Enürezis Tanılı Çocuklarda Davranışsal Tedavi Yöntemleri

Year 2024, Volume: 6 Issue: 2, 364 - 377, 25.08.2024

Tuba Gıynaş , Nurdan Akçay Didişen

Abstract

Enürezis, herhangi bir organik neden olmaksızın gece ya da gündüz, yatağına ya da giysilerine, istemli ya da istemsiz olarak haftada en az 2 kez idrar kaçırma olarak tanımlanmaktadır. Enürezin prevalansı sosyoekonomik duruma ve ebeveynlerin eğitim düzeyine göre farklılık göstermektedir. Genel olarak bildirilen sıklık beş yaşındaki çocuklarda %15’ dir. Enürezisin altında yatan sebepler hala tartışılmakta ve araştırılmaktadır. Bu sebeplerin tam olarak ne olduğu söylenememekle birlikte; etiyolojisinin karmaşık ve multifaktöriyel olduğu düşünülmektedir. Enürezis farklı etiyolojik nedenlerle ortaya çıkabilen bir semptom olduğu için, farklı disiplinleri ilgilendiren bir problemdir. Bu durum sonucu olarak enürezis ile ilgilenen her disiplin problemi kendi açısından değerlendirerek tedaviyi yönetmektedir. Bu nedenle enürezis tedavisi için çocuk sağlığı ve hastalıkları uzmanı, çocuk psikiyatristi, çocuk psikoloğu, fizik tedavi uzmanı ve pediatri hemşiresinden oluşan multidisipliner bir ekip gerekmektedir. Enüresizin tedavisi için, farmakolojik ve farmakolojik olmayan tedavi yöntemleri mevcuttur. Davranışsal tedavi yöntemleri olarak adlandırılan farmakalojik yöntemler arasında; tuvalet eğitimi, mesane ve sfinkter eğitimi, motivasyon tedavisi, alarm-uyarı tedavisi, biyofeed-back, nöromodülasyon, akupunktur, karyopratik, hipnoterapi, homeopati bu yöntemleri bulunmaktadır. Sonuç olarak enürezis tedavisinde farklı tedavi seçenekleri bulunmakla birlikte öncelikli olan tedavi yaklaşımı davranışsal tedavi yöntemleridir. Bu tedavi yöntemleri, tek başına kullanılabildikleri gibi birbirlerinin kombinasyonları şeklinde de kullanılabilmektedir. Bu yöntemlerin çocuğa uygulanmasında pediatri hemşireleri hem çocuk hem aile için önemli bir role sahiptir ve bu yöntemlerin uygulamasında peddiatri hemşirelerinin çok önemli katkılarının olacağı düşünülmektedir.

Keywords

Enürezis, Davranış Terapisi, Davranış Değiştirme.

Behavioral Treatment Methods in Children with Enuresis

Abstract

Enuresis was evaluated as a voluntary or involuntary loss of exit to children or clothes, day or night, at least 2 times a week, in the exclusion of organic causes. The prevalence of enuresis shows its effect according to socioeconomic status and education level. The overall reported frequency is 15% in children aged five years. The underlying causes of enuresis are still debated and investigated. Although it cannot be said exactly what these reasons are; Sevens whose etiology is complex and multifactorial. Enuresis is a problem that targets different disciplines, as it is a symptom that can occur with different etiological findings. As a result of this situation, the discipline dealing with enuresis evaluates the problem from his own perspective and manages the treatment. Therefore, a multidisciplinary team consisting of a doctor, child psychiatrist, child psychologist, physical therapist and nurse is required for the treatment of enuresis. There are pharmacological and non-pharmacological treatment modalities for the treatment of enuresis. Among the pharmacological methods called behavioral treatment methods; these methods are toilet training, bladder and sphincter training, motivation therapy, alarm-warning therapy, biofeed-back, neuromodulation, acupuncture, chiropractic, hypnotherapy, homeopathy. As a result, although enuresis treatment has different treatment options, the previous treatment approach is behavioral treatment methods. These treatment methods can be used alone or as end-uses. Pediatric nurses have an important place in the application of these methods to the child and it is thought that pediatric nurses will have a very important contribution in the application of these methods.

