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The Family and the Wet Bed: The parents’ perspective and the child’s treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (CHAP)ORCID iD: 0000-0002-2760-2015
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect.

 

Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy.  Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data.

  

Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.

 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1093
Keyword [en]
Nocturnal Enuresis, Parents, Children, Treatment, Nursing
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-248496ISBN: 978-91-554-9223-6 (print)OAI: oai:DiVA.org:uu-248496DiVA: diva2:799336
Public defence
2015-05-22, Universitetshuset Sal IX, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-30 Last updated: 2015-07-07
List of papers
1.
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2. Infrequent enuresis, the uninvestigated majority: comparisons between children with enuresis of varying severity.
Open this publication in new window or tab >>Infrequent enuresis, the uninvestigated majority: comparisons between children with enuresis of varying severity.
2015 (English)In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, no 1, 24.e1-24.e6 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE).

SUBJECTS AND METHODS: The parents recorded the number of wet and dry nights for a period of 14 days, and measured the voided volumes as well as nocturnal urine production for 48 h. History data relevant to bladder and bowel function was also recorded.

RESULTS: The children could be grouped as follows: IE, n = 14; FE, n = 18; and CE, n = 22. The children with IE were slightly older than the other groups, IE mean 7.57; FE mean 6.22; CE, mean 6.56 (p = 0.004). When comparing the groups in terms of the measured parameters, only one significant difference was found: the FE group had larger average daytime voided volumes, but only when the first morning void was included. The only significantly differing anamnestic variable was previous daytime incontinence, which was more common among the children in the IE group.

CONCLUSIONS: When comparing children with varying enuresis severity, no major differences regarding bladder function and urine production were found. Furthermore, children with infrequent enuresis tend to be slightly older when they seek medical help.

National Category
Pediatrics Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-237744 (URN)10.1016/j.jpurol.2014.06.026 (DOI)000351948300010 ()25270869 (PubMedID)
Available from: 2014-12-04 Created: 2014-12-04 Last updated: 2017-12-05
3. No effect of basic bladder advice in enuresis: a randomised controlled trial
Open this publication in new window or tab >>No effect of basic bladder advice in enuresis: a randomised controlled trial
2015 (English)In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, no 3, 153.e1Article in journal (Refereed) Published
Abstract [en]

Background

There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.

Aim

To explore whether basic bladder advice has any effect against nocturnal enuresis.

Study design

The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.

Results

The basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.

Discussion

This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.

Conclusions

The recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.

National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-247662 (URN)10.1016/j.jpurol.2015.03.004 (DOI)000356357700038 ()25975733 (PubMedID)
Available from: 2015-03-30 Created: 2015-03-23 Last updated: 2017-12-04
4. No difference in relationship satisfaction between parents of children with enuresis and normative data
Open this publication in new window or tab >>No difference in relationship satisfaction between parents of children with enuresis and normative data
Show others...
2016 (English)In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 25, no 4, 1345-1351 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this cross-sectional study was to evaluate relationship satisfaction in parents of children with nocturnal enuresis and put it in context by comparisons with normative data. The secondary aim was to investigate the potential differences in feelings of incompetence in the parenting role and parental conflict among parents of children with enuresis of varying severity. Parents (n = 52) of 41 children with enuresis aged between 6 and 12 years participated. The questionnaire consisted of five components: demographic background, The Dyadic Adjustment Scale, The Swedish Parent Stress Questionnaire, The Parent Problem Checklist, and The Depression, Anxiety, and Stress Scale. Normative data was used to provide an age- and gender-stratified sample, with adequate distribution and representation of both sexes and all ages. This sample consisted 1411 parents of 1411 children aged 6-9 years. Parents of children with enuresis reported similar relationship quality as a representative sample of parents with children of the same age. The parents' report of feeling of incompetence and parental conflict were similar among children with enuresis of varying frequency. Mothers reported more problematic areas related to child rearing than fathers. This study shows that to have a child with enuresis doesn't necessarily affect the parents' feeling of competence or the quality of the intra-parental relationship.

Keyword
Nocturnal enuresis, Parenting, Children, Relationship satisfaction
National Category
Pediatrics Family Medicine
Identifiers
urn:nbn:se:uu:diva-247669 (URN)10.1007/s10826-015-0298-0 (DOI)000371807000028 ()
Available from: 2015-03-30 Created: 2015-03-23 Last updated: 2017-12-04Bibliographically approved

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