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29 May 2018

A new report from the NSW Agency for Clinical Innovation (ACI) has highlighted the need for improved management and healthcare of bedwetting children.

Titled Young People with Urinary Incontinence, the report was released ahead of World Bedwetting Day, which is May 29.

In partnership with the Sydney Children’s Hospital Network and the Continence Foundation of Australia, ACI took part in a project known as PISCES, which stands for paediatric information, schema, continence, education, support.

The project was designed to better understand the experiences of children with urinary incontinence, their parents, and the health practitioners who support them.

The report of the project details difficulties in obtaining timely diagnosis and support for the problem, with parents being routinely told “the child will grow out of it”, and limited information about it being available.

The release of the report also coincided with the second edition of the Australian Nocturnal Enuresis Resource Kit, developed by the partnership and focussing on the issues surrounding lack of information and delayed access to specialist care post-diagnosis.

Designed to help fill this void, the kit serves as a resource for Australian healthcare professionals, patients and carers.

Nocturnal enuresis, or bedwetting, is defined as the intermittent leakage of urine during sleep.

According to the kit’s co-authors, paediatrician at the Children’s Hospital at Westmead, Associate Professor Patrina Caldwell; and paediatric urologist at John Hunter Children’s Hospital, Dr Aniruddh Deshpande, such a resource is essential in providing additional support to all those affected by nocturnal enuresis.

“We know there are delays diagnosing and treating nocturnal enuresis. Patients and their families require support throughout the treatment journey. Healthcare professionals sometimes need additional help to support their patients, particularly when initial attempts at treatments fail,” Professor Caldwell said.

“The Nocturnal Enuresis Resource Kit is designed to offer this support, by providing current and relevant information on nocturnal enuresis management and how to address the challenges and barriers that may present. 

“There is a common assumption that bedwetting resolves spontaneously. However, the impact of bedwetting on those who continue to experience nocturnal enuresis is often ignored. Bedwetting can significantly impact sleep quality, self-esteem, emotional wellbeing and daytime functioning, both at school and socially.

“This stigmatising condition is often not talked about, as children are usually very embarrassed about it, leading to feelings of shame, guilt, and helplessness.”

As many as 20 per cent of children continue to wet the bed at five years of age, while nocturnal enuresis, which has a male skew, ­­­­affects as many as 10 per cent of 10-year-olds.  Research shows that the risk of bedwetting increases if the child’s mother, more so than their father, experienced enuresis as a child.

Dr Deshpande said we now know how nocturnal enuresis affects a child’s psychosocial development and perceived quality of life. This impact is not severity dependent, but rather, age and gender dependent.

“Although the negative impact is broadly felt by all affected children, it appears to be perceived significantly more by girls and older children,” Dr Deshpande said.

“This is perhaps counter-intuitive and mandates an appropriate response at the primary care level. Research also suggests children who are treated for nocturnal enuresis show improvements in their working memory and other daily activities.

“However, the management of nocturnal enuresis appears to be inadequately taught in medical schools and perhaps even in junior medical staff years, so many GPs may not feel confident initiating treatment of an enuretic child, or know what to do should the initial treatment fail.

“We believe GPs can successfully manage a significant proportion of these children. Therefore, we would encourage the GPs to use the principles, tools and steps outlined in the Nocturnal Enuresis Resource Kit, and offer treatment to enuretic children who seek help.”

Continence Foundation of Australia chief executive officer Rowan Cockerell said the common assumption that children will always simply outgrow bedwetting is something that needed to be addressed. 

The Nocturnal Enuresis Resource Kit features the latest clinical evidence for the condition, including non-pharmacological approaches, such as pelvic floor training and transcutaneous electrical nerve stimulation (TENS) therapy. The updated pharmacotherapy section also reflects current, evidence-based practice recommendations and algorithms.

CHRIS JOHNSON

A copy of the Nocturnal Enuresis Resource Kit can be downloaded at:  https://www.neresourcekit.com.au 

 The Young People with Urinary Incontinence report can be found at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/421896/ACI_0024c-PISCES_Patient-experience-report-A4_FINAL.pdf

 

 

 

 


Published: 29 May 2018