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PubMed1999

Understanding nocturnal enuresis and its treatments.

Nocturnal enuresis is a condition that touches the lives of many children around the world. Affected children and their parents may experience feelings of guilt, frustration, and anxiety because of their lack of control over the situation. Nurses can play an important role in providing education to families in regards to the causes and treatment of enuresis. It is important for nurses to understand the problem of bedwetting thoroughly so they can assist the family in making an informed decision about the various options currently available. Nocturnal enuresis (bedwetting) is a common disorder that frequently results in frustration and stress on not only the children that experience it, but their parents as well. Scharf, Pravda, Jennings, Kauffman, and Ringel (1987) note that an estimated five to seven million children in America experience enuresis. Enuresis has family and psychosocial aspects, along with financial concerns. Therefore, it is important for nurses to be aware of the causes of enuresis, how it affects the family, and the current treatments that are available.

Adolescent↗

PubMed2004

[Enuresis: pathogenesis, diagnostics, and interventions].

This review summarizes the current scientific knowledge on enuresis. Enuresis is one of the most common disorders in childhood. New conclusions on classification, aetiology, clinical diagnostics and therapy could be drawn in the past years. Thus, recent results have shown that the previous classification of enuresis into nocturnal, diurnal and diurnal and nocturnal forms which is suggested by DSM-IV and ICD-10 is not sufficient. Daytime wetting consists of a heterogeneous group of syndromes, which should be considered as functional urinary incontinence. Primary nocturnal enuresis is mainly caused by biological factors. In contrast, psychosocial factors play an important role in the manifestation of the disease, especially in secondary enuresis. Diagnostical and therapeutical concepts have to consider the heterogeneity of this disorder. Evaluation studies were supported by effective intervention programs for nocturnal enuresis. But beneficial effects of treatments for functional urinary incontinence were not confirmed.

Child↗

PubMedDate not supplied

Prevalence and risk factors for childhood nocturnal enuresis.

A large population based study was carried out to describe the epidemiology of nocturnal enuresis and to outline medical management of the problem. Parents of 1,806 schoolchildren were surveyed and prevalence was ascertained at 13% with two thirds classified as primary enuretics. Significant associated factors included social class, unemployment, family stress and a parental family history of enuresis. Enuretics were more likely to be behind at school, have behavioural problems, soiling and daytime wetting. Enuresis was distressful for the family yet most children never saw a doctor about the problem. In those that did, less than two thirds had a urine test and 40% of parents remained dissatisfied with the outcome of the visit to the doctor. Children were more likely to be prescribed medicine than other treatments whereas the enuresis alarm was recommended for only one in ten children. These findings illustrate that nocturnal enuresis continues to be a problem, that the characteristics of Irish enuretics differ from those in other countries and that medical management of enuresis has room for improvement.

Adolescent↗

PubMed1991

[Dry bed training in nocturnal enuresis].

In order to determine the prevalence of bedwetting, in the period September 1987-June 1989 an investigation was conducted among 1882 pupils of 15 primary schools in a rural area of the Netherlands. The investigation coincided with the periodical medical examination for which all pupils of these groups were invited and for which over 99% reported. In addition to this epidemiological study, a study was made of the effect of dry bed training, as a part of youth health care, in 36 children with nocturnal enuresis. Of the children examined, 8% wet their beds at least once a week, boys twice as often as girls. The secondary form of nocturnal enuresis occurred mostly in those aged 7-8 (44%) and mostly after certain events such as start of the school year, family problems or hospitalization. The proportion of bedwetting children with a parent with a history of nocturnal enuresis in youth was large: 56%. Of the girls with nocturnal enuresis, 25% had had a urinary tract infection as against 0.4% of the control group. Nocturnal enuresis often caused emotional stress in child and parents. The success rate of the dry bed training was 86%. Most children were dry within two months; 32% had a--frequently transient--relapse. After six months, 75% of the children who had had dry bed training remained dry at night. Group dry bed training appears a suitable method for children with nocturnal enuresis from age 8 when other methods (including the pad and buzzer) are unsuccessful. The training is feasible outside hospital and is an appropriate part of the tasks of youth health care.

