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PubMed2002

Enuresis and the effective factors--a case-control study.

OBJECTIVE: Enuresis is widespread and affects the child and the family both psychologically and socially. This research was performed between 1 February and 30 June 1998, in Gemlik district to investigate the effective factors on enuresis among 5-9 year-old children. MATERIAL AND METHODS: A questionnaire containing 31 questions was answered by the mothers during the house visits. Two hundred and seventy-seven cases were determined in a previous study and randomly selected 277 controls were matched according to their ages, gender and residential districts. RESULTS: Younger mothers, mothers with less education and working mothers have more enuretic children. Enuresis is more prevalent within the first children. Odds ratio is 11.1 if his/her mother and/or father has had enuresis. The age of toilet training was earlier among controls than cases. CONCLUSIONS: As enuresis is rather widespread, the parents may consider this as a transient problem and therefore no effort might be given for the solution. Trained health personnel and physicians should enlighten the parents about enuresis in order to eliminate the negative effect on the child.

Adult↗
PubMed2003

Hyperventilation response in the electroencephalogram and psychiatric problems in children with primary monosymptomatic nocturnal enuresis.

OBJECTIVES: The aim of this study was to determine the frequency of an increased hyperventilation (HV) response in the electroencephalogram and to compare the results of psychometric assessments and electroencephalography (EEG) patterns in children with and without primary monosymptomatic nocturnal enuresis and in dry siblings of enuretics. We also compared the results of psychometric assessments and EEG patterns between enuretic and non-enuretic children. MATERIAL AND METHODS: The study included 89 children divided into three groups: 41 with primary monosymptomatic nocturnal enuresis, their 29 dry siblings and 19 with no history of voiding dysfunction (controls). Resting EEG changes were evaluated in all children. In addition to a psychiatric evaluation, the Maudsley Obsessive Compulsive Questionnaire, the Beck Child Depression Inventory and the State and Trait Anxiety Inventory for Children were used to assess obsessive-compulsive disorder, depression and anxiety, respectively. RESULTS: The time at which real words were first spoken occurred significantly later in enuretic children (p<0.01). The frequency of EEG abnormalities was significantly higher in the enuresis group and in their dry siblings than in the control group (p<0.01). Additionally, as an indicator of cortical dysmaturity, an increased HV response was observed more often in enuretic children and their dry siblings than in the control group (p<0.001). Anxiety scores for the enuretic children were higher than those for the controls (p<0.01). There was no significant difference in psychiatric problems between the enuresis and control groups (p>0.05). CONCLUSIONS: The increased frequency of a high-level HV response in resting-state EEG recordings and the anxiety scores suggested that delayed cortical maturity and high anxiety may be important factors in the pathogenesis of primary monosymptomatic nocturnal enuresis. The HV responses in the dry siblings of the enuretic children may emphasize the relationship between insufficient cerebral maturation and the genetic origin of nocturnal enuresis.

Adolescent↗
PubMed2005

Enuresis alarm treatment.

OBJECTIVE: Treatment for childhood nocturnal enuresis emphasizes either a psychological or pharmacological approach. The enuresis alarm, in comparative studies, has emerged as the most effective psychological treatment. In this review we investigate both outcome rates and influential factors from recently published studies. MATERIAL AND METHODS: A search of papers published between 1980 and 2002 in the English language involving at least 10 children in which the enuresis alarm was employed as a stand-alone intervention revealed 38 studies. RESULTS: Heterogeneity in terms of inclusion and outcome parameters made comparison between studies problematic. The most frequently adopted definitions were "wet at least 3 times a week" in terms of severity at inclusion, "14 consecutive dry nights" as a success criterion and "> 1 wet night a week" as a relapse criterion. Success rates across all studies ranged from 30% to 87% and were influenced by the type of enuresis, the treatment duration and the success criteria adopted. In an homogenous subset of 20 studies, 65% success with alarm treatment was found. Further analysis revealed equivalence between different forms of alarm, pre- and within-treatment predictors of outcome and possible mode of action. Relapse rates (ranging between 4% and 55%) were reported in 20 studies, with an homogeneous subset indicating that 42% of children relapsed following alarm treatment. CONCLUSIONS: The enuresis alarm is an effective intervention for children with nocturnal enuresis. There are a number of factors, both pre- and within-treatment, that appear to influence its effectiveness and may assist clinical decisions concerning its appropriateness for any particular child.

