Introduction \& Background:
Nocturnal Enuresis (NE) is the involuntary urination during sleep in children over 5 years of age, commonly known as bedwetting. It often causes psychological and social distress. Several contributing factors include:
Genetics - Children with a family history are at higher risk.
Bladder dysfunction - Overactive or underactive bladders can contribute.
Hormonal imbalances - Especially a deficiency in antidiuretic hormone (ADH), which leads to excessive nighttime urine production.
NE is classified as:
Primary NE: The child has never achieved nighttime dryness.
Secondary NE: The child had achieved dryness but started wetting again.
It can also be:
Mono-symptomatic (nighttime only)
Non-mono-symptomatic (includes daytime symptoms)
Current Treatments:
Behavioral: Bedwetting alarms, bladder training
Pharmacological: Desmopressin (synthetic ADH), oxybutynin
Psychological: Counseling and emotional support
Role of Telerehabilitation:
Telerehabilitation is a branch of telehealth offering remote rehabilitation services via communication technologies. Benefits include:
Useful where direct provider access is limited
Cost-effective and time-saving
Increases access to care in underserved or rural areas
Particularly valuable during public health emergencies (e.g., COVID-19)
Reduces waiting times for therapy
Study Aim:
To assess the effectiveness of telerehabilitation-specifically lifestyle and dietary advice delivered remotely-in reducing the frequency of bedwetting in children with primary NE.
Methodology:
Design:
Randomized Controlled Trial (RCT)
Participants:
Inclusion Criteria:
Children aged 5-10 years
Diagnosed with primary NE
Bedwetting occurs more than 4 nights per week
Exclusion Criteria:
Secondary NE due to neurological/musculoskeletal/congenital conditions
On pharmacological treatment for NE
Recruitment:
Online via social media
Parents filled out a screening form
Informed consent obtained from caregivers
Sample size calculated using G-Power software
Group Allocation:
Study Group: Received telerehabilitation (lifestyle + dietary advice)
Control Group: Did not receive any intervention
Intervention Details (Telerehabilitation):
Duration:
1 week of intervention, following a 1-week baseline, with 1-week post-treatment follow-up
Components:
Lifestyle and Motivational Counseling (based on Hjalmas et al., 2004):
Reassurance ("You WILL become dry!")
Regular voiding and fluid intake routines
Encourage calm bedtime routines
Educate parents and child about normal bladder function
Dietary Advice (based on Pietro Ferrara et al., 2015):
Recommended Foods: Vegetables, cereals, eggs, yogurt, fruits (pineapple, banana), fish
Avoid at Evening: Milk, cheese, salty foods
Avoid Completely: Chocolate, caffeine, carbonated drinks, citrus juices
Outcome Measures:
Reduction in Wet Nights (per ICCS classification):
Non-responder: \<50% reduction
Partial responder: 50-99% reduction
Full responder: 100% dry nights
Pediatric Quality of Life: Measured pre- and post-treatment
Assessment Procedure:
Week 1: Baseline recording of wet nights
Week 2: Intervention period (study group only)
Week 3: Follow-up assessment for both groups
Data Collection \& Analysis:
Demographics: Age, sex, weight, family history of NE
Clinical data: Frequency of wet nights
Descriptive stats: Means ± SEM for quantitative data; percentages for qualitative
Paired t-test: To compare outcomes before and after telerehabilitation
Expected Outcomes:
Reduction in bedwetting frequency in the study group receiving telerehabilitation
Improvement in quality of life metrics
Demonstrated feasibility and benefit of remote intervention in pediatric NE management
