Objective A cross sectional study using a self-administered questionnaire to establish the prevalence and causative factors of nocturnal enuresis in 5-10 year old South African children. Subjects and methods A questionnaire was distributed to the parents of 4700 school going children between the ages of 5-10 years in selected areas of Gauteng, Kwa-Zulu Natal and the Western Cape in South Africa. Where permission was granted, schools listed in these areas, and schools from different socio-economic areas (suburbs differing in affluence), were contacted telephonically. Those willing to participate were included in the study. Parents anonymously filled out the questionnaire and returned it to school. Data were reported as frequency and percentages in tables and graphs. The Chi-square test was used to compare proportions between groups with Fisher’s Exact test used to correct for small numbers of observations (n<5). Age differences were determined using Student’s t-test. A p value of less than 0.05 was considered to be statistically significant. Results The questionnaire response rate was 72.1%. The overall prevalence of nocturnal enuresis was 16.0%, 14.4% for mono-symptomatic nocturnal enuresis and 1.6% for daytime incontinence. A positive family history was found in 50.5% children and constipation was a problem in 16.0% of children with enuresis. Various stress factors were linked to enuresis according to vi the parents’ perceptions. Only 28.3% had received a form of treatment and 13.5% had been treated by a doctor. A higher prevalence rate of enuresis could not be linked to a lower socio-economic grouping. Parents’ awareness of treatment modalities available to their children is outdated and most of the management of the problem was done by the parents themselves. Conclusion These results suggest that the prevalence of nocturnal enuresis and associated causative factors in South Africa is similar to the prevalence in other countries, although it is difficult to compare these prevalence rates as studies use different inclusion criteria.

The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect.   Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy.  Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data.    Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.

Thesis (MEdPsych)--University of Stellenbosch, 2005. / Bibliography. Also available via the Internet.

Recent studies have shown that nocturnal enuresis can be successfully eliminated by parent-administered training in the home. However, many of the existing training packages contain numerous components which may discourage parents from following all training procedures consistently. In the current study a component analysis was conducted to determine which components were most effective in reducing bedwetting over a 2- month treatment program. Twenty-eight children four to eleven years of age were assigned to one of four groups, with seven children in each group. Children received either (1) Cleanliness training, (2) cleanliness training and hourly awakening, (3) positive practice, or (4) a standard training package. The results indicated that cleanliness training and hourly awakening, and positive practice were more effective components in reducing bedwetting. These findings suggest that further research should attempt to identify those child and parent characteristics that are likely to make one treatment approach more effective than another.

The present investigation attempted to experimentally investigate the effects of parental modification of oppositional behavior using time-out and differential reinforcement while noting any correlated changes in nocturnal enuresis. Using a multiple baseline design across families, the parents of three 5 to 6 year old boys were exposed to an intensive parent training package designed to teach them behavior modification techniques. Direct home observation of twelve parent behaviors and four child behaviors showed no differences from baseline to treatment in either the first mother's behavior or her son's The only change noted in the second mother's behavior during treatment vas a decrease in her rate of negative attention. Her son, however, did emit fever oppositional responses during treatment than during baseline. After parent training, the third mother showed a cessation of negative attention, negative physical contact with her son, and statements of contingencies. She also showed a slightly decreased use of commands, and increases in positive verbal contact and ignoring. Her son showed a decrease in his rate of oppositional behavior during treatment. No correlated changes in bedwetting were observed for any of the children. The experimental and methodological findings and problems are discussed.

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research. / Psychology of Education / M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

Conclusion. Impairment in bladder and brain functions was identified in children with severe NE. Post-treatment studies indicated that brain function normalized in parallel with amelioration of bladder dysfunction. Interaction between brain and bladder dysfunction is likely to have an important implication in the pathophysiology and resolution of NE. / Objective. To (1) investigate sleep pattern and cortical arousals in enuretic children; (2) assess brain and bladder function in enuretic children; (3) evaluate post-treatment brain and bladder functional changes in enuretic children and correlate these with the treatment outcomes. / Part II. Fifty-two patients with severe PNE and 15 normal controls were recruited. Bladder and brain functions (sleep arousal threshold, P300 ERPs latency and PPI of startle amplitude) in enuretic children were evaluated, and brain function was compared with normal controls. / Part II. Markedly reduced nocturnal FBC and impaired brain function were found in enuretic patients. Higher sleep arousal threshold was negatively correlated to lower FBC. Prolonged P300 ERPs and higher PPI of startle amplitude were positively correlated to a higher sleep arousal threshold. / Part III. NE episodes and bladder function were re-evaluated in 52 severely enuretic children (Part II) at 3 and 6 months on treatment. Brain function was re-evaluated in 41/52 enuretic children at 6 months on treatment. / Part III. Post-treatment FBC significantly increased, and sleep arousal threshold, number of awakenings, P300 ERPs latency and PPI of startle amplitude normalized in treatment responders. NE episodes reduction was significantly correlated to the improvement in FBC and brain function. Greater decrease in sleep arousal threshold was positively correlated to higher FBC increase. Higher P300 ERPs latency and PPI of startle amplitude reduction were positively correlated to greater decrease in sleep arousal threshold. / Patients and methods. Part I. Thirty-five children with refractory PNE and 21 normal controls were recruited. Overactive bladder contractions, NE episodes and volume in enuretic children, sleep stages and cortical arousals in all children were recorded. / Results. Part I. Underlying bladder dysfunction, abnormal sleep architecture and increased cortical arousal index were found in enuretic children. Cortical arousal index was positively correlated to the frequency of overactive bladder contractions. / Diao Mei. / "May 2005." / Adviser: Chung-Kwong Yeung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3693. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 135-159). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Since 1904 bedwetting alarms have been developed and scientifically described for the treatment of nocturnal enuresis, also known as bedwetting. Currently, several bedwetting alarms of various designs are available on the overseas market. These can be imported to South Africa at great cost. As affordable alarms were not readily available in South Africa, there was a need to develop and evaluate a new unit. In order to improve the efficacy of this new device, it was accompanied by detailed user guidelines and instructions. The use of this alarm was tested and the observations of thirteen bedwetting children recorded. Additionally, a programme was developed to counsel enuretic children with accompanying problems, and to assist the parents in dealing with their child's bedwetting problem. The observations and findings will be useful in practice and future research. / Psychology of Education / M. Ed. (Educational Psychology - Specialisation in Guidance and Counselling)

