1. Bedwetting is a problem for children and parents a problem largely to be tackled by an EBDM approach
Johan Vande Walle
Pediatric nephro-urologic centre,
University Hospital, Ghent
14/07/2012

2. Bedwetting is a problem for children and parents a problem largely to be tackled by an EBM approach
Johan Vande Walle
Pediatric nephro-urologic centre,
University Hospital, Ghent
14/07/2012

3. Parents : Ideas on nocturnal enuresis
Psychological problems
Lack of motivation
To deep sleep
To much drinking
Self healing condition
Organic
Mismatch
Nocturnal diuresis
bladdervolume
heriditary
Doctors / care givers : Ideas on nocturnal enuresis

4. Parents : Ideas on nocturnal enuresis
Psychological problems
Lack of motivation
To deep sleep
To much drinking
Self healing condition
Organic
Mismatch
Nocturnal diuresis
bladdervolume
Heriditary
Persistent ½ severe cases
Doctors / care givers : Ideas on nocturnal enuresis

5. Parents : Ideas on nocturnal enuresis
Psychological problems
Lack of motivation
To deep sleep
To much drinking
Self healing condition
Organic
Mismatch
Nocturnal diuresis
bladdervolume
Heriditary
Persistent ½ severe cases
Doctors / care givers : Ideas on nocturnal enuresis : 70%

6. Parents : Ideas on nocturnal enuresis
Psychological problems
Lack of motivation
To deep sleep
To much drinking
Organic
Mismatch
Nocturnal diuresis
bladdervolume
heriditary
alarm
Desmopressin

7. Parents : Ideas on nocturnal enuresis
To deep sleep
Psychological problems
Lack of motivation
To much drinking
If the child would wake up
Stress,..
If he would be motivated
Less fluid intake
Wrong conclusion
Its the problem of the child
It is not a disease… not needing medical treatment
Internet and population “wisdom”

8. Vande Walle 2001

9. Vande Walle 2001

11. If the child drinks to much
.. Not drinking after 5 o clock

12. Vande Walle 2001

13. If the child sleeps to deep .. Wake him up to void
Vande Walle 2001
If the child sleeps to deep
.. Wake him up to void

14. If the child sleeps to deep .. Wake him up to void
Vande Walle 2001
If the child sleeps to deep
.. Wake him up to void

15. Vande Walle 2001

16. ?
Vande Walle enuresis fabels

17. Vande Walle 2001
PSYCHOLOGICAL?

18. Vande Walle 2001
PSYCHOLOGICAL?

19. Psychology : rimary or secondary?
Enuresis Psychological problems
Risk factors

20. Enuresis → psychological problems
*Impact child: self-esteem ↓
stress ↑
Emotional reactions
Sadness
Moodiness
Feeling upset
Embarrassment
Humiliation
Guilt
Dreaded anticipation before sleep
*University Hospital Ghent studies: Theunis et al 2002, Van Hoecke et al 2006, Van Hoecke et al 2004

21. Enuresis → psychological problems
Impact child: self-esteem ↓
stress ↑
Social impact
Being teased
Having a secret
Feeling different
No sleepovers
No camps

22. Enuresis → psychological problems
*Impact family: Parental intolerance?
parental stress ↑
Tolerant
Concern
External attribution
Effort
Empathy
Intolerant
Burden
Financial
Practical
Guilt
Helpless
Child is blamed
- Child is punished
*University Hospital Ghent study: De Bruyne et al 2009

23. Psychological problems → enuresis
(Secondary) enuresis
Stressfull life event
Parental divorce
Birth of sibling
Parental sickness/death
Removal
Natural disaster

24. Evaluate the impact/psychological problems individually
How?
Good history + clinical observation!
SSIPPE
Short Screening Instrument for
Psychological Problems in Enuresis

26. Emotional problems
If > 2 times YES: full psychological screening

27. ADHD problems
If > 2 times YES: full psychological screening

28. 20-30%: psychiatric disorder(s) (ICD-10 / DSM-IV)
General population: 10-15%
Externalizing
Internalizing
Others
At risk: older age, male, low SES, admission to specialized clinics, NMNE, SNE

29. Baeyens et al 2004-2007 2y FU 73% of ADHD diagnoses confirmed
65% still had NE
4y FU
64% of ADHD diagnoses confirmed
42% still had NE

30. Is WAIT and SEE attitude
defendable?

31. Yes, if all the following conditions are fulfilled
It cures spontaneously, always, fast
It is an idiopathic condition or a maturation defect,
and not a disease
It has no negative influence on cognitive functions
There is no effective therapy or there is one fantastic therapy with 100 % success
It has no psychological consequences
For the child
For the parents
It is cheaper not to treat

32. Profound psychological and social impact
Anxiety
Stress
Parental stress
Social isolement
1.A. Von Gontard , J Urology 2011 april (185),
2. De Bruyne E, J of urology,182,

33. ”Enuresis affects self-esteem more than chronic illness”
Total score
Body image
Relation
to others
Enuretics
15.9
3.9
2.8
Children with chronic illness
18.9
4.3
Healthy children
22.5
5.3
4.8
Hinde M et al. Lakartidningen Sep 6;92(36):3225-9

34. Treatment of enuresis Improves self concept of the child
parents perception of childs behaviour .
Longstaffe et al. Pediatrics 105,

35. Bedwetting is a problem for children and parents an impact not identified by caregivers and society