Keywords

Enuresis, Behavior Therapy, Behavior Modification.

References

• Al-Harbi, S. M., Needlman, R. D., Khan, A. S., & Patni, T. (2004). Intensive behavioral therapy for primary enuresis. Saudi Med J, 25 (7), 934-40. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.864.3526&rep=rep1&type=pdf
• Alqannad, E. M., Alharbi, A. S., Almansour, R. A., & Alghamdi, M. S. (2021). Alarm therapy in the treatment of enuresis in children: Types and efficacy review. Cureus, 13(8), e17358. https://doi.org/10.7759/cureus.17358
• Apos, E., Schuster, S., Reece, J., Whitaker, S., Murphy, K., Golder, J., ... & Gibb, S. (2018). Enuresis management in children: retrospective clinical audit of 2861 cases treated with practitioner-assisted bell-and-pad alarm. The Journal of Pediatrics, 193, 211-216. https://doi.org/10.1016/j.jpeds.2017.09.086
• Arda, E., Cakiroglu, B., & Thomas, D. T. (2016). Primary nocturnal enuresis: A review. Nephro-urology Monthly, 8(4), e35809. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039962/
• Atar, M., & Sancaktutar, A.A. (2011). Enürezis nokturnanın tedavisinde ilaç dışı yaklaşımlar. Türk Üroloji Seminerleri, 2, 50-54. https://doi.org/10.5152/tus.2011.10
• Austin, P. F., Bauer, S. B., Bower, W., Chase, J., Franco, I., Hoebeke, P., ... & Nevéus, T. (2016). The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourology and Urodynamics, 35(4), 471-481. https://doi.org/10.1002/nau.22751
• Avanoğlu, A., Baskın B., Söylemezoğlu, O., Tekgül, S., Ziylan O., Zorludemir Ü. (2010). Türkiye enürezis kılavuzu.https://old.peduro.org.tr/docs/tek.pdf
• Baba, Ö. (2020). Bir aile sağlığı merkezine kayıtlı 5-14 yaş arası çocuklarda enürezis nokturna prevalansının belirlenmesi ve etkileyen faktörlerin değerlendirilmesi. [Yayınlanmamış Tıpta Uzmanlık Tezi]. Sağlık Bilimleri Üniversitesi, İstanbul.
• Bakhtiar, K., Pournia, Y., Ebrahimzadeh, F., Farhadi, A., Shafizadeh, F., & Hosseinabadi, R. (2014). Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of Khorramabad in 2013. International Journal of Pediatrics, 1, 1-7. https://doi.org/10.1155/2014/120686
• Barroso Jr, U., Lordelo, P., Lopes, A. A., Andrade, J., Macedo Jr, A., & Ortiz, V. (2006). Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study. BJU International, 98 (1), 166-171. https://doi.org/10.1111/j.1464-410X.2006.06264.x
• Barroso Jr, U., Tourinho, R., Lordêlo, P., Hoebeke, P., & Chase, J. (2011). Electrical stimulation for lower urinary tract dysfunction in children: A systematic review of the literature. Neurourology and Urodynamics, 30(8), 1429-1436. https://doi.org/10.1002/nau.21140
• Bayne, A. P., & Skoog, S. J. (2014). Nocturnal enuresis: An approach to assessment and treatment. Pediatrics in Review, 35(8), 327-334. https://doi.org/10.1542/pir.35-8-327
• Berard, E. (2016). Pediatric bladder disorders. In: Avner, E.D., Harmon. W.E., Niaudet, P., Yoshıkawa, N., Emma, F., Goldstein, S. L. (edt). Pediatric Nephrology (7th edition). Heidelberg: Springer.
• Bıcılıoğlu, Y., Mustafa, B. A. K., & Serdaroğlu, E. Monosemptomatik nokturnal enürezis tedavisinde desmopressin ile kombine edilen alarm tedavisinin etkinliği. Online Türk Sağlık Bilimleri Dergisi, 5(2), 249-259. https://doi.org/10.26453/otjhs.560449