Behavior Therapy↗
PubMed2005

Internalizing and externalizing problem behavior in children with nocturnal and diurnal enuresis: a five-factor model perspective.

OBJECTIVES: To describe personality traits, internalizing, and externalizing problems of 6- to 12-year-old children with nocturnal and diurnal enuresis, examining differences from healthy referents, and investigating the association between personality traits and problem behavior. METHODS: Eighty-five children with combined nocturnal and diurnal enuresis were compared with 56 children with nocturnal enuresis and 155 healthy children on personality characteristics and problem behavior. RESULTS: Post hoc analyses of multivariate analyses indicated that parents of children with combined nocturnal and diurnal enuresis reported on average lower conscientiousness and higher neuroticism scores in their children than parents of healthy children, although the magnitude of these differences was moderate. Considerable differences in mean scores were found for the Child Behavior Checklist (CBCL) total problem scale and moderate differences for internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) problems in children with nocturnal and diurnal enuresis compared with healthy referents. Regression analyses across enuretic and healthy groups demonstrated that personality trait and problem behavior scales share substantial variance. CONCLUSION: Moderate to substantially higher levels of problem behavior is demonstrated in children with nocturnal and diurnal enuresis, who also display slightly higher neuroticism and lower conscientiousness scores.

Child↗
PubMed2005

Nocturnal enuresis: a survey of parental coping strategies at 7 1/2 years.

BACKGROUND: Childhood nocturnal enuresis is a potentially distressing experience. Parents have been found to adopt many approaches designed to help their child become dry at night. This study sought to understand, through a large cohort of children at 7 1/2 years of age, the strategies parents adopt, both during the child's development and currently, to help their child overcome bed-wetting. METHODS: A longitudinal cohort of 13,971 children with expected date of delivery between April 1991-December 1992, in the County of Avon (Bristol) formed the population study group. At 7 1/2 years parents were asked, as part of a regular self-report questionnaire, what methods they had tried or were currently using to help their child stop bed-wetting. Eleven options were supplied. RESULTS: Of 8269 parents responding to the questionnaire, 3376 (40.8%) indicated they had tried at least one of 11 strategies, with restricting night-time fluids and lifting being the predominant methods employed. Amongst strategies employed in the past, lifting and showing displeasure were used significantly more by parents of children with nocturnal enuresis than by those with children dry at 7 1/2 years. However, a greater proportion of parents of dry children encouraged their offspring to toilet more regularly in the daytime than parents of those with nocturnal enuresis or infrequent wetting. In terms of treatment interventions, the enuresis alarm had been employed with 19.2% and medication with 13.1% of those with nocturnal enuresis, although only 31.9% of those with nocturnal enuresis had seen a health worker. The results are discussed in relation to preventative and clinical implications.

Adaptation, Psychological↗
PubMed1984

A longitudinal study of enuresis from five to nine years.

The prevalence of primary and secondary enuresis was examined longitudinally in a large sample of New Zealand children at ages 5, 7, and 9 years. While the prevalence of primary enuresis fell over time, secondary enuresis increased in prevalence between 5 and 7 years. There were no sex differences. An examination of some of the developmental and background characteristics of the sample indicated that enuresis was not associated with neurodevelopmental delay or 'psychosocial' factors. However, there were strong, long term associations between secondary enuresis and behavioural deviance. The behavioural results suggested that behaviour problems did not arise as a consequence of enuresis, but rather preceded it.

Child↗
PubMed1997

Determinants of nocturnal enuresis in England and Scotland in the '90s.

The aim of this study was to assess whether changes have occurred in the determinants of nocturnal enuresis in Scotland and England in comparison with previous studies. The study was based on 22 study areas from a representative English sample, 14 areas from a representative Scottish sample, and 20 areas from an English inner-city sample. A total of 14,674 subjects was included in the analysis from 16,835 eligible children in the age range 5 to 11 years. For the main analysis, an enuretic child was one who wet the bed at least once a week. As expected, the frequency of enuresis was higher in boys and decreased markedly with age in both sexes. Bedwetting was more frequent in: Afro-Caribbean children compared with white children in the representative samples (OR 1.72 95% CI 1.22 to 2.42); those whose mothers smoked at least 10 cigarettes at home compared with non-smokers (OR 1.58 95% CI 1.26 to 1.98); children who had disturbed sleep compared with those who slept well (OR 1.96 95% CI 1.53 to 2.51); those with mothers aged less than 20 years at the child's birth compared with mothers in the age range 25 to 34 (OR 1.63 95% CI 1.20 to 2.22); and in the second- or third-born in the family in comparison with the first-born (OR 1.42 95% CI 1.17 to 1.72). Father's social class was associated with enuresis only in girls. Only 50% of the parents consulted a doctor for enuresis in their child. The percentage was even lower in Afro-Caribbean families (33%). Enuresis continues to be a highly prevalent problem and has not decreased over the last 45 years. We confirm that environmental factors are still important in the aetiology of enuresis. It is surprising that despite the availability of effective treatment only half of parents consult a doctor about the problem.

