Bedwetting

Bedwetting is a problem for children and
parents
a problem largely to be tackled by an
EBDM approach
© 2008 Universitair Ziekenhuis Gent 1

parents
a problem largely to be tackled by an
EBM approach

Parents : Ideas on nocturnal enuresis
Organic
Mismatch
Nocturnal diuresis
bladdervolume
heriditary
Psychological problems
Lack of motivation
To deep sleep
To much drinking
Self healing condition
Doctors / care givers : Ideas on nocturnal enuresis

Organic
Mismatch
Nocturnal diuresis
bladdervolume
Heriditary
Persistent ½ severe cases
Lack of motivation
To deep sleep
To much drinking
Doctors / care givers : Ideas on nocturnal enuresis

Organic
Mismatch
Nocturnal diuresis
bladdervolume
Heriditary
Persistent ½ severe cases
Lack of motivation
To deep sleep
To much drinking
Doctors / care givers : Ideas on nocturnal enuresis : 70%

Organic
Mismatch
Nocturnal diuresis
bladdervolume
heriditary
Lack of motivation
To deep sleep
To much drinking
Desmopressin
alarm

To deep sleep
Lack of motivation
To much drinking
If the child would wake up
Stress,..
If he would be motivated
Less fluid intake
Wrong conclusion
-Its the problem of the child
-It is not a disease… not needing medical treatment
-Internet and population “wisdom”

If the child drinks to much
.. Not drinking after 5 o clock

If the child sleeps to deep
.. Wake him up to void

?
Vande Walle enuresis fabels

PSYCHOLOGICAL?

Psychology : rimary or secondary?
Enuresis Psychological problems
Risk factors

Enuresis → psychological problems
*Impact child: sseellff--eesstteeeemm ↓↓
ssttrreessss ↑↑
Emotional reactions
Sadness
Moodiness
Feeling upset
Embarrassment
Humiliation
Guilt
Dreaded anticipation before sleep
*University Hospital Ghent studies: Theunis et al 2002, Van Hoecke et al 2006, Van Hoecke et al 2004

Impact child: sseellff--eesstteeeemm ↓↓
ssttrreessss ↑↑
Social impact
Being teased
Having a secret
Feeling different
No sleepovers
No camps

*Impact family: PPaarreennttaall iinnttoolleerraannccee??
ppaarreennttaall ssttrreessss ↑↑
Tolerant
- Concern
- External attribution
- Effort
- Empathy
Intolerant
- Burden
- Financial
- Practical
- Guilt
- Helpless
- Child is blamed
- Child is punished
*University Hospital Ghent study: De Bruyne et al 2009

Psychological problems → enuresis
(Secondary) enuresis
Stressfull life event
Parental divorce
Birth of sibling
Parental sickness/death
Removal
Natural disaster

Evaluate the impact/psychological problems
individually
How?
Good history + clinical observation!
SSIPPE
Short Screening Instrument for
Psychological Problems in Enuresis

Emotional problems
If > 2 times YES: full psychological screening

ADHD problems
If > 2 times YES: full psychological screening

20-30%: psychiatric disorder(s) (ICD-10 / DSM-IV)
General population: 10-15%
Externalizing
Internalizing
Others
At risk: older age, male, low SES, admission to specialized clinics,
NMNE, SNE

Baeyens et al 2004-2007
2y FU
73% of ADHD diagnoses confirmed
65% still had NE
4y FU
64% of ADHD diagnoses confirmed
42% still had NE

Is WAIT and SEE attitude
defendable?

Yes, if all the following conditions are fulfilled
It cures spontaneously, always, fast
It is an idiopathic condition or a maturation defect,
and not a disease
It has no negative influence on cognitive functions
There is no effective therapy or there is one fantastic therapy
with 100 % success
It has no psychological consequences
For the child
For the parents
It is cheaper not to treat

Profound psychological and social impact
Anxiety Stress
Social isolement
Parental stress
1.A. Von Gontard , J Urology 2011 april (185),1432-1437
© 2008 Universitair Ziekenhuis Gent 2. De Bruyne E, J of urology,182,2012-2021
3322

”Enuresis affects self-esteem
more than chronic illness”
Total score Body image Relation
to others
Enuretics 15.9 3.9 2.8
Children with
chronic illness
18.9 4.3 3.9
Healthy
children
22.5 5.3 4.8
Hinde M et al. Lakartidningen. 1995 Sep 6;92(36):3225-9

Treatment of enuresis
Improves
self concept of the child
parents perception of
childs behaviour
Longstaffe et al. Pediatrics 105,935-940

parents
an impact not identified
by caregivers and society

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Thank you for your attention

Bedwetting

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Bedwetting

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