• Bosson S, & Lyth N. (2001). Nocturnal enuresis. Clinical Evidence 5, 268-273. https://pubmed.ncbi.nlm.nih.gov/15652017/
• Bozatlı, L., Uğurtay, C., Güneydaş, B., & Görker, I. (2022). Enürezis tanısı alan çocuk ve ergenlerin başvuru yakınmaları, eşlik eden tanıları ve tedavilerinin değerlendirilmesi. Van Tıp Dergisi, 29(1), 13-18. https://doi.org/10.5505/vtd.2022.98975
• Cabıoğlu, M. T., Ergene, N., & Tan, U. (2006). The mechanism of acupuncture and clinical applications. International Journal of Neuroscience, 116(2), 115-125. https://doi.org/10.1080/00207450500341472
• Caldwell, P. H., Codarini, M., Stewart, F., Hahn, D., & Sureshkumar, P. (2020). Alarm interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 5, 1-208. https://doi.org/10.1002/14651858.CD002911.pub3
• Caldwell, P. H., Nankivell, G., & Sureshkumar, P. (2013). Simple behavioural interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews, 7, 1-56. https://doi.org/10.1002/14651858.CD003637.pub3
• Cigerli, O. & İlhan, F. (2021). Homeopatinin salgın hastalıklar tarihindeki rolü. Bütünleyici ve Anadolu Tıbbı Dergisi, 2 (2), 30-45. Retrieved from https://dergipark.org.tr/en/pub/batd/issue/62370/799216
• Collis, D., Kennedy‐Behr, A., & Kearney, L. (2019). The impact of bowel and bladder problems on children's quality of life and their parents: A scoping review. Child: Care, health and development, 45(1), 1-14. https://doi.org/10.1111/cch.12620
• De Wachter, S., Vermandel, A., De Moerloose, K., & Wyndaele, J. J. (2002). Value of increase in bladder capacity in treatment of refractory monosymptomatic nocturnal enuresis in children. Urology, 60(6), 1090-1094. https://doi.org/10.1016/S0090-4295(02)02127-1
• Delbeke, J., Hoffman, L., Mols, K., Braeken, D., & Prodanov, D. (2017). And then there was light: perspectives of optogenetics for deep brain stimulation and neuromodulation. Frontiers in Neuroscience, 11, 663. https://doi.org/10.3389/fnins.2017.00663
• Demirgöz, M. (2009). Enurezisi olan çocuk/adölesanların tedavisinde davranışsal tedavi yöntemleri. Florence Nightingale Journal of Nursing, 17 (3), 203-210. https://dergipark.org.tr/en/download/article-file/95196
• Diseth, T. H., Vandvik. I. H. (2004). Hypnotherapy in the treatment of refractory nocturnal enuresis. Tidsskr Nor Laegeforen, 19;124(4): 488-91. https://europepmc.org/article/med/14983195
• Dolgun, G., Savaser, S., Balci, S., & Yazici, S. (2012). Prevalence of nocturnal enuresis and related factors in children aged 5-13 in Istanbul. Iranian Journal of Pediatrics, 22(2), 205. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446056/
• Ebiloglu, T., Ergin, G., Irkilata, H. C., & Kibar, Y. (2016). The biofeedback treatment for non‐monosymptomatic enuresis nocturna. Neurourology and Urodynamics, 35 (1), 58-61. https://doi.org/10.1002/nau.22678
• El-Anany, F. G., Maghraby, H. A., Shaker, S. E. D., & Abdel-Moneim, A. M. (1999). Primary nocturnal enuresis: A new approach to conditioning treatment. Urology, 53(2), 405-408. https://www.sciencedirect.com/science/article/pii/S0090429598005974