Adolescent↗

PubMedDate not supplied

[Clinical and urodynamic study of enuresis in a juvenile male population].

We carried out a clinical and urodynamic assay of 100 cases of enuresis of a male population of ages ranging from 17 to 25. 64% displayed urodynamic alterations and these were significantly greater (p less than 0.005) amongst those suffering from nocturnal enuresis with diurnal symptoms (90%) than amongst those suffering from nocturnal enuresis only (59%). 36% of the patients did not display any urodynamic alteration. The urodynamic dysfunction most commonly displayed was vesical instability (46%). The other urodynamic dysfunctions found were 18% of the total, and detrusor contraction alteration constituted 10% of these (2 of the cases corresponded to vesical-urethral neurogenic dysfunction). The presence of minimum latent rachichisis was accompanied by urodynamic alterations in a significantly larger proportion (p less than 0.005) than in individuals not displaying this. The three case of wide-scale rachischisis were accompanied by urodynamic alterations corresponding to vesico-urethral neurogenic dysfunction. The case of secondary enuresis displayed neither urodynamic nor radiological alterations. Juvenile age enuresis displayed similar characteristics to infantile enuresis, although the percentage of vesical instability was lower. However, detrusor contraction alterations increased and the presence of previously non diagnosed vesico-urethral neurogenic dysfunctions was displayed.

Adolescent↗

PubMed1986

Childhood enuresis: prevalence, perceived impact, and prescribed treatments.

Childhood enuresis can indicate an underlying problem as benign as developmental immaturity or as serious as urinary tract obstruction. As part of a large population-based study, parents of 1,753 children aged 5 to 13 years were asked about the presence and frequency of enuresis, perceived impact, and physician-prescribed treatments. Enuresis at least once during a 3-month period was reported for 14% of this general population of children. Boys were significantly more likely to experience enuresis than girls (16% v 12%; P less than .01). The prevalence of enuresis at least once a week was similar among boys and girls (7% v 6%). Parents reported that more than half of the children are distressed by their enuresis, and two thirds of parents expressed concern. Thirty-eight percent of bed wetters have seen a physician about their condition. More than one third of these children have been treated with a drug. The most commonly recommended regimen in the literature, the bed alarm, was prescribed to only 3% of bed-wetting children who saw a physician.

Adolescent↗

PubMed1995

Enuresis in sickle cell disease.

The prevalence of enuresis and management options for this condition were studied in our population of sickle cell patients. A total of 91 active patients (6 to 21 years old) followed at our regional sickle cell center was surveyed for the symptoms of primary nocturnal enuresis. Of the 91 patients 27 (29.6%) had primary nocturnal enuresis. Of those with enuresis 17 had homozygous sickle cell anemia, 5 had hemoglobin sickle cell disease, 4 had sickle cell beta + thalassemia and 1 had sickle cell beta zero-thalassemia. Of 10 patients who elected to receive intranasal desmopressin acetate 6 (60%) had complete or partial resolution of nocturnal enuresis. Our data confirm the high prevalence of nocturnal enuresis in patients with sickle cell disease and support the role of desmopressin acetate in the treatment of these patients.

Adolescent↗

PubMed1993

[Influential factors on the therapeutic response in the conditioning treatment of enuresis with an original therapeutic machine].

The conditioning treatment of enuresis with our original therapeutic machine, that is to awake the patient before enuresis may occur, has been performed since 1987. Influential factors on the therapeutic response were investigated. Twenty two patients with enuresis Type I were admitted and were treated for 5 nights with the therapeutic machine. Seven patients were cured (the cured group) and a certain effectiveness (decrease of the frequency of enuresis of more than 50%) was observed in 8 patients (the effective group). No effectiveness was obtained in 7 patients (the no change group). The average age of the cured group was higher than that of the no change group, and the difference was significant. No significant differences were found among the three groups in sex, the frequency of enuresis or the past experience of awakening before enuresis. Significant differences among the three groups were found in the average awakening score (how easily the patient awoke when a nurse called the patient after the machine alarmed) and the change of awakening score during treatment. The average awakening score of the cured group was the highest and that of the no change group was the lowest. The change of awakening score during treatment of the no change group was significantly lower than that of the cured group or that of the effective group. The desire to cure, scored 0-2 points at the time of discharge, was significantly stronger in the cured group than in the no change group. No significant differences were noticed among the three groups in the sleeping condition and the remembrance of awakening at the next morning.

