Nocturnal enuresis in children prevalence, predisposing factors, and the relationship with upper respiratory obstruction

ABSTRACT

The aim of this study is to detect the percentage of nocturnal enuresis from the point of sex, age, kind of enuresis [primary and secondary] and to know the percentage of the most predisposing factors of it, and to determine the relationship between sharing these factors and the severity of this case, and to determine the relationship between the nocturnal enuresis and the upper respiratory obstruction as one of the predisposing factors. Definition of nocturnal enuresis It is the persistent sleep wetting more than once a month past the age of five year. It is a symptom and not a disease state affecting 15-20% of 5 years old, 5-10% of 10 years-old, and 1-2% of 15 years old. Although the etiology of enuresis remains controversial, evidence supports the theory of maturation lag and/or development delay that may be influenced by a number of factors including stress, nocturnal polyuria, genetic predisposition and infection although psychopathology and enuresis may coexist, the majority of enuretics don't suffer from a psychological disorder. However, enuretics often have lower self-esteem and are more likely to underachieve compared with nonenuretics. Recent evidence does not support the theory that enuresis represents a sleep stage remains a possibility. Treatment of childhood enuresis must begin with careful history physical examination, urinalysis, and urine culture to determine if one is dealing with uncomplicated or complicated enuresis. The majority of patients have uncomplicated enuresis and there are a number of treatment options available to the physician that can be tailored to the individual patient. Behavioral modification techniques specifically conditioning therapy yield the highest reported long-term cure rates averaging 80%. This approach compared with pharmacologic therapy requires greater commitment and involvement of physician, parents and child. Imipramin has been the most commonly used drug. Desmopressin has shown promising results with similar reported response rates. Both drugs are associated with high relapse rates following discontinuation of treatment. Anticholinergics may be beneficial in those children who also have daytime frequency or enuresis. Regardless of the choice of treatment, parental support, reassurance and encouragement of the parents and child by the physician are necessary for optimal results. With the aim of detecting the percentage of most predisposing factors of nocturnal enuresis in children. The study was carried out throughout the 2003-2004 years in/2200/children of/5-15/years old, the doctor investigated only/206/child of them. The doctor investigated the parent, a good physical examination was done especially to investigate the upper respiratory obstruction. Ages of studied children-Number-Percentage-; 5-30-14.5%; 6-27-13.1%; 7-26-12.6%; 8-27-13.1%; 9-24-11.6%;. Age-Number-Percentage-;-10-19-9.2%-;-11-22-10.6%-;-12-15-7.2%-;-13-8-3.8%-;-14-5-2.4%-;-15-3-1.4%-; Table/1/. Sex of studied children Sex-Male-Female; Number--125-81; Percentage--60.6%-39.3%; Table/2/. Kind of enuresis-Kind-Primary-Secondary; Number--185-21; Percentage--89.8%-10.1%; Table/3/. The percentage of the most predisposing factors-; O-Factors-Numbers-Percentage; Family history-142-68.9%;--Punishment-159-77.2%; Early toilet training-116-56.2%; Deep sleep-143-69.4%; Male sex-125-60.6%; Female sex-81-39.3%; Poor family-117-56.7%; Drinking before sleep-112-54.3%; Winter-120-58.2%; Illiteracy of father-42-20.3%; Illiteracy of mother-56-27.18%; Small age of mother-65-31.5%; Upper respiratory obstruction-39-18.9%; Table/4/. This study which was concentrated on/206/children of/2200/children at Aleppo in 2003-2004 concluded the following-The percentage of male is 60.6% and female is 39.3%. -The percentage of primary enuresis is 89.8% and secondary enuresis is 10.1%. -The most category of age is 6-8 years and its percentage is 38.8%-The percentage of the most predisposing factors is 77.2% of punishment, then 69.4% of deep sleep, then 68.9% of familial history, then 60.6% of male sex, and other factors. -Sharing between two factors makes the case worse and the higher percentage is 63.09% which it is sharing between family history and punishment. -Upper respiratory obstruction is one of the predisposing factors of nocturnal enuresis