Malin Borgstrom: The fight for a dry night: Studies on treatment, comorbidity and family experience of nocturnal enuresis

Abstract

Aim: This thesis aimed to understand the importance of constipation therapy, basic bladderadvice and/or the enuresis alarm in the first-line therapy of nocturnal enuresis, and how these treatmentsare experienced. The aim was also to find out whether children with enuresis are more likelyto be constipated than others.

Methods: To provide more evidence for the efficacy, or non-efficacy, of basic bladder advicein enuresis a randomized controlled study was designed. A comparative study evaluated theantienuretic effect of fecal disimpaction in children with enuresis and concomitant constipation.A qualitative approach was used to study children’s and their parents’ experiences of labor-intensiveprocedures in the management of enuresis. Finaly constipation in children withenuresis as compared to children without bladder problems were evaluated. 

Results: No favorable effect of basic bladder advice as first-line treatment of enuresis was found. Nosignificant reduction of wet nights per 14 days was noted with laxative treatment and whencomparing to healthy controls, children with enuresis were not more constipated. However,children with enuresis showed indirect signs of overactive bladder since they had smallervoiding volumes than children without bladder related symptoms. For the first time, childrenwith their parents were heard regarding management of the procedures related to enuresistherapy and it was experienced as challenging and difficult. However, strategies for managingand overcoming these difficulties were suggested by the participants.

Conclusions: Basic bladder advice lacks therapeutic effect in nocturnal enuresis and treatmentof constipation is also, by itself, ineffective to get children dry at night. Overall, we found nosupport for a major link between constipation and enuresis. And since laxative therapy, bladderadvice and the enuresis alarm were all found to be cumbersome by the children and their familieswe recommend that only the evidence-based procedure – i.e. the enuresis alarm – be used asa standard management of nocturnal enuresis. Furthermore, to adhere to treatment childrenwith enuresis express that they need more support from their parents. The healthcareprovider, in collaboration with the parents, needs to find options to suit the individual child.