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Increased Risk of Physical Punishment among Enuretic Children with Family History of Enuresis.

Sá CA, Gusmão Paiva AC, de Menezes MC, de Oliveira LF, Gomes CA, de Figueiredo AA, de Bessa J Jr, Netto JM

The Journal of Urology, Volume 195, Issue 4, Part 2, April 2016, Page 1227-31

Commented by Guy Bogaert

Punishing for nocturnal enuresis is still an actual and important issue.  To this conclusion came the present study that was conducted in Brasil.  87 children with primary nocturnal enuresis between 6-15years of age and their family were included in this study.  The parents were questioned by psychologists during a separate session as with the doctor.  All children were punished in one way or the other.  100% were punished verbally (threats, humiliation, insulting), 40% were beaten.  75% of one or both parents had a history of bedwetting and almost all of them were also punished during childhood.  60% of the families had a low social status.  If the bedwetting child was a boy, he had 3 times more the chance to be punished and the chance increased when one of the parents had a history of bedwetting.  It is striking that the parents had no understanding for the bedwetting of their child, even if they had a history of bedwetting them selves.  The punishments were more likely to be done by mothers.  It is known that the quality of life of mothers with a bedwetting child is impaired, and that the QOL improves if the child can be treated successfully.  The feelings of parents vary between fury and aggression on one hand and guilty feeling and self doubt on the other hand.  Low social status is a high risk factor for punishing, and parents are even convinced that punishing is meaningful.  This study is an important contribution to the knowledge and awareness that caretakers who treat children with nocturnal enuresis should inquire about how parents deal with the problem, what their knowledge is and their understanding. 

It is the task of the doctors, dealing with the problem of bedwetting to demystify the problem of nocturnal enuresis, to inform child and parents about the pathophysiology, to ask for parental tolerance and motivation as well as to warn for significant secondary effects of punishment.



Some parents blame their children for bedwetting and, therefore, punish them. This study aimed to assess the rate of punishment experienced by enuretic children and associated causative factors.

Materials and Methods:

A total of 87 children 6 to 15 years old with monosymptomatic enuresis were assessed individually. Parents answered the questions in the tolerance scale. The forms of punishment were classified as verbal, chastisement and physical aggression. Family history of enuresis was considered only when 1 or both parents had experienced enuresis.


Of the 35 girls and 52 boys with a mean ± SD age of 9.3 ± 2.3 years 67 had a family history of enuresis. Of the 67 parents 57 (85.0%) had a history of being punished due to enuresis. All children experienced some sort of verbal punishment. Children who had a family history of enuresis were more prone to being punished by physical aggression than those without such a family history (32 of 67 or 47.8% vs 4 of 20 or 20%, OR 3.7, 95% CI 1.1-12.1, p = 0.03). Punishment was found 3 times more frequently in girls than in boys (20 of 35 or 57.1% vs 16 of 52 or 30.8%, OR 3.0, 95% CI 1.2-7.3). Parents of 79 of the 87 children (90.8%) had high scores on the tolerance scale regardless of the history of enuresis.


Enuretic children are at a high risk for experiencing some kind of punishment. Children whose parents had enuresis are at risk for being physically punished. Parents should be taught about the involuntary nature of enuresis and the fact that no punishment would help improve the condition.


World Bedwetting Day

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.