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Intervention Review

Simple behavioural and physical interventions for nocturnal enuresis in children

  1. Cathryn MA Glazener1,*,
  2. Jonathan HC Evans2

Editorial Group: Cochrane Incontinence Group

Published Online: 19 APR 2004

Assessed as up-to-date: 21 NOV 2005

DOI: 10.1002/14651858.CD003637.pub2


How to Cite

Glazener CMA, Evans JHC. Simple behavioural and physical interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003637. DOI: 10.1002/14651858.CD003637.pub2.

Author Information

  1. 1

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  2. 2

    Nottingham University Hospitals NHS Trust, Department of Paediatric Nephrology, Nottingham, UK

*Cathryn MA Glazener, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. c.glazener@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2004

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This is not the most recent version of the article. View current version (19 JUL 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treating bedwetting include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction.

Objectives

To assess the effects of simple behavioural interventions on nocturnal enuresis in children, and to compare these with other interventions.

Search methods

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 22 November 2005). The reference list of a previous version of this review was also searched.

Selection criteria

All randomised or quasi-randomised trials of simple behavioural interventions for nocturnal enuresis in children up to the age of 16. Trials focused solely on daytime wetting were excluded.

Data collection and analysis

Two reviewers independently assessed the quality of the eligible trials and extracted data.

Main results

Thirteen trials met the inclusion criteria, involving 702 children of whom 387 received a simple behavioural intervention. However, within each comparison each outcome was addressed by single trials only, precluding meta-analysis.

In single small trials, reward systems (e.g. star charts), lifting and waking were each associated with significantly fewer wet nights, higher cure rates and lower relapse rates compared to controls. There was not enough evidence to evaluate retention control training (bladder training), whether compared with controls or dry bed training, or used as a supplement to alarms, or versus desmopressin. Cognitive therapy may have lower failure and relapse rates than star charts, but this finding was based on one small trial only.

One small trial of poor quality suggested that star charts were initially less successful than amitriptyline but this difference did not persist after the treatments stopped. Another suggested that imipramine was better than fluid deprivation and avoidance of punishment.

Authors' conclusions

Simple behavioural methods may be effective for some children, but further trials are needed, in particular in comparison with treatments known to be effective, such as desmopressin, tricyclic drugs and alarms. However, simple methods could be tried as first line therapy before considering alarms or drugs, because these alternative treatments may be more demanding and may have adverse effects.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Simple treatments for bedwetting in children

Bedwetting (nocturnal enuresis) is a stressful condition that particularly affects young children. It is the involuntary loss of urine at night without an underlying disease as the cause. It can result in social problems, sibling teasing and lowered self esteem. It affects around 15 to 20% of five year olds, and up to 2% of young adults

Simple methods to help children gain control include star charts and other reward systems, fluid restriction, lifting and wakening. They are often used as a first attempt to control the problem before using drugs or alarms.

The review found 13 trials which involved 702 children. Each treatment was only studied in single mostly small trials which makes the evidence less reliable. Simple treatments such as rewarding dry nights (e.g. with star charts), lifting and waking did seem to work better than no treatment in reducing wet nights. However, they were not compared with other treatments known to work, such as bed wetting alarms and drugs such as desmopressin. On the other hand, simple treatments do not have any side effects or safety concerns. Therefore, simple methods could be tried as first line therapy before considering alarms or drugs. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於兒童夜間遺尿利用簡單行為學或是物理治療的介入性治療

遺尿(尿床)是一個令人窘迫的事情同時也會造成社交障礙,這樣的情形影響15∼20%的五歲孩童甚至有2%的年輕成人也被困擾著. 雖然有蠻高的機會能自然緩解,但是在社交,情緒,身心上付出的成本可能相當高. 治療尿床的簡單行為方法包括獎勵系統,如:用積分表的方式:獎勵沒有尿床的晚上,在晚上提醒或是喚醒小孩去解尿,儲尿控制訓練還增加膀胱儲尿容積(膀胱訓練)及限制液體的攝取.

目標

評估簡單行為學介入性治療,並且用此與其他治療方式比較對於夜間遺尿兒童的治療

搜尋策略

我們搜尋考科藍實證醫學團隊特殊的試驗紀錄(2005年11月22日)我們也搜尋前一版的回顧性文章之參考目錄.

選擇標準

所有兒童至16歲之夜間遺尿症用簡單行為學的介入性治療之隨機和半隨機的試驗. 排除針對日間遺尿的試驗.

資料收集與分析

由二位審查員分別評估這些合適的試驗及摘錄資料的品質。

主要結論

主要結論 有十三個試驗達到入選的標準,包括702位兒童,其中387位接受簡單行為學的治療。然而,每項對照及結果僅經由單一試驗提出,阻礙metaanalysis。在單一小型試驗中,獎勵系統(例如積分表)、夜晚提醒或喚醒孩童解尿相較於控制組下,與較少尿床、較高治癒率及較低復發率有顯著相關。沒有足夠證據去評估膀胱儲尿容積(膀胱訓練),無論是與控制組、不尿床訓練或使用鬧鈴輔助對照,或是與desmopressin比較。認知訓練與積分方式比較後,可能有較低的失敗率及復發率,但僅是根據一個小型試驗的發現。一個品質不佳的小型試驗指出,相較於amitriptyling的使用,一開始積分方式較少治療成功,但治療結束後,就不再有這樣的差異持續存在。另一項試驗指出impipramine的使用效果,比液體限制及無效的懲罰效果佳。

作者結論

簡單行為學治療方式對於一些小孩有效,但是需要更進一步的試驗, 尤其是與目前已知具有療效的方式進行比較,如:desmopressin,三環抗鬱藥及鬧鈴治療. 然而簡單行為學治療方式可以作為在考慮使用鬧鈴治療或是藥物之前的第一線治療,因為這些替代性治療可能會有需要更多的配合及副作用.

翻譯人

本摘要由中國醫藥大學附設醫院李明泓翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

尿床(夜間遺尿)是一個令人感到壓力大的狀況,尤其在年輕的兒童身上. 非疾病造成的不自主漏尿. 這可能造成社交上的問題,遭到兄弟姐妹的嘲笑,降低自尊. 這大約影響著15∼20%的五歲孩童甚至有2%的年輕成人也被困擾著. 簡單行為學治療方式幫助兒童控制尿床,其中包含:積分表及其他獎勵系統,液體限制或是提醒及喚醒方式. 在使用藥物或是鬧鈴治療之前,這些方式常被用來做為首先嘗試控制尿床的問題. 這份回顧性文章找了13個試驗其中包還有702位兒童. 每個治療方式大多數都只在單一的小試驗作研究, 證據的可靠性較低. 簡單行為治療方式相較於不進行治療似乎有較好的減少尿床次數成效,例如:獎勵不尿床的夜晚(用積分表)及提醒及喚醒方式. 然而,這些試驗未與已知具有療效的方式進行比較,例如:尿床鬧鈴及藥物如:desmopressin.另一方面,簡單行為學治療方式沒有任何副作用或是安全性的考量. 因此,在考慮藥物或是鬧鈴治療前,可以嘗試簡單行為學治療方式作為第一線治療. 這還是要更多的研究.