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Enuresis Management in General Practice

Australian GPs are confident and competent at managing kids with bedwetting issues, new research confirms.

But they are less sure what to do with children with daytime wetting or when childhood enuresis persists into adulthood, according to the study findings recently published in the Australian Journal of General Practice.

As you may remember, back in late 2016, health professionals on the Healthed database were invited to participate in a survey designed by leading paediatric urologist, Dr Patrina Caldwell to investigate their knowledge and experience with managing urinary incontinence in childhood.

Almost 1500 Australian health professionals responded, mostly GPs. Researchers found that 88% of survey participants reported being slightly or very knowledgeable about managing childhood urinary incontinence. Their confidence seems well-founded at least for nocturnal enuresis.

Having been given multiple answer options about first-line management, 93% of participants correctly selected urotherapy and enuresis alarm training as the ideal first-line management for childhood enuresis.

This is despite less than half (48%) being able to correctly identify the commonest cause of the condition as being abnormal physiology of sleep and bladder function. Over a third of people incorrectly thought childhood enuresis was simply a delay in developing toileting skills.

However, it is a different kettle of fish when it comes to managing daytime urinary incontinence which only 81% of participants felt at least somewhat confident managing. Of concern was the finding that 18% of health professionals would treat this condition with inappropriate and potentially harmful treatments. More specifically, a small percentage of participants chose tricyclic antidepressants which used to be a popular treatment option but is now no longer recommended as first-line therapy for daytime urinary incontinence due to its potential side-effects.

The situation was even worse for adult patients who had problems with enuresis that had persisted since childhood. Only 61% of participants felt they were even slightly knowledgeable managing these patients, although most chose the most appropriate first-line therapy of urotherapy and desmopressin.

According to the study authors, the knowledge of the health professionals with regard to the various categories of urinary incontinence was largely reflective of the prevalence of each of the different conditions in their clinical experience. Most GPs were currently managing at least a few cases of nocturnal enuresis but the other two conditions were much rarer.

Reference

Caldwell PHY. Manocha R, Hamilton S, Scott KM, Barnes EH. Australian community health practitioners’ knowledge and experience with managing urinary incontinence that begins in childhood. Aust J Gen Pract. 2019 Jan; 48(1-2); 60-5. Available from: https://www1.racgp.org.au/ajgp/2019/january–february/managing-urinary-incontinence-that-begins-in-child