DISCUSSION
In our study, the prevalence of urinary incontinence was found to be
3.1%, and the frequency of urinary incontinence was found to decrease
with increasing age. The frequency of urinary incontinence in school-age
children is stated to be 2-7% (12). The prevalence of enuresis is
15-20% on average in 5-year-old children, 5-6% in the 10-year-old
group, and less than 1% in the 15 and above-year-old group (13, 14).
Studies (7, 15, 16) have also stated that the prevalence of enuresis
decreases with increasing age. Our result is compatible with the
literature. This result is thought to be due to the increase in
controlling ability in children as the age increases.
In our study, it was determined that the frequency of urinary
incontinence was 3.2% in boys and 3% in girls, and the relationship
between them was not significant (p>0.05). Similarly, in
the study of Kahriman and Mumcu (2011), it was found that enuresis was
seen more in boys, but the result was not significant. Goksu et al.
(2020), in their study with primary school children, found that the
frequency of enuresis was higher in boys. Similarly, in a meta-analysis
conducted with Iranian children (18), it was found that the prevalence
of enuresis was higher in boys. Contrary to these results, there are
also studies (16, 19) in which the frequency of urinary incontinence was
higher in girls. It is thought that this difference in the results may
be due to the lack of gender homogeneity in the studies. In the
literature, it is stated that girls complete toilet training earlier
than boys, and male gender is seen as a risk factor delaying toilet
training (12). The reason for this is thought to be that girls develop
faster than boys, as continence is associated with developmental
maturity. It has been suggested that the incidence of enuresis is also
less common in girls for this reason, although it has not yet been
proven conclusively (20).
In our study, a significant difference was found between children’s
school success and urinary incontinence problem. Similar to our results,
studies (21, 22) have also found that enuretic children have a lower
school success. These results can be considered as the reflection of low
self-esteem and sense of failure due to urinary incontinence problem
experienced by children on school success.
In our study, a significant relationship was found between the age of
starting toilet training and the frequency of urinary incontinence.
Similar to our results, Barone et al.’s (2009) study also states that as
the age of starting toilet training is delayed, the frequency of urinary
incontinence increases and urge-type urinary incontinence problem is
observed. Contrary to these results, Goksu et al. (2020) concluded in
their study that the age of starting toilet training did not affect the
frequency of enuresis. However, it was thought that this situation might
be due to a random response given at face-to-face interviews with the
families. In the literature (24), it has been stated that starting
toilet training before the child reaches the age of 1.5 and after the
age of 2.5 may pave the way for enuresis. It has been suggested that a
higher rate of enuresis may be seen, especially in children who start
toilet training late.
In our study, a significant relationship was found between the child’s
operation status, chronic illnesses, presence of psychological illnesses
and their urinary incontinence problem. There are previously conducted
studies that show a relationship between adenoidectomy (25, 26) and
attention deficit and hyperactivity disorder (27), and the enuresis
frequency. In addition, there are studies reporting a relationship
between urinary incontinence and obesity and high body mass index (28,
29). Erdem et al. (2006) suggested that obesity will result in bad
eating habits and constipation, and that this may be associated with
urinary incontinence.
In our study, the rate of urinary incontinence was found to be
significantly higher in children who had at least one urinary tract
infection (UTI). Similarly, studies (30-33) have shown that there is a
significant relationship between urinary tract infection and urinary
incontinence problem. In addition, it has been stated that the
possibility of a structural anomaly in the urinary system increases in
cases with UTI with enuresis (30).
In our study, it was found that the problem of urinary incontinence was
significantly higher in children with constipation. In the literature
(17, 31, 34), it has been stated that constipation is a risk factor for
enuresis. This result is thought to be due to the fact that the
genitourinary and gastrointestinal systems share the same embryological
origin, anatomical cavity and innervation (35).
In our study, it was found that the lower the family income level, the
higher the frequency of urinary incontinence. In many studies (17, 18,
36, 37), it is stated that urinary incontinence is a common pathology in
children of families with low socio-economic status. This shows that
economic and social problems in the family can increase the frequency of
urinary incontinence by creating stress on children. In a study
conducted by Erguven et al. (2004), it was found that there was no
significant relationship between children with primary enuresis and the
control group in terms of socio-economic and educational levels of
families. However, it was stated that this result was due to the
participation of people with similar socioeconomic status.
In our study, it was found that children with a history of urinary
incontinence in their mothers, fathers and siblings have urinary
incontinence problems significantly. In accordance with our result, it
has been stated in the literature (18, 39, 40) that genetic factors or
genetic predisposition are important in the etiology of urinary
incontinence problem. In the study of Akyuz et al. (2014), it was
determined that 50% of the patients had a history of enuresis nocturna
in their siblings, 42.1% in the mother, 28.9% in the father and 89.5%
in their relatives from their mother or father’s side. However, it was
reported that it would be wrong to explain this situation only with
genetic transmission, and the toilet training the child received and the
approach of the family may also have an effect.
In our study, it was found that 56% of the children with urinary
incontinence problem had not been taken to any health institution before
due to this problem. In the literature (42-44), it was stated that
families also did not seek treatment because they had a history of
urinary incontinence, believed that it would recover spontaneously, and
fear that the drugs used could cause infertility. This result showed the
importance of detecting children with urinary incontinence problems by
screening and the need for medical information for the families of
children with problems.
In our study, some families whose children had urinary incontinence
stated that they reacted as ”I am angry at my child, I am shouting”, ”I
state that I am angry with my body language”, ”I say that it hurts me”,
”I compare them with other children”. In their study, Karaman et al.
(2013) found that 58.1% of the families used at least one punishment
method against their children with urinary incontinence problem, such as
reprimanding, threatening with punishment, humiliating in the presence
of others and not fulfilling their requests. In the study of Sarhan et
al. (2021), it was stated that 47% of the families punished their
children for urinary incontinence. In the study of Tabanoglu and Ozlu
(2021), on the contrary to these results, 86.4% of the families stated
that the child who has urinary incontinence problem at night should not
be punished. In a study (47) comparing children with enuresis who were
punished by their families and those who were not, it was found that
depressive symptoms were significantly higher and quality of life was
lower in children who were punished. In addition, it was stated that the
severity of enuresis in punished children was significantly higher than
in children who were not punished. Based on this result, it can be said
that the punishment approach of families does not prevent urinary
incontinence in children, on the contrary, it harms and increases the
severity of the problem.