Adolescent↗

PubMed1996

[An epidemiological analysis of the sequence of bladder control and nocturnal enuresis prevalence in the children of the province of León].

The objective of this study was to better understand the development of nocturnal bladder control in our population of children and to analyze the different factors that influence this process. A transversal epidemiological study in a randomly chosen sample of schoolchildren, between the ages of 6 and 10 years, in the province of Leon was performed. The study was carried out by means of an anonymous survey given to the children's parents through the school center. The survey was comprised of personal, environmental and sphincter control development questions. We define nocturnal enuresis as at least one wet night per month in children older than 6 years of age. Of the surveys distributed, 65.1% were answered. The prevalence of primary, secondary and total nocturnal enuresis was 10.18%, 2.91% and 13.09%, respectively, for children 6 years of age and 6.59%, 0.9% and 7.49%, respectively in 10 year old children. Among the children without nocturnal enuresis, in the event of family antecedents of nocturnal enuresis, in absence of toilet training, or when sphincter education was started later than 15 months of age, slower maturation of sphincter control was observed. We conclude, that the nocturnal enuresis prevalence is similar to that reported in other related countries and that bladder control maturation among children without bed-wetting tendencies is related to the educational attitude of the parents and family antecedents of nocturnal enuresis.

Child↗

PubMed1997

Long-term home studies of water balance in patients with nocturnal enuresis.

A 2-week, home-based study was conducted on 75 children with nocturnal enuresis to monitor the frequency of enuretic episodes and the volume of nocturnal urine production. The objectives of the study were to correlate nocturnal urine production to the occurrence of nocturnal enuresis and response to desmopressin (Minirin, DDAVP) treatment. Furthermore, patient compliance was evaluated. Enuresis episodes and nocturnal urine production was recorded every night during two base-line weeks without treatment and during 2 weeks with 20-40 micrograms desmopressin at bedtime. During both periods fluid intake and micturition volumes were recorded for 2 days. Desmopressin response was defined as > 50% reduction in wet nights during treatment. It was found that patient compliance was acceptable in most patients. Regarding urine output it was found that base-line nocturnal urine production was significantly higher during nights when enuresis occurred than during "dry" nights and significantly higher in desmopressin responders compared with desmopressin non-responders. During treatment with desmopressin, nocturnal urine production in desmopressin responders decreased to levels similar to those of non-responders. The results confirm inpatient circadian studies of urine output and emphasise the importance of nocturnal polyuria in patients with monosymptomatic enuresis. The response to desmopressin was found to correlate with the occurrence of nocturnal polyuria. Home studies were considered to be a useful tool in the characterisation of patients with nocturnal enuresis.

Administration, Intranasal↗

PubMedDate not supplied

Nocturnal enuresis in children.

Millions of children nationwide are affected by nocturnal enuresis. Despite the numbers of children affected, enuresis continues to be poorly understood is and often poorly managed. Because enuresis is a symptom and not a disease, it is difficult to discern a cause or an effective treatment. Although less than 5% of children with nocturnal enuresis have an organic basis for their wetting, the physical examination and history should carefully rule out any physical causes. Factors that have been observed to be associated with the occurrence of nocturnal enuresis include developmental delay, introduction of negative factors, heredity, small bladder capacity, and reduced nocturnal secretion of antidiuretic hormone. The cornerstone of therapy for all children with nocturnal enuresis should be behavioral management. Medical management should be initiated only after behavioral management has failed. No one therapy guarantees success, and multiple therapies may be attempted before dryness is obtained.

Child↗

PubMed1955

Enuresis; a critical review of the symptom.