• Ellis, N. (2002). Complementary therapies acupuncture. In: Laycock, J., Haslam, J. (Eds.). Therapeutic managament of ıncontinence and pelvic disorders. Springer, London, 219-22. https://www.kisa.link/QhE5
• Ergin, G., Ebiloğlu, T., & Kibar, Y. (2014). Birinci Basamakta Enürezis Noktürnada Alarm Tedavisi. Smyrna Tıp Dergisi, 3, 57-60. https://l24.im/0gqM7h
• Ergüven, M., Çelik, Y., Deveci, M., & Yıldız, N. (2004). Primer enürezis nokturnada etiyolojik risk faktörleri. Türk Pediatri Arşivi, 39 (2), 83-87. https://dergipark.org.tr/en/pub/tpedar/issue/13213/159614
• Giggins, O. M., Persson, U. M., & Caulfield, B. (2013). Biofeedback in rehabilitation. Journal of Neuroengineering and Rehabilitation, 10(1), 1-11. https://doi.org/10.1186/1743-0003-10-60
• Globe, G., Farabaugh, R. J., Hawk, C., Morris, C. E., Baker, G., Whalen, W. M., ... & Augat, T. (2016). Clinical practice guideline: Chiropractic care for low back pain. Journal of Manipulative and Physiological Therapeutics, 39 (1), 1-22. https://doi.org/10.1016/j.jmpt.2015.10.006
• Grzeda, M. T., Heron, J., Tilling, K., Wright, A., & Joinson, C. (2017). Examining the effectiveness of parental strategies to overcome bedwetting: an observational cohort study. BMJ Open, 7(7), e016749. http://dx.doi.org/10.1136/bmjopen-2017-016749
• Gündüz, B. (2020). Okul çocuklarında (5-12 yaş) enürezis sıklığının endişe düzeyi ile ilişkisi. [Yayınlanmamış Yüksek Lisans Tezi]. İstanbul Okan Üniversitesi, İstanbul.
• Gündüz, O., Demirdağ, H., & Güleç, C. (2018). Primer enürezis nokturnada hipnoterapi ve psikoterapi. J Tradit Complem Med, 1 (1), 35-38. https://doi.org/10.5336/jtracom.2017-58397
• Gür E, Turhan P, Can G. (2004). Enuresis: Prevalence, risk factors and urinary pathology among school children in İstanbul, Turkey. Pediatrics International, 46, 58-63. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1442-200X.2004.01824.x
• Haid, B., & Tekgül, S. (2017). Primary and secondary enuresis: Pathophysiology, diagnosis, and treatment. European Urology Focus, 3(2-3), 198-206. https://doi.org/10.1016/j.euf.2017.08.010
• Hamed, A., Yousf, F., & Hussein, M. M. (2017). Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: An epidemiological study. World Journal of Urology, 35(3), 459-465. https://doi.org/10.1007/s00345-016-1879-2
• Huang, H. M., Wei, J., Sharma, S., Bao, Y., Li, F., Song, J. W., ... & Jiang, H. L. (2020). Prevalence and risk factors of nocturnal enuresis among children ages 5–12 years in Xi’an, China: A cross-sectional study. BMC Pediatrics, 20(1), 1-8. https://doi.org/10.1186/s12887-020-02202-w
• Humphreys, M. R., Vandersteen, D. R., Slezak, J. M., Hollatz, P., Smith, C. A., Smith, J. E., & Reinberg, Y. E. (2006). Preliminary results of sacral neuromodulation in 23 children. The Journal of Urology, 176(5), 2227-2231. https://doi.org/10.1016/j.juro.2006.07.013
• Isıyel E., Çomak E., Er İ. (2022). The Role of biofeedback treatment in children with lower urinary tract dysfunction. Türkiye Çocuk Hastalıkları Dergisi, 16(2), 117-120. https://doi.org/10.12956/tchd.858689
• Joinson, C., Sullivan, S., von Gontard, A., & Heron, J. (2016). Stressful events in early childhood and developmental trajectories of bedwetting at school age. Journal of Pediatric Psychology, 41(9), 1002-1010. https://doi.org/10.1093/jpepsy/jsw025
