Submitted by Heather Rhodes, APRN-BC

Tags: behavioral interventions child Enuresis literature review treatment options


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Enuresis Article Review

The article is by Yani, Xiaomei and Ying (2017) and is titled: Behavioral factors for predicting severity of enuresis and treatment responses in different compliance groups receiving behavioral therapy. It was published in the Pakistan Journal of Medical Sciences. The purpose of this research study was to determine if life and/or behavioral factors were the primary determinants affecting enuresis before medical treatment. The literature review was drawn from the disciplines of child and adolescent psychiatry, urology, health development, pediatric urology, gastroenterology, clinical nutrition, and neurology. The focus of previous research has been on structural issues and behavioral interventions (i.e., voiding before bed, limiting fluids, reward systems, etc.) without considering the combination of medication and behavioral interventions. This was identified as the primary gap in the literature. The literature review was not comprehensive as it only included 21 articles.

The study was conducted between September 2016 and December 2016. Three hundred eleven children and adolescents between 5 and 15 years-of-age with a diagnosis of primary nocturnal enuresis were enrolled. Of those enrolled, eleven were excluded for either not fully meeting inclusion criteria, or not being lost to follow up. Of the remaining participants, 158 were male, and 142 were female. None of the participants had received any medication for enuresis during the last six months, and they all lacked clinical or laboratory signs that would suggest any underlying disease pathology associated with enuresis. The study was approved by the Institutional Review Board of Beijing Children’s Hospital and was conducted within the guidelines of Good Clinical Practice and the Declaration of Helsinki.

All participants were treated with desmopressin. After two months, the participants were placed in groups according to the compliance of behavioral therapy. The groups were then compared using multivariant analysis. The five behavioral interventions that defined the multivariant analysis include: 1) education, 2) life-style advice, 3) encouragement and reward systems, 4) wake up training and 5) bladder training. Variables considered included: gender, lower urinary tract symptoms, family economic conditions, maternal education level, stool frequency, hard stool, appetite, dinner time, time for bed, drinking water before bed, snoring (or not), awake the child to toilet at night, and age of stopping use of diapers.

The study found that an underlying cause of nocturnal enuresis (NE) is nocturnal polyuria (increased urine production while asleep) sequela to increased fluid intake prior to sleep and/or a reduced production of antidiuretic hormone. The study also found that participants who experienced constipation had a higher rate of enuresis. Bowel and bladder dysfunction are associated, and treating constipation, thus reducing rectal distention compressing the bladder wall, improved the symptoms of enuresis. Participants who had a greater appetite had less symptoms of enuresis. It was determined that poor eaters experienced developmental delays and had a higher incidence of enuresis. The study also found that participants who were highly compliant (completed behavioral interventions daily) also experienced a complete response (no enuresis). The less compliant the participant, the more likely the participant was to experience enuresis.

This article could be applied to advanced nursing practice as a resource for behavioral interventions that work in addition to the medical treatment of desmopressin. The study supports the hypothesis that behavioral interventions, with desmopressin, positively impact the decreased incidence of enuresis. Although the article does not include a comprehensive literature review, I do recommend this article to others as an example to add to the understanding of enuresis. It shows a number of influencing factors on the occurrence of enuresis and gives insight into appropriate interventions to implement.


  1. Yani, M., Xiaomei, L., & Ying, S. (2017). Behavioral factors for predicting severity of enuresis and treatment responses in difference compliance groups receiving behavioral therapy. Pakistan Journal of Medical Sciences, 33 (4), 1-6.