Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a
Chung K Yeung1, Biji Sreedhar, Jennifer D Y Sihoe
1Department of Surgery, Division of Paediatric Surgery and Paediatric Urology, Prince of Wales Hospital, Hong Kong. ckyeung@surgery.cuhk.edu.hk
Insights
Primary nocturnal enuresis (PNE) prevalence decreases with age, but symptoms can worsen in older children. Younger children with PNE differ significantly from adolescents, who experience more severe symptoms and daytime incontinence.
Area of Science:
- Pediatrics
- Urology
- Public Health
Background:
- Primary nocturnal enuresis (PNE) is common in childhood, but its characteristics and prevalence vary with age.
- Parental awareness and perception of PNE as a medical issue can influence reporting and management.
- Understanding age-related differences in PNE is crucial for effective intervention.
Purpose of the Study:
- To investigate and compare the clinical characteristics of primary nocturnal enuresis (PNE) in younger children versus adolescents.
- To assess the prevalence and severity of PNE and associated daytime incontinence across different age groups.
- To explore parental awareness of PNE as a significant medical problem.
Main Methods:
- A cross-sectional study involving 21,000 questionnaires distributed to children aged 5-19 years in Hong Kong.
- Questionnaires assessed bed-wetting frequency, daytime incontinence, systemic illness, family history, and parental awareness of PNE.
- Data analysis compared characteristics of PNE between younger children and adolescents.
Main Results:
- A total of 16,512 questionnaires were completed, identifying 512 children with PNE (30.2% boys, 210 girls).
- PNE prevalence decreased with age, but symptom severity increased, with more frequent wetting in older children.
- Adolescents (>10 years) showed significantly higher rates of daytime urinary incontinence compared to younger children (32% vs. 14.6%).
Conclusions:
- PNE resolution with age is likely limited to milder cases; severe symptoms persist and may worsen.
- Significant differences exist in PNE characteristics between younger children and adolescents, particularly regarding symptom severity and daytime incontinence.
- Parental indifference and lack of awareness contributed to the previously underestimated prevalence of PNE in Hong Kong.
Objective:
To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents.
Subjects And Methods:
In all, 21 000 questionnaires designed to determine the presence or absence of bed-wetting, diurnal incontinence, frequency of wetting, systemic illness, and family history, were sent to children aged 5-19 years from 67 kindergartens, primary schools and secondary schools randomly selected by a computer from different areas in Hong Kong. In addition, questions were asked to evaluate when and how the parents became aware that bed-wetting is a significant medical problem deserving attention in children after the age of 5 years.
Results:
Of the 21,000 questionnaires distributed, 16 512 (78.6%) were completed. Among the respondents, 512 children (302 boys, 210 girls) had PNE; of these, 106 (20.7%) also had daytime incontinence. There was a marked reduction in the overall prevalence of PNE with advancing age. At 5 years old, 16.1% of children had PNE (20.7% boys, 10.8% girls; at age 9 and 19 years, 3.14% and 2.2% of children had PNE, respectively. However, this reduction was significantly more apparent among those with mild enuretic symptoms (wet <3 nights/week) than in those with more frequent bed-wetting. Furthermore, younger enuretic children behaved very differently from adolescents and older patients. As age increased there was a significant tendency towards more severe enuretic symptoms. At age 5 years, 14.3% of enuretic children wet 7 nights/week, compared with 48.3% at age 19 years (P < 0.001). In addition, significantly more adolescent boys aged >10 years had daytime urinary incontinence than had enuretic children aged < or = 10 years (32% vs 14.6%, respectively, P < 0.001). Most (89%) parents only became aware that bed-wetting was a significant medical problem deserving attention through material in the mass media over the past 3-4 years.
Conclusions:
The present finding suggesting that PNE spontaneously resolves with increasing age probably applies only to those with mild enuretic symptoms. There are significant differences in characteristics between younger enuretic children and older subjects. As age increases there is an increasing proportion of enuretic patients with more severe bed-wetting. Enuretic children aged >10 years and adolescents have significantly more daytime urinary symptoms and incontinence. The previously reported low prevalence of PNE in Hong Kong was probably due to parental indifference to the problem.
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