• Jurković, M., Tomašković, I., Tomašković, M., Smital Zore, B., Pavić, I., & Roić, A. C. (2019). Refugee status as a possible risk factor for childhood enuresis. International Journal of Environmental Research and Public Health, 16 (7), 1293. https://doi.org/10.3390/ijerph16071293
• Kavaklı, A. (2010). Akupunktur. Fırat Tıp Dergisi, 15(1), 1-4. https://dergipark.org.tr/tr/pub/firattip/issue/6355/84794
• Kiddoo, D. (2011). Nocturnal enuresis. BMJ Clinical Evidence. https://europepmc.org/article/pmc/pmc3275307
• Köroğlu E. (2015). Ruhsal bozuklukların tanısal ve sayımsal el kitabı (DSM-5) (1.baskı). Amerikan Psikiyatri Birliği. Hekimler Yayın Birliği, Ankara.
• Kurtsan, M. (2019). Türkiyede homeopatinin uygulanabilmesi için yapılması gerekenlerin belirlenmesi. [Yayınlanmamış Yüksek Lisans Tezi]. İstanbul Üniversitesi, İstanbul.
• Kuwertz-Bröking, E., & von Gontard, A. (2018). Clinical management of nocturnal enuresis. Pediatric Nephrology, 33(7), 1145-1154. https://doi.org/10.1007/s00467-017-3778-1 Küçük, L. (2010). Çocuk ve ergenlerde önemli bir sorun olan enürezisin psikososyal yönü. Maltepe Hemşirelik Bilim ve Sanat Dergisi, 3(3), 68-72. https://www.maltepe.edu.tr/hemsirelik
• Lambert-Delgado, A., Cobian-Mena, A. E., Fuentes-Domínguez, N., & Sánchez-Hechavarría, M. E. (2021). Effectiveness of hypnotherapeutic and pharmacological treatment in primary monosymptomatic enuresis. Terapia Psicológica, 39 (3), 393-404. https://doi.org/10.4067/S0718-48082021000300393
• Lewis, P. M., Thomson, R. H., Rosenfeld, J. V., & Fitzgerald, P. B. (2016). Brain neuromodulation techniques: A review. The Neuroscientist, 22 (4), 406-421. https://doi.org/10.1177/1073858416646707
• Maternik, M. (2019). Understanding of and misconceptions around monosymptomatic nocturnal enuresis: findings from patient and physician surveys. Journal of Pediatric Urology, 15(1), 37.e1- 37.e8 https://doi.org/10.1016/j.jpurol.2018.09.013
• McCarthy, M. (2005). Critics slam draft WHO report on homoeopathy. The Lancet, 366(9487), 705-706. https://doi.org/10.1016/S0140-6736(05)67159-0
• Milena, L. P., Juan Carlos, B. P., & Lilisbet, R. E. (2020). Evaluación clínica de la enuresis no orgánica tratada con homeopatía. In Fórum Estudiantil Ciencias Médicas. http://www.forumestudiantilcienciasmedicas.sld.cu/index.php/forum/2020/paper/viewFile/52/50
• Nevéus, T., Fonseca, E., Franco, I., Kawauchi, A., Kovacevic, L., Nieuwhof-Leppink, A., ... & Rittig, S. (2020). Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society. Journal of Pediatric Urology, 16(1), 10-19. https://doi.org/10.1016/j.jpurol.2019.12.020
• Nevéus, T., von Gontard, A., Hoebeke, P., Hjälmås, K., Bauer, S., Bower, W., ... & Djurhuus, J. C. (2006). The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. The Journal of Urology, 176(1), 314-324. https://doi.org/10.1016/S0022-5347(06)00305-3
• Ramakrishnan, K. (2008). Evaluation and treatment of enuresis. American Family Physician, 78(4), 489-496. https://www.aafp.org/pubs/afp/issues/2008/0815/p489.html
• Robson, W. L. M. (2009). Evaluation and management of enuresis. New England Journal of Medicine, 360(14), 1429-1436.