Black or African American↗
PubMed1996

Nocturnal enuresis in community-dwelling older adults.

OBJECTIVE: To investigate the prevalence and characteristics of nocturnal enuresis in community-dwelling older adults and to identify potential predisposing variables. DESIGN: Interview survey. SETTING: Five rural counties in northwestern Pennsylvania. PARTICIPANTS: Subjects were 3884 community-dwelling older adults aged 65 to 79 years who volunteered for a health promotion demonstration. MEASUREMENTS: The dependent variable was self-reported accidental loss of urine during sleep. Independent variables included demographic variables, self-reported disease history and symptomatology, and standardized screening instruments for depression (CES-D), dementia (MMSE), and functional status (ADLs). MAIN RESULTS: Prevalence of nocturnal enuresis was 2.1%, and was significantly higher among women (2.9%) compared with men (1.0%; P < .0001). Compared with subjects with daytime incontinence only, those with nocturnal enuresis reported greater severity and impact of incontinence on several parameters. Enuretics were more likely to have received treatment; treatment outcome, however, was significantly less successful. In univariate analyses, enuresis was significantly associated with symptoms of congestive heart failure (CHF), impairment in activities of daily living, depression, and use of sleep medications at least once per week. In stepwise logistic regression modeling, two symptoms of congestive heart failure and regular use of sleep medication entered the model. CONCLUSIONS: Nocturnal enuresis appears to be uncommon among older adults, but it may be associated with poorer therapeutic outcomes compared with the more common forms of daytime incontinence. The findings are consistent with the hypothesis that daytime fluid accumulation followed at night by mobilization of excess fluid is a contributor to enuresis in older adults.

Aged↗
PubMed2005

Bone age and probable aetiological causes in primary nocturnal enuresis.

AIM: To investigate probable aetiological risk factors and to identify whether there are any differences in bone age between normal children and children with primary nocturnal enuresis (PNE). METHODS: Ninety children with primary nocturnal enuresis and 40 healthy children were included in the study. Enrolment began in January 2001, and continued through July 2002. Data were obtained via consultation with children and their families, physical examination and laboratory findings. Left hand and wrist graphs of each patient were acquired, and, using Tanner Whitehouse charts (TW-2), bone ages were determined via comparison of 20 hand and wrist bones. RESULTS: Of the total of 90 children with primary nocturnal enuresis participating in the study, 52 (57.8%) were male and 38 (42.2%) were female. Of the control group, 24 (60%) were male and 16 (40%) were female. Differences between chronological ages and bone ages of the PNE and control groups were 0.57+/-0.59 and 0.54+/-0.67 y, respectively, and no significant difference was seen (p = 0.484). In 90% of the children in the PNE group there was found to be a primary nocturnal enuresis history in the family, whereas in the control group this rate was only 7.5%. Of the children with PNE, 62.2% had very deep sleeping habits, while 7.5% of the control group had this problem. CONCLUSION: Our study provides no evidence that bone ages of children suffering from PNE are lower than normal children. We found that a family history of enuresis, male sex and difficulty in waking were risk factors in primary nocturnal enuresis.

Age Determination by Skeleton↗
PubMed1997

Nocturnal enuresis and daytime wetting: a multicentric trial with oxybutynin and desmopressin.

OBJECTIVE: Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. METHODS: 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. RESULTS: Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. CONCLUSIONS: The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.

Administration, Intranasal↗
PubMed1983

Enuresis: a new look at stimulant therapy.

A case is presented in which a hyperactive child with secondary enuresis had a dramatic response to both syndromes of methylphenidate therapy. A review of the literature reveals a paucity of controlled studies on the drug treatment of secondary enuresis. Although the deep sleep theory of enuresis is not applicable to primary enuresis, the authors consider its applicability to secondary enuresis, and point out the need for further studies on the treatment of secondary enuresis.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Failure of tolterodine to treat clozapine-induced nocturnal enuresis.

OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. Clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms. DISCUSSION: This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence. CONCLUSIONS: Nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction.

Adolescent↗
PubMed2004

Significance of recent onset nocturnal enuresis in adult men: a prospective study.

INTRODUCTION: Although literature on childhood nocturnal enuresis and its persistence into adulthood is abundant, recent onset nocturnal enuresis in adults is a poorly studied symptom. OBJECTIVE: To determine the significance of recent onset nocturnal enuresis in adult males in relation to lower urinary tract pathology, and its treatment. METHODS: All men with recent onset nocturnal enuresis attending a urology unit over a period of 12 months were evaluated prospectively. Their treatment and outcome were recorded. RESULTS: There were 30 patients (mean age 64 years). Ultrasonography revealed upper urinary tract dilatation in 22 patients. Another six patients had post-void residual urine volume over 500 mL without upper tract dilatation. Only two patients did not have ultrasonographic evidence of bladder outflow obstruction. Elevated blood urea was noted in 14 patients. Twenty patients underwent transurethral resection of the prostate (TURP) and one patient with balanitis xerotica obliterans had circumcision and meatotomy. Three patients were taught clean intermittent self catheterisation, and three patients preferred indwelling urethral catheters. One patient while awaiting TURP died of a myocardial infarction. Eight patients, who were treated with alpha-adrenergic antagonists initially, required further intervention later as the response to medical therapy was poor. CONCLUSIONS: Recent onset nocturnal enuresis in adult males is a symptom closely associated with significant lower urinary tract pathology requiring early urological intervention. Considering its impact on management it is reasonable to classify recent onset nocturnal enuresis as a lower urinary tract symptom in adult men and including it in symptom scores used to assess bladder outflow obstruction.

Adult↗
PubMed1999

Treatment of primary nocturnal enuresis persisting into adulthood.

PURPOSE: We evaluate the therapeutic effectiveness of treating monosymptomatic primary nocturnal enuresis (PNE) that has persisted into adulthood. MATERIALS AND METHODS: Patients older than 18 years with persistent monosymptomatic primary nocturnal enuresis were treated with 20 to 40 microg. desmopressin (DDAVP) nightly for 6 months. If the patients remained incontinent on maximal pharmacotherapy or if they became incontinent after cessation of DDAVP we initiated treatment with an enuretic alarm for 6 months. Patients not responsive to DDAVP or the enuresis alarm were given a trial of 50 mg. imipramine nightly. All patients were reassessed for continence 18 months after initiation of the treatment protocol. RESULTS: We treated 29 patients of a median age of 20 years (range 18 to 33) who were enuretic more than 4 nights per week. With the initial DDAVP treatment 19 (66%) became continent (enuresis 0 or 1 night a month) but after discontinuation of DDAVP only 2 (7%) remained continent. Of the 27 patients subsequently treated with an enuretic alarm 9 (33%) became continent and 18 had persistent enuresis. Of these 18 patients 11 resumed DDAVP and became dry, while 7 nonresponsive to DDAVP were given imipramine and 2 (29%) are continent. CONCLUSIONS: Overall, 83% of patients (24 of 29) achieved continence, including 38% (11 of 29) who are continent off all treatment modalities and 45% (13 of 29) who are currently continent on pharmacotherapy (11 on DDAVP and 2 on imipramine). The remaining 17% of patients (5 of 29) have persistent primary nocturnal enuresis recalcitrant to all therapeutic attempts.

Adolescent↗
PubMed1998

[Enuresis and pediatric urinary incontinence--epidemiology, diagnosis and therapy today].

To describe epidemiology, diagnosis and therapy of enuresis and urinary incontinence in children we have to work with exact definitions. Enuresis is defined as a normal nearly complete emptying of the bladder at a wrong locality at a wrong time at least twice a month after the 5th year of life. Enuresis is regarded as delayed development of bladder function. From enuresis we have to differentiate urinary incontinence in children, which is any kind of loss of urine without normal emptying the bladder. Wetting in those cases is a symptom of a disease (structural, neurogenic, psychogenic or functional). A detailed anamnesis is the most important diagnostic tool in enuresis whereas in the case of urinary incontinence a lot of diagnostics from non-invasive to invasive have to be performed. Enuresis can be treated with alarm or you can apply Desmopressin (DDAVP). Therapy of urinary incontinence in children depends on the disease causing the symptom of wetting.

