ENURESIS Y ENCOPRESIS INFANTIL PDF

It has been published without interruption since Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more.

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It has been published without interruption since Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health.

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.

CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Enuresis may have a negative impact on the self-image in childhood and adolescence.

The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age.. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes monosymptomatic and non-monosymptomatic , stratified by sex, was described. A logistic regression was used for adjusted analysis.. The prevalence of enuresis at age 6 years was of At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis 6.

At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.

There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.. Enuresis is a chronic, multifactorial condition characterized by genetic, biological, and psychological factors and has a vast impact on the social life of children, adolescents, and their families, limiting opportunities and causing a negative impact on their self-image.

The knowledge of enuresis has been changed throughout the years. The advances on the researches showed somatic factors as the main factors causing enuresis: nocturnal polyuria, overactive bladder, and parasomnias. Regarding the association between enuresis and behavioral disorders, four possible basic combinations have been raised: the behavioral disorder may be consequence of voiding disorders; the behavioral disorder may precede and induce urinary leaks when there is a genetic predisposition to enuresis; enuresis and behavioral disorders may share the same neurobiological disorder; and enuresis and behavioral disorders may randomly coexist, without causal relationship between them.

Most studies available were carried out in selected samples of children, usually in specialty outpatient clinics. Birth cohorts, particularly population-based cohorts, may provide more accurate information on the prevalence and association of enuresis with emotional problems. Thus, this study aimed to evaluate the presence of psychiatric disorders in children from the Pelotas Birth Cohort at ages 6 and 11 years, with or without a history of enuresis.

This study is the result of the follow-up of a birth cohort beginning at in the city of Pelotas, RS, Brazil. The mothers resident in the city were interviewed during their hospitalization for the delivery and their babies were measured length and weight and examined.

The children were examined again at ages 3, 12, 24, and 47 months, and at 6 and 11 years old, time when the mothers were interviewed and the children went through a series of examinations. At each visit, the mothers answered a questionnaire on the child's health situation, morbidities, diet, sleep patterns, vaccination, and urinary and intestinal habits, as well as data related to maternal health.

Sphincter control, urinary and intestinal habits, enuresis, and urinary symptoms have already been described in previous publications. The International Classification of Diseases ICD , version 10, defines enuresis as bedwetting at least once a month, for three months, in children aged 5 years or more. The American Psychiatric Association defines enuresis as bedwetting at least twice a month, for three months.

In this analysis, enuresis was defined as bedwetting at night at least once a month for the last three months, according to the mother's report. The criteria defined by the International Continence Society were used to assess the urinary symptoms. Encopresis was defined as passage of stool for the last three months. Urinary and intestinal symptoms were categorized by frequency, as: never, sometimes one to 14 days per month , often 15 to 29 days per month , and always seven days per week , based on Farhat's voiding score described in the assessment at 7 years old.

The instrument is composed of an initial part with structured questions based on the diagnostic criteria of the DSM-IV and ICD, and another part with open questions about the disorders to which there was a minimum number of positive structured questions. The DAWBA must be answered by the legal guardian alone up to 10 years old and, after 11 years old, by the legal guardian and the adolescent itself. DAWBA has a final section to assess the child's positive qualities abilities.

For this analysis, the ICD diagnoses were used, to allow comparisons with other studies. Children with mental retardation score in the IQ test 70 at 6 and 11 years old were excluded in the analysis of the behavioral and psychiatric symptoms. For this study, six groups of psychiatric disorders were considered: any problem, emotional changes, anxiety disorders including separation anxiety, generalized anxiety, obsessive compulsive disorder, social phobia, and specific phobias , depression, hyperactive disorders hyperactivity and other hyperactivities , and oppositional disorders defiant, oppositional, unsociability, sociability, and other conduct disorders.

The interviewers were trained to conduct the interviews. All mental health assessments were carried out by trained psychologists, supervised by a psychologist with extensive experience in population-base researches and by a child psychiatrist with major clinic experience. First, the distribution of the sample was analyzed and the presence of enuresis at 6 and 11 years old was calculated, pursuant to the characteristics of the mother and the child. Then, the presence of psychiatric disorders at 6 and 11 years old was calculated for the entire cohort and, after stratification per sex, pursuant to the existence of monosymptomatic or non-monosymptomatic enuresis.

The analysis by sex was stratified based on the theoretical basis arising from the literature review and a previous article in the same cohort. For the adjusted analysis, a theoretical conceptual model was created pursuant to the hierarchical relationship between the variables,in order to identify potential confounding factors. The first level included the socio-demographic and birth variables prematurity, low birth weight, maternal age and education, number of children in the house, maternal skin color, and socioeconomic status ; the second level included monosymptomatic or non-monosymptomatic enuresis for each type of enuresis there was a different logistic regression.

A written consent was requested to participate in the study, after the mother was informed about the goals and the confidentiality was ensured.

At 11 years old, the adolescents signed an informed consent to participate in the study. Among the 3, children assessed, the prevalence of enuresis at age 6 years was of In The prevalence of monosymptomatic enuresis in the overall sample at 6 years of age was of 1.

