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In a study of children with nocturnal enuresis a close relationship was found between disturbed family environment and the frequency of enuresis. It will appear that negative parental attitudes in contrast to positive ones, as defined in this paper, are predisposing factors for the appearance of nocturnal enuresis. It is well known that nocturnal enuresis is one of the most serious problems encountered in children. It is estimated that over 25 percent of the children examined in Child Guidance Clinics suffer from nocturnal enuresis. In fact enuresis is considered the most common reason for referral of children to such Clinics. Much has been said about the etiology of nocturnal enuresis, and the organic factor was considered to be of primary importance by physicians of past generations. Spina bifida, local infections, small cyst, adenoids, epilepsy and mental retardation were at times considered as the main causes. Today the organic factor is accepted as an important one in a percentage not exceeding that of five percent. As a psychological psychosomatic phenomenon, nocturnal enuresis is considered to be the result of many interacting factors. One of the psychological factors is known to be the child-parent relationship and the influence of the family environment as a whole. The purpose of this paper is the study of the influence of the family environment on the frequency of nocturnal enuresis regardless of the parents' reactions to the enuresis itself.
It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.
One hundred children with enuresis were studied to find out various factors responsible for this condition. Enuresis was more frequent in first born, service class and bottle fed children. There was a significant role of stress factors in causation of enuresis. We found a higher frequency of behavioral symptoms among children with enuresis. There was no significant correlation between enuresis and sex, education of parents, social class, sleep patterns, age of mother at marriage and intellectual grades of the children. Worm infestations, giardiasis, amebiasis and urinary infection were seen in 70% of cases. General body weakness, cold and nervousness were the common causes of enuresis in the parents' opinion. The main reason for not seeking the treatment at an early stage in view of parents' was that they thought enuresis a normal variant.
We studied 115 consecutive cases of primary enuresis. Excretory urography, urodynamic testing and endoscopy are needed only in children with enuresis and concomitant urinary infection. A detailed urologic history was the most important factor in deciding upon a treatment program. Children with diurnal and nocturnal enuresis or nocturnal enuresis and daytime urgency and frequency of urination are started on anticholinergic medication. Girls with enuresis and urinary infection also are started on anticholinergic medication. Significant improvement occurs in up to 90% of the patients. Children with only nocturnal enuresis and no other symptoms are started on imipramine with a 70% improvement rate.
Enuresis is not a disease, but rather a benign clinical disorder that is very common in young children. In considering the many facets of enuresis, physicians caring for children with this disorder should always remember the dictum "Primum non nocere". Most children with enuresis will be found to have primary enuresis, that is, no organic disease or psychopathology will be found. Physicians should proceed cautiously and should avoid costly, harmful and unnecessary workups. Treatment of few disorders is more dependent on the art and skill of clinical medicine than that of childhood enuresis. All of the physician's talents and compassionate nature enter into the proper evaluation of and therapy for this disorder. Physicians must keep in mind the high spontaneous cure rate. This factor alone should encourage them to be extremely optimistic about the outcome of enuresis in their pateints.
A group of 234 children, 4 to 7 years old, in a middle- to upper-middle-class Caucasian population, were divided into four groups and matched for age and sex. Group 1 consisted of 50 children previously treated for urinary infection: control group 1 contained 55 well children; group 2 consisted of 69 children treated for respiratory allergy; and control group 2 contained 60 well children. There was no statistical difference in persistent enuresis (night wetting every week), persistent day wetting (every week), allergy, or family history of enuresis, when group 1 and control group 1 were compared. A family history of urinary infection was higher (P less than .05) in group 1. There was no statistical difference in persistent enuresis, persistent day wetting, previous urinary infection, or family history of enuresis or urinary infection when group 2 and control group 2 were compared. This study suggests that there is no relationship between respiratory allergy, enuresis, and urinary infection.
The prevalence of nocturnal enuresis has been investigated in 477 children (243 boys, 234 girls) attending government Basic Schools in Kingston, Jamaica. Enuresis, defined as wet at least 2 nights a week, occurred in 62%, 48%, 42% and 40% at 2, 3, 4 and 5 years of age, respectively. Enuresis, defined as wet at least one night a month, occurred in 68%, 58%, 53% and 52%, respectively. There was no significant difference between the sexes. Children with a family history of enuresis (first degree relatives wet beyond 8 years of age) were more likely to be enuretic than those with no family history, the difference reaching statistical significance for girls (less than 0.001) and for the sexes combined (p less than 0.001) but not for boys alone (p = 0.06). The prevalence of nocturnal enuresis in Jamaican children is higher than reported for Black children elsewhere, which in turn is higher than in their White counterparts. Cultural attitudes to bedwetting contribute to this variation and have implications for choice of therapy, both in Jamaica and elsewhere.
INTRODUCTION: Nocturnal enuresis (NE) is a common neurodevelopmental condition, yet its underlying neural mechanisms remain unclear. This study leverages the large-scale Adolescent Brain Cognitive Development (ABCD) dataset to identify structural and functional brain correlates associated with active symptoms and the resolution of bedwetting. METHODS: Using cross-sectional data from 3472 participants aged 9-10 years, children were categorized into three groups: active nocturnal enuresis (ANE, n = 225), history of nocturnal enuresis (HNE, n = 1171), and healthy control groups (CG, n = 2076). Multimodal neuroimaging protocol evaluated macrostructural properties via structural MRI (sMRI), microstructural white matter integrity via diffusion MRI (dMRI), and functional connectivity via resting-state fMRI (fMRI). Group differences were evaluated using linear models within an ANCOVA framework, adjusting for intracranial volume and handedness with False Discovery Rate (FDR) correction. RESULTS: Compared to controls, the ANE group exhibited a significant volume deficit in the right caudate, decreased sulcal depth in the left insula, and lower internal correlation within the Cingulo-Opercular Network (CON). Conversely, the dry HNE group demonstrated significant structural adaptations, including bilaterally larger putamen volumes and increased right caudate volume compared to the ANE group. The HNE group also showed increased microstructural density (decreased mean diffusivity) in the bilateral hippocampus and an increased cortical surface area in the left insula. Both NE groups demonstrated persistently reduced functional coupling within the CON. CONCLUSIONS: Nocturnal enuresis appears to be associated with a potential complex central signaling deficits. Reduced internal correlation within the CON across both active and former bedwetters indicates a potential for impairment in processing internal homeostatic bladder signals during sleep.
