The Importance of Understanding Parental Perception When Treating Primary Nocturnal Enuresis: A Topic Review and an Institutional Experience

Abstract

Primary nocturnal enuresis (PNE) is a common childhood disorder that adversely affects a child's mental well-being and social life. Our clinical experience showed parents and their child often have significantly different perspective of enuresis, and these differences can affect family dynamics, treatment approaches, and treatment success. Parents' perception of PNE also influences the likelihood of seeking medical treatment, and we found parents of children with enuresis have markedly different beliefs regarding bedwetting than those of physicians. Because achieving remission for PNE requires parents and their child to actively participate in treatment, assessing their expectancy of success and their beliefs will allow clinicians to adjust treatment goals as necessary. When treating PNE, guidelines consistently recommend incorporating bed alarms as part of the therapy. However, through interviewing parents and treating their children, we found parents preferred medications or other behavioral strategies, such as limiting water intake, because of their convenience. Many parents would complain bed alarms woke them up instead of their child, and they would soon give up on bed alarms. Part of assessing their beliefs includes assessing their confidence in their child being able to wake up to alarms and to persist with treatment. Understanding how they manage and approach setbacks will also determine the treatment modality suited for their child. In this review paper, we detailed our experiences interviewing parents and treating their child with NE with urodynamics and medications at the Changhua Christian Hospital in Taiwan.

A retrospective study about incontinence and enuresis in the shadow of Covid19 pandemic

“…Enuresis can be further separated into monosymptomatic or non-monosymptomatic based on the presence of lower urinary tract symptoms or bladder dysfunction [10][11][12] . Prevalence of nocturnal enuresis in children at 7 years of age changes between 15-22% among male children and 7-15% among female children 9,13 . In align with that, in our cohort we also found a male dominance in primary nocturnal enuresis group (Group A) with a male/female ratio of 61/43.…”

“…Among our cohort 22 patients (10.8%) had secondary enuresis nocturna. Genetic predisposition, abnormally large production of urine, developmental issues, heavily sleeping, male gender, constipation, and low socioeconomic status are the known general risk factors associated with nocturnal enuresis 9 .…”

“…Studies document that several developmental disorders such as ADHD has an association with enuresis 14,18,19 . In addition, enuresis nocturna is associated with psychological disorders, and ADHD is present in as much as 20% of children with nocturnal enuresis 2,9 . Despite the unclearness of the mech-anism it is speculated that a delay in neuronal maturation might be related with it 14,18,20,21 .…”

“…We only had three patients treated with alarm method in our cohort. Most of the parents of enuretic children tend to prefer the combination of behavioral modifications and taking medications 9 . We did not prefer imipramine, which is originally a tricyclic antidepressant drug, due to its possible cardiac effects.…”

Nocturnal enuresis in children: Parents' perspectives

“…In China, the prevalence of NE varies by region, ranging from 4.07%–10.3% (Han et al, 2019 ; Miao & J., 2020 ; Wang et al, 2019 ), and it occurs more frequently in boys (Sarici et al, 2016 ). NE affects the social life of a child, and according to a survey, children with enuresis described bedwetting as the third most disruptive to their lives ranked only after divorce and parental conflict (Tai, Tai, Chang, & Huang, 2021 ). Although the disease does not cause acute harm to children, long‐term nocturnal bed‐wetting often begets a serious disease burden and psychological pressure on both children and their parents (Salehi, Yousefichaijan, Rafeei, & Mostajeran, 2016 ), resulting in anxiety and feelings of uncertainty (Jönson Ring, Nevéus, Markström, Arnrup, & Bazargani, 2017 ; Sinha & Raut, 2016 ).…”