EC Paediatrics

Background:Urinary incontinence UI (enuresis) is the symptom of involuntary urine loss which is a multidisciplinary and interdis- ciplinary problem. It is the commonest urinary symptom in children and adolescents and can lead to a long-term distress for the af- fected children and their parents. Incontinence is typically not diagnosed until 5 to 6 years of age. The age limit is focused on children who normally develop and thus will not be applicable to children with developmental retardation.

Objective:This study is conducted to determine the prevalence, risk factors and symptoms associated with urinary incontinence among Saudi children.

Methods:A community based cross-sectional study was conducted in different regions of Saudi Arabia from the period of 1 May to 30 August 2020. Study population included randomly selected participants (male and female Saudi children under 13 years old. Data was analyzed using statistical package for the social sciences (SPSS, version 16) and results were analyzed with frequencies and Chi- squared test as appropriate. P value was considered significant if < 0.05.

Results: 37.4% of children suffer from urinary incontinence. More than half of case 67.4% reported that they have UI only during sleep, 20.1% during sleep and waking up (most of the time) and 12.5% had UI during waking up. 15% reported that urinary incon- tinence problem increase with age. Only 5.1% reported that children suffer from pain during urination and 14.6% reported stomach or pelvic pain. 15.1% reported urine leakage occur during coughing or sneezing. 13.2% was previously diagnosed with a urinary tract disease or infection, 6.4% had family history with parents suffering from incontinence, 4.7% of children have nerve problems, 4.2% have muscle problems and 13.7% of children undergone a surgery before.

Conclusion: There is significant association between UI with child age and child gender which was more prevalent among male gen- der. Also, there is significant correlation between UI and age of mother and father of child, educational level of father and mother, the standard of living and if one of the parents or another child in the family suffer from the problem of enuresis.

Keywords: Urinary Incontinence; Enuresis; Urinary Incontinence in Children; Nocturnal Enuresis

1. Schultz-Lampel D., et al. “Urinary incontinence in children”. Deutsches Ärzteblatt International 108.37 (2011): 613-620.
2. Nevéus T., et al. “Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society”. The Journal of Urology 183 (2010): 441-447.
3. Sureshkumar P., et al. “Daytime urinary incontinence in primary school children: a population-based survey”. The Journal of Pediatrics 137 (2000): 814-818.
4. Abrams P., et al. “Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society”. Urology 61.1 (2003): 37-49.
5. Khandelwal C and Kistler C. “Diagnosis of urinary incontinence”. American Family Physician 87.8 (2013): 543-550.
6. Maternik M., et al. “The management of childhood urinary incontinence”. Pediatric Nephrology 30.1 (2015): 41-50.
7. Abrams P., et al. “Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence”. Neurourology and Urodynamics 29 (2010): 213-240.
8. Hu JS and Pierre EF. “Urinary Incontinence in Women: Evaluation and Management”. American Family Physician 100.6 (2019): 339-348.
9. Hoebeke P., et al. “Diagnostic evaluation of children with daytime incontinence”. The Journal of Urology 183 (2010): 699-703.
10. Dt Ges F. “Kinder- und Jugendpsychiatrie und Psychotherapie Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. Deutscher Ärzte Verlag. Köln: 2007”. Enuresis und funktionelle Harninkontinenz (2007): 327-342.
11. Subak LL., et al. “The effect of behavioral therapy on urinary incontinence: a randomized controlled trial”. Obstetrics and Gynecology 100.1 (2002): 72-78.
12. Riemsma R., et al. “Can incontinence be cured? A systematic review of cure rates”. BMC Medicine 15.1 (2017): 63.
13. Alhifthy EH., et al. “Prevalence of Nocturnal Enuresis among Saudi Children Population”. Cureus 12.1 (2020): e6662.
14. Haylen BT., et al. “An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction”. The International Urogynecology Journal 21 (2010): 5-26.
15. Burgers R., et al. “Functional defecation disorders in children with lower urinary tract symptoms”. The Journal of Urology 189.5 (2013): 1886-1891.
16. Barber MD., et al. “The impact of stress urinary incontinence on sexual activity in women”. Cleveland Clinic Journal of Medicine 72.3 (2005): 225-232.
17. Butler RJ and Heron J. “The prevalence of infrequent bedwetting and nocturnal enuresis in childhood. A large British cohort”. Scandinavian Journal of Urology and Nephrology 42 (2008): 257-264.
18. Swithinbank LV., et al. “The natural history of daytime urinary incontinence in children: a large British cohort”. Acta Paediatrica 99 (2010): 1031-1036.
19. Eshpande AV., et al. “Management of daytime urinary incontinence and lower urinary tract symptoms in children”. Journal of Paediatrics and Child Health 48 (2012): E44-E52.
20. Sureshkumar P., et al. “A population based study of 2,856 school-age children with urinary incontinence”. The Journal of Urology 181 (2009): 808-816.
21. Chung JM., et al. “Prevalence and associated factors of overactive bladder in Korean children 5-13 years old: a nationwide multicenter study”. Urology 73 (2009): 63-67.
22. Yousef KA., et al. “Daytime urinary incontinence among kindergarten children in aden governorate, 2003”. The Saudi Journal of Kidney Diseases and Transplantation 21 (2010): 1092-1099.
23. Von Gontard A., et al. “Psychological and psychiatric issues in urinary and fecal incontinence”. The Journal of Urology 185 (2011): 1432-1436.