Enuresis is a symptom for which many kinds of treatments ranging the gamut of unscientific medical practices have been tried. To establish bladder control at the appropriate age is important because it means self-control, one of the foundations of a healthy personality. In most children with enuresis there has been no convincing demonstration of organic pathology of the urinary system. The cure of enuresis lies in the correction of psychological causal factors such as sibling jealousy, suppressed hostile feelings and sex difficulties. Routine urologic investigation of enuresis is unwarranted and unkind, unless there is a valid medical indication. Any therapeutic program for enuresis should center upon the child and not his bladder.

Child↗

PubMed2004

Complex behavioural and educational interventions for nocturnal enuresis in children.

BACKGROUND: Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. OBJECTIVES: To assess the effects of complex behavioural and educational interventions on nocturnal enuresis in children, and to compare them with other interventions. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (December 2002) and the reference lists of relevant articles. Date of the most recent searches: December 2002. SELECTION CRITERIA: All randomised or quasi-randomised trials of complex behavioural or educational interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and physical behavioural methods, alarms, desmopressin, tricyclics, and miscellaneous other interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of the eligible trials, and extracted data. MAIN RESULTS: Sixteen trials involving 1081 children were identified which included a complex or educational intervention for nocturnal enuresis. The trials were mostly small and some had methodological problems including the use of a quasi-randomised method of concealment of allocation in three trials and baseline differences between the groups in another three.A complex intervention (such as dry bed training (DBT) or full spectrum home training (FSHT)) including an alarm was better than no-treatment control groups (eg RR for failure or relapse after stopping DBT 0.25; 95% CI 0.16 to 0.39) but there was not enough evidence about the effects of complex interventions alone if an alarm was not used. A complex intervention on its own was not as good as an alarm on its own or the intervention supplemented by an alarm (eg RR for failure or relapse after DBT alone versus DBT plus alarm 2.81; 95% CI 1.80 to 4.38). On the other hand, a complex intervention supplemented by a bed alarm might reduce the relapse rate compared with the alarm on its own (eg RR for failure or relapse after DBT plus alarm versus alarm alone 0.5; 95% CI 0.31 to 0.80).There was not enough evidence to judge whether providing educational information about enuresis was effective, irrespective of method of delivery. There was some evidence that direct contact between families and therapists enhanced the effect of a complex intervention, and that increased contact and support enhanced a package of simple behavioural interventions, but these were addressed only in single trials and the results would need to be confirmed by further randomised controlled trials, in particular the effect on use of resources. REVIEWER'S CONCLUSIONS: Although DBT and FSHT were better than no treatment when used in combination with an alarm, there was insufficient evidence to support their use without an alarm. An alarm on its own was also better than DBT on its own, but there was some evidence that combining an alarm with DBT was better than an alarm on its own, suggesting that DBT may augment the effect of an alarm. There was also some evidence that direct contact with a therapist might enhance the effects of an intervention.

Behavior Therapy↗

PubMed2005

Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale.

OBJECTIVES: This review identified reports of acupuncture for childhood nocturnal enuresis, with the aim of ascertaining whether acupuncture is efficacious and or better than standard therapy for treating enuresis. MATERIALS AND METHODS: Studies of children of either gender <18 years of age who received acupuncture treatment for nocturnal enuresis, were considered. The primary outcome measure was change in the mean number of wet episodes following treatment. Electronic searching was supplemented by hand searching of western medicine and traditional Chinese medicine (TCM) journals along with English language alternative medicine journals. Trials were assessed for quality and sources of bias. Meta-analysis was performed and the overall weighted odds ratio (OR) and associated 95% confidence interval (CI) were computed using the fixed effect model; the Forest plot was used to demonstrate results. RESULTS: Two hundred six abstracts were identified, of which 11 studies were eligible for data extraction. All the trials were of low methodological quality. There was some evidence that acupuncture is useful for nocturnal enuresis when used in conjunction with other treatment that may also include a different form of acupuncture (OR 3.98, CI: 2.2-7.2). When one form of acupuncture is compared with another there was marked heterogeneity, implying that some forms of acupuncture are effective. CONCLUSION: This review provides tentative evidence for the efficacy of acupuncture for the treatment of childhood nocturnal enuresis. Due to the low methodological quality of studies, evidence to identify, which parameters of acupuncture work best, is lacking. More rigorous trials are clearly warranted.

