Elsevier

Journal of Pediatric Urology

Volume 10, Issue 6, December 2014, Pages 1261-1266
Journal of Pediatric Urology

Impact of enuresis nocturna on health-related quality of life in children and their mothers

https://doi.org/10.1016/j.jpurol.2014.07.005Get rights and content

Abstract

Objective

Nocturnal enuresis (NE) is a common childhood disorder. As children age and NE persists, it may become more stressful for both them and their caregivers. The aim of the present study was to assess the impact of NE on the quality of life of children who were diagnosed with NE, and their mothers, and to compare the results with a healthy control group.

Subjects and method

Eighty-two children with NE, and their mothers, and 93 healthy children and their mothers were enrolled in the study. The sociodemographic data were evaluated. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) were used to assess the children's health-related quality of life (HRQoL); and the World Health Organization Quality of Life Instrument; short form (WHOQOL-BREF) was used for the mothers' HRQoL.

Results

The PedsQL 4.0 mean scores for the children with NE group were as follows: total score, 68.74; physical health score, 72.79; psychosocial health score, 66.56. The scores for the children in the control group were as follows: total score, 80.98; physical health score, 81.11; psychosocial health score, 80.88. The WHOQOL-BREF scores for the mothers of the children with NE were as follows: physical health score, 67.90; psychosocial health score, 62.66; social relationships score, 60.90; environmental area score, 61.04. The WHOQOL-BREF scores for the mothers in the control group were as follows: physical health score, 75.96; psychosocial health score, 72.39; social relationships score, 72.18; environmental area score, 67.44.

Conclusions

Nocturnal enuresis negatively affects the quality of life of both children and their mothers. Therefore, when physicians see children with enuresis, they should also be aware of the effect of NE on the mothers' quality of life.

Introduction

Nocturnal enuresis (NE) is a frequently encountered disorder in the clinical practice of child psychiatry, and is thought to substantially influence the lives of the affected children and their families. Primary NE is defined as: unintentional bedwetting for at least two nights in a week, in three successive months, in children who are five years of age or are developmentally five years old. Secondary nocturnal enuresis (SNE) is bedwetting that develops after at least six months of consistent dryness [1], [2]. The etiology is likely to be multifactorial [3]. Studies have reported that the prevalence of NE in children at five years of age is 20%; this decreases by 15% for each year of age, and drops to 6% in children of 11 years old [4], [5]. However, researchers have found that family expectations regarding taking responsibility and self-control skills increase as the child grows older, and this situation increases the stress on the child [6]. It is thought that increased stress with age leads to unfavorable outcomes for the child's self-image and social development [7]. Moreover, studies have shown that parents might also feel under pressure, may question their parental skills and are at risk in terms of psychiatric problems due to disappointment [8]. Butler believed that additional washing, ridding the room of the smell, setting up alarm clocks and waking up several times during the night may lead the caregiver to feel angry and hostile toward the child and may cause punitive behaviors. The activities of extra waking up and additional washing have negative effects on the caregiver's quality of life (QoL) [9].

Since the second half of the 20th century, a new parameter: health-related quality of life (HRQoL), has arisen in health-related evaluations, along with the observation that individuals with similar clinical characteristics have a distinct perception of satisfaction with their lives and about disease-related wellbeing. Although QoL is generally summarized as how an individual perceives his or her status, within the context of cultural characteristics and values, HRQoL is defined as an individual's perception of the impact of a disease and/or treatment. HRQoL investigates the aspects of QoL influenced by diseases [10], [11].

Only a few studies on NE have examined children's and parents' QoL together, and the results show that both QoL are negatively affected [12]. In the present study, the aim was to assess the QoL of children who had been diagnosed with NE, and their mothers. It was hypothesized that NE has negative effects on the Qol of both the children and their mothers.

Section snippets

Materials and methods

This case control study included 87 children between the ages of 8 and 12 years who had been diagnosed with NE, and their mothers, and who presented to the Bakırköy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery Child and Adolescent Psychiatry outpatient clinic between January 2012 and June 2013.

The children had to meet the DSM-IV-TR diagnostic criteria for NE, which was confirmed with a clinical interview, and should have had no other chronic

Results

The mean age ± standard deviation (SD) of the sample was 9.63 ± 1.31 years, which consisted of 49 (59.8%) boys and 33 (40.2%) girls. The mean age of the control group was 9.54 ± 1.23 years, and 51 (54.8%) of the children in the control group were boys. No significant differences were found between the patients and the control group in terms of age, gender and maternal education. The mean age ±SD at the completion of toilet training was 27.84 ± 11.16 months in the NE group and 25.56 ± 7.28

Discussion

The results of the present study suggest that NE negatively affects the QoL of children with NE, and their mothers. There are limited number of papers on NE and QoL. In Japan, Natioh et al. conducted a study with 139 children with NE, and their mothers, and found that compared to the control group, the perceived QoL in the children with NE was significantly lower only in the family subscale [18]. In the present study, the QoL scores of the children with NE were lower in all QoL aspects. There

Conflict of interest

None declared.

Role of funding source

None sought.

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