Havlng evaluated previous attempts to toilet train developmentally disabled indtviduals, Foxx and Azrin (1973) developed a treatment package designed to produce and maintain independent toileting in institutionalized retardates. The training procedure is divided into two phases. The first phase is the bladder training procedure, which is then followed by the self-initiation training. Foxx and Azrin note that, regardless of previous toileting behavior, all trainees should receive the same sequence of training in the toilet training program, i.e. , bladder training, followed by selfinitiation training. The authors do not differentiate between various types of enuresis, nor do they suggest that a specific type of treatment be utilized for a specific type of enuresis. Without first identifying which children have self-initiated prior to training (irregular enuretics), it is impossible to evaluate if a specific treatment is more beneficial for a particular type of enuresis. Although Foxx and Azrin (1971; 1973) have included overcorrection as part of a total treatment package, the effects of overcorrection, as the major treatment component, in the treatment of a particular subgroup of enuretics, has yet to be established. The purpose of the present study was to test the efficacy of.an overcorrection procedure, combined with verbal praise, for toilet training developmentally disabled children who display irregular enuresis (Yates, 1970). Four developmentally disabled children with irregular enuresis were administered an overcorrection procedure contingent upon each toileting accident. Verbal praise was also administered for the absence of "accidents." Results indicated that the training procedure was successful in" eliminating incontinence in three of the four subjects on whom the training was administered. The reduction of incontinence generalized outside "the children's home environment and was mainted during a one month follow-up.

Ms. K is a 19-year-old Caucasian female with no prior psychiatric diagnoses who presented to outpatient clinic with chief complaint of depressed mood. She reports depressed mood, low energy, low motivation, low self-esteem, anhedonia, and loss of appetite for past 2 months. She reports sleeping only 4 hours per night and denies daytime naps. She was diagnosed with major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorder, 5 edition in our outpatient clinic. She denies suicidal thought, homicidal thoughts, or plan. She denies hopelessness, worthlessness, and recurrent thoughts of death. She denies history of mania, psychosis, PTSD, eating disorder or OCD. She works as a server at a local restaurant. She denies tobacco, alcohol use and other illicit substance use. She doesn’t have history of inpatient hospitalization, suicide attempt or homicide attempt. She had not tried psychotropics in the past. She doesn’t have any medical illness and not on any current medications. She has history of nocturnal enuresis at age 6 improved and remitted with minimizing fluid intake before bedtime and enuresis alarm. She was started on fluoxetine 10mg daily for 7 days and increase to 20mg daily for depression. She came for follow up 4 weeks later. She reported significant improvement in her mood, energy, interest, and sleep. She has been sleeping 8 hours per night. During the follow up she denied depressed and other depressive symptoms. She reported onset of nocturnal enuresis 1 weeks after start of fluoxetine. She is reporting nocturnal enuresis 4 times a week. fluoxetine 20mg daily was decreased to 10mg daily however enuresis persisted. After discussing with patient, we decided to discontinue fluoxetine and start escitalopram 10mg daily for depression. 4 days later, patient reported that nocturnal enuresis resolved completely. Patient reached remission of her depressive symptoms on escitalopram 10mg daily. Case reports describing SSRI induced incontinence with paroxetine, sertraline have been published. Escitalopram is extremely selective for serotonergic transport proteins when compared with other antidepressant such as sertraline, fluoxetine, paroxetine, and fluvoxamine. Clinicians should keep in mind the possibility that enuresis may possible be either precipitated or exacerbated by SSRI. In this poster, we discuss fluoxetine induced enuresis, possible mechanism and bladder pathophysiology.