Acupuncture Therapy↗

PubMed1996

Hyponatremia in patients with nocturnal enuresis treated with DDAVP.

UNLABELLED: Treatment of nocturnal enuresis with DDAVP is associated with a low incidence of adverse effects. The only reported serious adverse effect is seizure or altered level of consciousness due to water intoxication. We reviewed 14 articles that reported data on serum sodium in patients treated with DDAVP for nocturnal enuresis and 11 articles that reported patients who developed a seizure or altered level of consciousness during treatment with DDAVP for nocturnal enuresis. Excess fluid intake was identified as a contributing factor in 6 of the 11 case reports. CONCLUSION: Hyponatremia is a potential adverse effect in patients with nocturnal enuresis who are treated with DDAVP. To prevent this adverse effect we recommend that the patients prescribed DDAVP for nocturnal enuresis should be counseled not to ingest more than 240 ml (8 ounces) of fluid on any night that DDAVP is administered.

Adolescent↗

PubMed2005

Spina bifida occulta in functional enuresis.

OBJECTIVE: To study incidence of spina bifida occulta in nocturnal enuresis cases and to compare outcome of enuresis with spina bifida occulta and enuresis without spina bifida occulta. METHODS: Patients with enuresis divided into two groups based on X-ray lumbosacral spine. Outcome of these patients were compared on behavioral therapy. RESULTS: Spina bifida occulta was detected in 18 out of total 48 patients. Levels of spina bifida were L5 vertebrae in 3,L5-S1 in 5,S1 in 8 and S1-S2 in 2 patients. Outcome was evaluated in 42 patients who were followed up for more than 6 months. There was no significant difference between both the groups. CONCLUSION: Spina bifida occulta is a common finding in enuresis. Outcome of patients with spina bifida occulta is not different than the patients without spina bifida occulta.

Adolescent↗

PubMed2004

[Enuresis in children with sickle cell disease].

POPULATIONS AND METHODS: In order to analyze epidemiological and clinical characteristics of enuresis in children with sickle cell disease, and identify risk and aetiological factors, 987 subjects (aged 5-20 years) took part in a cross-sectional study. These children were divided into two groups: group 1 consisted of 456 homozygous children with sickle cell disease (haemoglobin SS), while group 2 consisted of 531 normal children. These groups were paired according to age and sex. RESULTS: The prevalence of enuresis was 50.9% in group 1 and 16.4% in group 2, and was significantly higher (P < 0.05) in the girls. The frequency decreased significantly between the ages of 5-20. At age 16, frequency of enuretic children with sickle cell disease remained statistically greater (15.9% vs. 8.0%). The frequency of wet nights was higher (P < 0.05) in group 1. In addition, anaemia crisis and painful crisis were related to prevalence of enuresis. There was a significant (P < 0.01) negative correlation between haemoglobin F percentage and prevalence of enuresis. CONCLUSION: Enuresis is frequent in children with sickle cell disease and its intensity is linked to severity of disease.

Adolescent↗

PubMed1993

The role of family history in predicting response to desmopressin in nocturnal enuresis.

The response to desmopressin in 71 children with nocturnal enuresis was evaluated to determine whether a family history of nocturnal enuresis could be helpful in predicting which patients would respond. The overall response rate to desmopressin (53 of 71 patients, 75%) was comparable to previous studies. A poor response was associated with a negative family history of nocturnal enuresis (1 of 14 patients, 7%), whereas the response in those with a positive family history was excellent (52 of 57 patients, 91%). We conclude from this preliminary retrospective study that a high rate of success may be predicted when desmopressin is used in patients with familial nocturnal enuresis, whereas less optimism is warranted when no family history of nocturnal enuresis can be elicited. This observation should be validated in a larger, prospective clinical study.

Adolescent↗