• Rolider, A., & Van Houten, R. (1986). Effects of degree of aw akenıng and the crıterıon for advancing awakening on the treatment of bedwetting. Education and Treatment of Children, 9(2), 135-141. https://www.jstor.org/stable/42898959
• Sağlık Bakanlığı. Geleneksel ve tamamlayıcı tıp uygulamaları yönetmeliği. https://www.resmigazete.gov.tr/eskiler/2014/10/20141027-3.htm
• Sancak, E. B., Akbas, A., Alan, C. & Ersay, A. R. (2016). Enurezisli erişkin hastalarda biofeedback tedavisinin etkinliği. The New Journal of Urology, 11(2), 30-33. https://dergipark.org.tr/en/download/article-file/1019575
• Sarıcı H, Telli Ö, Özgür BC, Demirbaş A, Özgür S, Karagöz MA. (2016). Okul çağındaki çocuklarda gece enürezisinin yaygınlığı ve yaşam kalitesine etkisi. Journal of Pediatric Urology, 12(3), 159. https://www.jstor.org/stable/42898959#metadata_info_tab_contents
• Seabrook, J. A., Gorodzinsky, F., & Freedman, S. (2005). Treatment of primary nocturnal enuresis: A randomized clinical trial comparing hypnotherapy and alarm therapy. Paediatrics & child health, 10(10), 609-610. https://doi.org/10.1093/pch/10.10.609
• Siddiqui, J. A., Qureshi, S. F., Allaithy, A., & Mahfouz, T. A. (2019). Nocturnal enuresis: A synopsis of behavioral and pharmacological management. Sleep and Hypnosis (Online), 21(1), 16-22. http://dx.doi.org/10.5350/Sleep.Hypn.2019.21.0168
• Tabanoğlu Ş. (2017). Enürezis Nokturna ile İlgili Ailelerin Bilgi ve Tutum Düzeyi. [Yayınlanmamış Tıpta Uzmanlık Tezi]. Ankara Yıldırım Beyazıt Üniversitesi, Ankara.
• Taneli, C. (2003). Cerrah gözüyle enürezis. Klinik Çocuk Forumu Dergisi Pediatrik Cerrahi Özel Sayısı, 3(5), 1-7. https://www.cocukcerrahisidergisi.org/
• van Poecke, A. J., & Cunliffe, C. (2009). Chiropractic treatment for primary nocturnal enuresis: A case series of 33 consecutive patients. Journal of Manipulative and Physiological Therapeutics, 32(8), 675-681. https://doi.org/10.1016/j.jmpt.2009.08.019
• Walach, H., Jonas, W. B., Ives, J., Wijk, R. V., & Weingärtner, O. (2005). Research on homeopathy: State of the art. Journal of Alternative & Complementary Medicine, 11(5), 813-829. https://doi.org/10.1089/acm.2005.11.813
• Walker, R. A. (2019). Nocturnal enuresis. Primary Care: Clinics in Office Practice, 46(2), 243-248. https://doi.org/10.1016/j.pop.2019.02.005
• World Health Organization. (2005). Kayropraktikte temel eğitim ve güvenliği üzerine WHO rehber kitapçığı. https://apps.who.int/iris/bitstream/handle/10665/43352/9241593717_tur.pdf
• World Health Organization. (2019). WHO global report on traditional and complementary medicine. https://l24.im/kST8Lw
• Yang, C., Hao, Z., Zhang, L. L., & Guo, Q. (2015). Efficacy and safety of acupuncture in children: An overview of systematic reviews. Pediatric Research, 78(2), 112-119. https://doi.org/10.1038/pr.2015.91
• Zamorano, M. M., Abad, M. M., & Nieto, V. G. (2005). Effectiveness of behavioral intervention in nocturnal enuresis. Anales de Pediatria, 63(5), 444-447. https://doi.org/10.1157/13080411
• Zivkovic, V., Lazovic, M., Vlajkovic, M., Slavkovic, A., Dimitrijevic, L., Stankovic, I., & Vacic, N. (2012). Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med, 48(3), 413-421. https://www.kisa.link/QhE4