Videocystourethrography with synchronous pressure and flow-rate recordings has been carried out on 50 patients referred for the investigation of persistent primary enuresis. Urodynamic studies showed nocturnal enuresis to be associated mainly with normal detrusor function and nocturnal plus diurnal enuresis mainly with abnormal detrusor function. Evidence is presented which suggests that these two distinct types of enuresis occur de novo and do not overlap. Out of 18 of formerly enuretic male patients nine with abnormal detrusor function showed persistent nocturnal plus diurnal symptoms.
Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. On diet, the enuresis stopped in 12 of these children and improved in an additional four. Identification of provoking foods was by sequential reintroduction of the foods that were avoided on the oligoantigenic diet. In eight of the 12 children who recovered on the oligoantigenic diet and in the four who improved, reintroduction of one or more foods provoked a reproducible relapse of the enuresis. Nine children were subjected to a placebo-controlled, double-blind reintroduction of provoking foods. Six children relapsed during testing with incriminated foods; none reacted to placebo. Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.
The word "enuresis" is the greek word for incontinence. Enuresis has to be considered as a symptom and not as a disease. We have to keep in mind that urine leaking may be due to an anatomical anomaly (epispadias, ectopic ureter, spinal coral lesion, urethral obstacle) in which case treatment of the underlying disease constitutes treatment of enuresis. Nevertheless, enuresis is isolated in 95% of cases. Three groups are defined depending on whether the bladder is normal, hyperactive or retentionnist with bladder-sphincter dyssynergia. We emphasize the frequency of coexistence of these three aspects and the gravity of a wrong diagnosis. The onset or presence of bladder-sphincter dyssynergia is a major concern for the pediatric urologist due to its severity and the difficulties of treatment.
The authors present their observations on treatment with Noveril of nocturnal enuresis in 49 children aged from 6 to 16 years. The drug is a derivative of dibenzodiazepine belonging to the group of thymoleptic agents with an action similar to that of imipramine. Noveril was given in doses from 20 to 100 mg daily during 3 to 9 weeks. In the final evaluation of the drug the frequency of enuresis before, during and after treatment was taken into account. In 25 cases an improvement was observed, usually in psychogenic nocturnal enuresis. Side effects included oral dryness, headaches and dizziness, and sleep disturbances observed in 4 cases. The tolerance of the drug was good. Noveril has a favourable effect in children with nocturnal enuresis, particularly of psychogenic origin.
Ninety one patients with urinary tract infection, infection with enuresis or enuresis alone, but without any malformation of the lower urinary tract have been examined clinically as well as by cystomanometric und uroflow-metric studies. It could be shown that the most important parameters to evaluate blader function were the bladder compliance and the detrusor contraction during the filling of the bladder. The bladder compliance was estimated from the volume pressure relationship under resting conditions, at the first urgency to voide and at the moment when the maximal bladder capacity was reached, Concerning the detrusor contraction we distinguished partial isovolumetric detrusor contractions with an amplitude of 1--8 mm Hg and uninhibited detrusor contractions with an amplitude of more than 10 mm Hg. According to these two parameters it was possible to differentiate cystomanometrically seven different types of irritable and non irritable bladder, and to introduce a new theory of the pathogenesis of enuresis. According to this theory we suppose that enuresis in childhood is mostly caused by neurovegetative psychogenic disorders similar to anorectal sphincter achalasia in patients with overflow encopresis.
Over a one-year period 216 children had a radiographic survey of their urinary tracts performed for the evaluation of enuresis with many of these having a precedent history of urinary infection as well. Significant urinary tract abnormalities were found in 27 per cent of the children. Clinical correlation was obtained in 135 of these children with 19.3 per cent requiring surgery. The groups of children with a history of diurnal enuresis or urinary infection were quite different from the group with nocturnal enuresis alone. These differences are discussed.
Examined whether a well-established treatment program for functional enuresis, the urine alarm procedure, would be useful for children with both enuresis and diabetes. 5 children between the ages of 7 and 14 whose pretreatment physical examination suggested no neurological impairment were treated. A multiple baseline design across children indicated that the urine alarm procedure was successful in stopping enuretic episodes for all 5 children with treatment gains maintained for the 4 children available for assessment at 2-month follow-up. These results suggest that if no diabetes-related organic impairment is evident, behavioral treatment for enuresis can be beneficial for children with diabetes.
Of some 12,000 children in the National Child Development Study for whom the information was available, 10-7 per cent were enuretic between the ages of five and seven years, and 4-8 per cent were enuretic at 11 years. More boys than girls were wet at 11 years, although there was no difference at seven years. At both ages the manual social-classes were over-represented among the children with enuresis. These findings add support to the theory that nocturnal enuresis has multiple causes. The relative importance of social, developmental and psychiatric factors varies with the different groups of children early bed-wetting being associated with delayed development and later enuresis being more strongly associated with behaviour difficulties.