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Enuresis: please, start treatment!
Enuresis treatment is recommended from the age of 6.
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By Charlotte van Herzeele
Enuresis is often considered a benign problem. However, recent research demonstrates that this is far from the truth. Suffering from enuresis implies a major impact on the child and its family: practical, financial and emotional(1). Even more, there is increased comorbidity with psychological/psychiatric disorders(2). Enuresis is not just being wet at night. Children with enuresis suffer from consequences beyond the wetting problem. Treatment is mandatory from the age of 6 years.
Enuresis is not a benign disorder, it can result to or aggravate the predisposition for neuropsychological problems and sleep disorders. The sensation of a full bladder overnight stimulates central nervous pathways in the brain, resulting in a more fragmented sleep and associated periodic limb movements during sleep(3). This observation clearly overrules the old idea of a deficient arousal and deep sleep, but gives enough arguments for a fragmented sleep pattern(3, 4).
It is shown that treatment of enuresis not only resolves the wetting problem but has beneficial consequences on sleep and daytime functioning(5). A significant decrease in periodic limb movements during sleep is demonstrated. Even when children do not become dry, an anti-diuretic effect of the treatment has positive effects on the child by prolonging the first undisturbed sleep period thus possibly improving sleep quality. Additionally, neuropsychological functioning is improved after enuresis treatment on several domains: quality of life, executive functioning, internalizing problems and externalizing problems(5). It is open for discussion whether it is the improved sleep that caused better neuropsychological functioning or just being continent or a combination of both? The results suggest a causal relationship with a possible common pathway in pathogenesis. Although this certainly remains to be further elaborated, there is no doubt about the conclusion, that it is no longer defendable to withhold effective therapy in children with enuresis, considering it a benign disorder. Several lines of research document that enuresis is not a benign disorder, it may have serious side-effects on sleep and neuropsychological functioning. The study was performed in a highly selective patient group of patients with monosymptomatic nocturnal enuresis associated with polyuria. The question arises if the same is true in other types of nocturnal enuresis. Larger studies are needed to generalize the findings to all patients with enuresis.
Taking care of children with enuresis implicates also paying attention to their sleep and neuropsychological functioning. Underestimating the importance of sleep and neuropsychological functioning might undermine the treatment success in children with nocturnal enuresis. A multidisciplinary approach increases the chance of achieving the ultimate goal of treatment: complete dryness and a preserved sleep.
1. Van Herzeele C, De Bruyne P, De Bruyne E, Walle JV. Challenging factors for enuresis treatment: Psychological problems and non-adherence. J Pediatr Urol. 2015.
2. von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C. Psychological and psychiatric issues in urinary and fecal incontinence. J Urol. 2011;185(4):1432-6.
3. Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C, Vande Walle J. Abnormal sleep architecture and refractory nocturnal enuresis. J Urol. 2009;182(4 Suppl):1961-5.
4. Dhondt K, Van Herzeele C, Roels SP, Raes A, Groen LA, Hoebeke P, et al. Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria. Pediatr Nephrol. 2015.
5. Van Herzeele C, Dhondt K, Roels SP, Raes A, Hoebeke P, Groen LA, et al. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol. 2016;31(9):1477-84.