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.