Adolescent↗
PubMed2000

Secondary enuresis: post-traumatic stress disorder in children after car accidents.

BACKGROUND: In our experience, secondary enuresis nocturna is a common complaint among children after a motor vehicle accident. However, as these children are often brought for examination as part of an insurance compensation claim, this complaint is not always reliable. OBJECTIVE: To describe a series of children in whom secondary enuresis occurred after a motor vehicle accident. METHODS AND RESULTS: Five children were brought to our clinic for evaluation of secondary nocturnal enuresis. Review of past history revealed a car accident preceding the onset of the enuresis. All but one had additional behavioral symptoms typical of post-traumatic stress disorder. Four children had evidence of head trauma, and one had psychological but no physical trauma. CONCLUSIONS: Nocturnal enuresis can occur after a motor vehicle accident due either to purely psychological trauma or organic head trauma. While nocturnal enuresis is generally attributed to organic causes, psychological mechanisms also play a significant role.

Accidents, Traffic↗
PubMed2000

Enuresis--background and treatment.

Nocturnal urinary continence is dependent on 3 factors: 1) nocturnal urine production, 2) nocturnal bladder function and 3) sleep and arousal mechanisms. Any child will suffer from nocturnal enuresis if more urine is produced than can be contained in the bladder or if the detrusor is hyperactive, provided that he or she is not awakened by the imminent bladder contraction. Urine production is regulated by fluid intake and several interrelated renal, hormonal and neural factors, foremost of which are vasopressin, renin, angiotensin and the sympathetic nervous system. Detrusor function is governed by the autonomic nervous system which under ideal conditions is under central nervous control. Arousal from sleep is dependent on the reticular activating system, a diffuse neural network that translates sensory input into arousal stimuli via brain stem noradrenergic neurons. Disturbances in nocturnal urine production, bladder function and arousal mechanisms have all been firmly implicated as pathogenetic factors in nocturnal enuresis. The group of enuretic children are, however, pathogenetically heterogeneous, and two main types can be discerned: 1) Diuresis-dependent enuresis - these children void because of excessive nocturnal urine production and impaired arousal mechanisms. 2) Detrusor-dependent enuresis - these children void because of nocturnal detrusor hyperactivity and impaired arousal mechanisms. The main clinical difference between the two groups is that desmopressin is usually effective in the former but not in the latter. There are two first-line therapies in nocturnal enuresis: the enuresis alarm and desmopressin medication. Promising second-line treatments include anticholinergic drugs, urotherapy and treatment of occult constipation.

Arousal↗
PubMed2001

Melatonin production is similar in children with monosymptomatic nocturnal enuresis or other forms of enuresis/incontinence and in controls.

PURPOSE: Monosymptomatic nocturnal enuresis is a disorder, the precise etiology and pathomechanism of which remain unknown. An elevated sleep arousal threshold leading to deep sleep, and an amplitude disturbance in circadian arginine vasopressin secretion and urine production have been suggested as possible causes of the disease. The pineal hormone melatonin is allegedly implicated in the physiological sleep mechanism and circadian system. Melatonin serum levels are high at night and low during the day. The major metabolite of melatonin, 6-hydroxy-melatonin-sulfate (aMT6s), is excreted in the urine and is a good indicator of its production. We explore whether alterations in melatonin secretion assessed by its aMT6s excretion might be implicated in the pathomechanism of monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: Urine was collected for 24-hour periods from 44 children with monosymptomatic nocturnal enuresis, 10 children with other forms of enuresis/incontinence (nonmonosymptomatic nocturnal enuresis) and 25 controls, and its aMT6s concentration was estimated using a commercially available radioimmunoassay. The total amount of aMT6s excreted per day was calculated. RESULTS: We found no significant differences in the amount of aMT6s excreted in a 24-hour period among patients with or without monosymptomatic nocturnal enuresis and controls with values of 17.6 microg. (1st to 3rd percentile 10.0 to 27.8) versus 13.4 (9.1 to 19.6) versus 21.5 (13.5 to 31.4), respectively. If aMT6s excretion was related to body weight, the result did not change. CONCLUSIONS: Our data do not indicate that alterations in melatonin production might be involved in the elevation of the sleep arousal threshold associated with deep sleep in children with monosymptomatic nocturnal enuresis.

Child↗