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Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children

By H. Sarici, O. Telli, B.C. Ozgur, A. Demirbas, S. Ozgur, M.A. Karagoz

Journal of Pediatric Urology, doi:10.1016/j.jpurol.2015.11.011

Editor's comments:
This is a prospective cross-sectional epidemiological study in 10 primary schools (between 6-13years old) to the parents of 4250 children. There was a high response rate of 60%, and the overall prevalence rate of enuresis was 9,52%, varying from 45% at the age of 6-7 years of age to 4,8% at the age of 12-13 years of age. These numbers are quite high and this could partly be explained that the study was performed in less developed regions and the study did not differentiated the socio-economic background. It was nevertheless very interesting to conclude that 71% of the parents stated that bedwetting of their children had a little or no impact on the overall quality of their life. It might well be that the parents did not participate in the social life of the children, and considered the condition as developmental and only temporary. The authors conclude that education and information to parents are important specifically regarding treatment options and self-esteem issues of the children with nocturnal enuresis.

Summary


Objective

According to the ICCS definitions, enuresis is defined by an intermittent, wetting during sleep after organic causes have been ruled out with a minimum wetting frequency of once per month. Previous studies reported a prevalence rate of 9–12%. Eighty to 90% of enuresis cases are identified as primary enuresis and are based on genetic predisposition, biological and developmental factors. On the other hand, secondary enuresis frequently arises from psychological factors. In this study we aimed to determine the prevalence and associated factors of nocturnal enuresis (NE) among primary school children.

Method

We initiated a prospective cross-sectional epidemiological study from January 2013 to May 2013 by sending a questionnaire to parents of 4250 school children, aged 6–13 years. The questionnaire consisted of three parts. The first part investigated the demographic characteristics of the child and family, such as age, gender, number of siblings, and enuresis history of the parents and siblings. The second part consisted of questions about the presence and frequency of bedwetting, presence of constipation/fecal incontinence, and presence of daytime incontinence (DI). The last part surveyed school performance and the effect of enuresis on quality of life of parents and children. Logistic regression analyses were conducted to determine the significant predictive factors for NE.

Results

The overall prevalence of enuresis was 9.52%. The prevalence of NE among boys and girls was 12.4% and 6.5%, respectively. Daytime incontinence was present in 18% of children. Of enuretic children, 59.2% had a positive family history of enuresis. Constipation was found in 13.2% of children with enuresis and there was no significant association between NE and the presence of constipation. In addition, 48% of enuretic children had poor school performance.

Conclusions

The current study demonstrated that age, male gender, parents' history of enuresis, and siblings' history of enuresis were significant predictive factors for NE. The majority of the parents did not have adequate interest in enuretic children and most of the children were not treated. Physicians should inform parents of enuretic children with the aim of solving this problem to prevent future issues and development of adulthood lower urinary tract symptoms (LUTS).


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.