Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study

Abstract

OBJECTIVE To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents. SUBJECTS AND METHODS In all, 21 000 questionnaires designed to determine the presence or absence of bed‐wetting, diurnal incontinence, frequency of wetting, systemic illness, and family history, were sent to children aged 5–19 years from 67 kindergartens, primary schools and secondary schools randomly selected by a computer from different areas in Hong Kong. In addition, questions were asked to evaluate when and how the parents became aware that bed‐wetting is a significant medical problem deserving attention in children after the age of 5 years. RESULTS Of the 21 000 questionnaires distributed, 16 512 (78.6%) were completed. Among the respondents, 512 children (302 boys, 210 girls) had PNE; of these, 106 (20.7%) also had daytime incontinence. There was a marked reduction in the overall prevalence of PNE with advancing age. At 5 years old, 16.1% of children had PNE (20.7% boys, 10.8% girls; at age 9 and 19 years, 3.14% and 2.2% of children had PNE, respectively. However, this reduction was significantly more apparent among those with mild enuretic symptoms (wet <3 nights/week) than in those with more frequent bed‐wetting. Furthermore, younger enuretic children behaved very differently from adolescents and older patients. As age increased there was a significant tendency towards more severe enuretic symptoms. At age 5 years, 14.3% of enuretic children wet 7 nights/week, compared with 48.3% at age 19 years (P < 0.001). In addition, significantly more adolescent boys aged >10 years had daytime urinary incontinence than had enuretic children aged ≤ 10 years (32% vs 14.6%, respectively, P < 0.001). Most (89%) parents only became aware that bed‐wetting was a significant medical problem deserving attention through material in the mass media over the past 3–4 years. CONCLUSIONS The present finding suggesting that PNE spontaneously resolves with increasing age probably applies only to those with mild enuretic symptoms. There are significant differences in characteristics between younger enuretic children and older subjects. As age increases there is an increasing proportion of enuretic patients with more severe bed‐wetting. Enuretic children aged >10 years and adolescents have significantly more daytime urinary symptoms and incontinence. The previously reported low prevalence of PNE in Hong Kong was probably due to parental indifference to the problem.

Noktürnal enürezis

“…The prevalence has been found to be 20-25% in children aged 4 years old. While the prevalence is 10-15% at the age of 5-7 years, it decreases to approximately 0.5-2.2% at the age of 15 years and older by showing spontaneous recovery each year with a rate of approximatley 15% (4)(5)(6). In the studies performed in our country, the prevalence has been reported to be 11.5-12.4% between the ages of 6 and 16 (7,8).…”

“…Many studies related to the prevalence of nocturnal enuresis have been performed in our country and abroad (4)(5)(6)(7)(8)(9). The prevalence has been found to be 20-25% in children aged 4 years old.…”

“…Rarely?). the frequency of nocturnal wetting has been reported to be a sign of poor prognosis in terms of treatment (5).…”

¿Y si nos consultan porque moja la cama?

“…Sin embargo, la enuresis moderada (3-6/semana) o grave (diaria) y la que persiste a los diez años, difícilmente se resolverá sin tratamiento 7 . Independientemente de la gra- Usualmente el objetivo buscado es la curación, que significa sequedad completa definitiva tras finalizar el tratamiento.…”

Management of patients with refractory nocturnal enuresis

“…In the latter type, enuretic alarm treatment should be considered initially, and it is then important to investigate whether a respiratory obstruction is present in patients with nocturnal polyuria, whether the patient is constipated, and whether patients with non-monosymptomatic nocturnal enuresis have lower urinary tract symptoms or attention deficit hyperactivity disorder. [7]. (A) If patients take the desmopressin after 8 p.m. in them who sleeps at 9 p.m., they will be able to fully exercise the effect of the drug because the time of the effect of the desmopressin is included during the sleeping time.…”