Table 1 describes the prevalence of enuresis and its subtypes at 6 and 11 years old, pursuant to the characteristics of the mother and the child. Boys, children of lower socioeconomic status, children of younger, less educated, and black mothers, and children with higher number of siblings in the house showed higher prevalence of enuresis both at 6 and 11 years old. Description of the overall sample and presence of mono and non-monosymptomatic enuresis at 6 and 11 years of age.

Chi-squared test was used to calculate p -value. Table 2 describes the prevalence of psychiatric disorders divided by sex, at 6 years of age, in children with and without enuresis. Psychiatric, hyperactivity, and oppositional disorders were more prevalent among boys: Presence of psychiatric disorders at 6 years of age according to the classification of enuresis, stratified by sex.

At 6 years of age, boys with enuresis showed higher prevalence of hyperactivity disorders when compared with those without enuresis 5. When enuresis was classified as monosymptomatic and non-monosymptomatic, only hyperactivity disorder in boys with non-monosymptomatic enuresis was shown to be more prevalent. Children with encopresis were more likely to have any psychiatrist disorder when compared with those without encopresis: At 11 years of age Table 3 , the prevalence of any psychiatrist, hyperactivity, and oppositional disorders was higher among boys than among girls, and among boys with monosymptomatic enuresis.

Among girls, the presence of any disorder was three times higher; the presence of oppositional disorder was five times higher among girls with non-monosymptomatic enuresis. Presence of psychiatric disorders at 11 years of age according to the classification of enuresis, stratified by sex.

Boys with urinary incontinence had higher rates of any disorder Girls also had higher rates of any psychiatric Boys with encopresis had higher rates of any psychiatric The multivariable analysis Table 4 showed that the presence of non-monosymptomatic enuresis at 11 years of age maintained the association with psychiatric disorders hyperactivity and oppositional disorders among boys; and oppositional disorders among girls , even after adjustment for confounding factors.

Monosymptomatic enuresis was not associated with psychiatric disorders in both sexes at 6 or 11 years of age. Gross odds ratios adjusted for psychiatric disorders at 11 years of age, according to the report of enuresis at 11 years of age. Adjusted for number of children in the house, socioeconomic status. Adjusted for number of children in the house, socioeconomic status, and maternal age. The other psychiatric disorders did not show statistical significance, as well as monosymptomatic enuresis.

Despite the low prevalence of psychiatric disorders in the children assessed, the authors observed that it increased significantly in children with non-monosymptomatic enuresis.

Moreover, for definition of the outcomes, the study used a tool validated for Brazil that enables the diagnosis for psychiatrist disorders DAWBA rather than a simple tracking tool, as used in most studies. In turn, the present study presented limitation due to the absence of medical examinations, as the physical examination is recommended in the investigation of urinary problems. Additionally, mental, intestinal, and urinary symptoms were reported by the mothers in an interview, being subject to bias.

The present findings are consistent with the results observed in other populations. The Tokyo Early Adolescence study showed an independent association between enuresis and ADHD in a population of adolescents at 10 years of age. Other behavioral disorders were not verified in that study. From the biological standpoint, neurophysiology and neuroimaging studies suggest an immaturity in the development of the central nervous system common to both pathologies.

In the study by Shreeram et al. Such finding is consistent with those of the present study, which showed a probability 3. Baeyens et al. Accordingly, Ferguson et al.

The study by Van Hoecke showed that children with enuresis, and especially with urinary incontinence, presented higher scores in the evaluation of low self-esteem, had concentration issues, were less cooperative, and were more likely to lose their temper when compared with children without enuresis. Von Gontard demonstrated that children with enuresis, urinary incontinence, and encopresis showed four times more risk to have behavioral comorbidities and psychological symptoms when compared with a normal population, and that these changes interfered with treatment, suggesting that both pathologies should be addressed.

Uropsychological care focusing on both pathologies is important. Some researchers believe in a neurocentric rather than a vesicocentric assessment. The treatment of enuresis requires behavioral measures, and changes in the habits regarding liquid intake and frequency of urination.

Adherence to treatment is important, as well as the persistence to follow the recommendations, both by the child and their family members, who many times may be intolerant towards the child. As Van Hoecke stated, children less motivated and with lower concentration may present difficulties in following the routine of liquid intake and eliminations times scheduled for urinating , and might show less sensibility to the sign of a full bladder.

Irritable children get easily frustrated in the absence of immediate results and stop the treatment. Emotional and behavioral disorders are frequent among children with enuresis, encopresis, and urinary incontinence, and it is recommended that pediatricians and other healthcare practitioners recognize the psychiatric disorders in patients with lower urinary tract dysfunction LUTD , so that they can refer patients to specialists in order to reduce their suffering and enhance their prognosis.

Accordingly, it is also necessary to alert the mental-care practitioners to the possibility of associating psychiatric disorders with LUTD. Another important data is that many families do not seek care for enuresis because of established family beliefs. Most mothers thought that heavy sleepiness, laziness, attempts to call attention to themselves, and emotional problems were the main causes of enuresis, and a common problem in the family.

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