents, NE in siblings, gender, and age. The quality of the included studies was assessed by Newcastle Ottawa Scale.

RESULTS

Sixteen cross-sectional studies, totaling 14 284 participants, were included. NE prevalence was 24.8% (95% CI: 17, 34). The prevalence of NE one to two times per week was 26.8% (95% CI: 15.1, 43.0), three to four times was 31.8% (95% CI: 18.5, 48.9), and five to seven times was 33.8% (95% CI: 18.2, 54.1). NE occurring at night was 24.4% (95% CI: 22.8, 26.2) and at day and night was 16.6% (95% CI: 15.3, 17.9). A significant difference was found between the regions of Saudi Arabia in the prevalence of NE, with the southern and eastern regions having the highest prevalence and the central region having the lowest prevalence. The overall pooled prevalence of embarrassment and social shame in children with NE was 63% (95% CI: 46, 77). The percentage of mothers seeking medical advice was 54.4% (95% CI: 39.7, 68.3). The prevalence of NE is positively correlated with the prevalence of NE in parents and siblings, but no association was found with males or age.

CONCLUSION

A quarter of Saudi Arabian children suffer from NE, and it is associated with feelings of embarrassment and social shame. Half of the mothers seek medical counseling. Having parents or siblings with NE increases the likelihood of NE in the child. Future research is needed to corroborate the findings of other risk factors, such as age and gender. Future research will also be required to identify the precise causes or effects within each region that contribute to the varying prevalence of NE.

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.

Sleep-Disordered Breathing and Its Association with Nocturnal Enuresis at the Primary Schools in Saudi Arabia: A Cross-Sectional Study

The correlation between nocturnal enuresis (NE) and sleep-disordered breathing (SDB) was reported. We aim to determine whether there is an association between NE and SDB in children and to assess the prevalence of SDB and NE in primary school children aged 6-12 years in Saudi Arabia. A cross-sectional observational study was conducted among the caregivers of children aged 6-12 years in all Saudi Arabia regions. The data were gathered through a self-administered online questionnaire. It included demographic information, weight and height, and associated comorbidities, in addition to the weekly frequencies of snoring symptoms and of enuresis, as well as of unrefreshing sleep using Likert-type response scales. Counts and percentages, the mean ± standard deviation, chi-square test, independent samples t-test, and regression analysis were used in the statistical analysis using R v 3.6.3. The questionnaire was completed by 686 respondents. Most respondents did not report any comorbidities in their children (77.1%). Asthma and adenotonsillar hypertrophy were reported in 16.2% and 15.6% of children, respectively. Unrefreshing sleep, mouth breathing at night, snoring, chronic nasal obstruction, and difficulty breathing while asleep were reported once or twice per week in 38%, 34%, 28%, 18%, and 18% of children, respectively. The prevalence of NE was 22.3%, with about 36.6% of children having NE two or more times per week. Significantly, NE was reported in 26.6% of children who slept before 10 PM compared to 19% of children who slept after 10 PM; in 28.6% of children who snored or loudly snored (57.1%) three times or more per week; and in 51.2% and 27.5% of children with difficulty breathing while asleep and who breathed through their mouth at night for one or two nights per week, respectively. A multivariable regression analysis showed that male gender (OR = 1.52, p = 0.010), obesity (OR = 1.24, p = 0.028), early sleeping time (OR = 1.40, p = 0.048), loud snoring for three or more nights per week (OR = 1.54, p = 0.001), difficulty breathing for one or two nights per week (OR = 1.85, p = 0.010), and mouth breathing at night for one or two nights per week (OR = 1.55, p = 0.049) were associated with higher odds of NE. Our study revealed that 22.3% of primary school children reported suffering from NE. SDB is a common problem among children with NE. The exact mechanism that links SDB to the increase in the risk of NE is unknown. Male gender, obesity, early sleeping time, loud snoring, difficulty breathing, and mouth breathing at night are potential independent risk factors of NE in school-age children.

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.

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.