Childhood enuresis – a major predictor for pelvic floor disorders in adulthood

Al-Mukhtar Othman J1, Åkervall S1, Nilsson I1, Milsom I1, Gyhagen M1

Research Type


Abstract Category

Pelvic Organ Prolapse

Abstract 483
Neurogenic Bladder and Pediatrics
Scientific Podium Short Oral Session 26
Friday 31st August 2018
10:15 - 10:22
Hall C
Female Incontinence Pelvic Organ Prolapse Stress Urinary Incontinence Urgency Urinary Incontinence
1. Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.

Jwan Al-Mukhtar Othman



Hypothesis / aims of study
To survey the adult prevalence of urinary (UI) and fecal (FI) incontinence and symptomatic pelvic organ prolapse (sPOP) in a large cohort of nulliparous women, with or without a history of childhood nocturnal enuresis (NE).
Study design, materials and methods
A national questionnaire survey was conducted in 2014. The study population was identified by the Central Bureau of Statistics from the Total Population Register and comprised Swedish women that had not given birth and were 25-64 years of age. Twenty thousand women were randomly invited to participate in this study from the total number of eligible nullipara (n = 625 810). The 20 000 participants comprised four, independent, random samples, stratified by decades of age, with oversampling of the two youngest age groups for a subsequent longitudinal follow-up. The women were invited to answer a 40-item self administered questionnaire (web and postal version) which included questions about urinary or fecal incontinence, genital prolapse, childhood nocturnal enuresis, severity and subjective impact of disorders, treatment, etc. Childhood NE was defined according to the International Childrens Incontinence Society (ICCS). Multivariable logistic regression models were used.
The response rate was 52.2%, lowest (44.7%) in the youngest age group (25-34 years) increasing consistently to 62.4% among the oldest (55-64 years). One or more PFDs occurred in 26.7% (95% CI 25.8-27.7) of NE-negative women and increased to 43.4% (40.3-46.5) in NE-positive women. Correspondingly UI increased from 13.7% (CI 13.0-14.5) to 28.9% (CI 26.1-31.8). The subtypes of UI i.e. urge urinary incontience (UUI) and stress urinary incontinence (SUI) were doubled for UUI from 2.4% (CI 2.1-2.8) to 5.7% (CI4.4-7.3) and for SUI from 5.7%(CI 5.2-6.2) to 10.5% (CI 8.8-12.6) in women without a history of childhood NE compared to women with a history of NE. Mixed urinary incontinence  (MUI), the most bothersome subtype of UI, more than doubled from 3.3% (CI 2.9-3.7) in NE-negative women to 8.3% (CI 6.8-10.2) in those with a history of childhood NE. FI and sPOP also nearly doubled in the NE-positive women in comparison to NE-negative women. The effect of BMI was substantial. UI increased nearly more than 5 fold from 11,2% in NE-negative group with normal BMI <25 to 55,7% in NE-positive group with high BMI >35.
Interpretation of results
A history of childhood NE was associated with a doubling of the prevalence of all pelvic floor disorers (PFDs) compared with nullipara without NE. One or more PFDs occurred in 26.7% of NE-negative women but increased to 43.4% for NE-positive women.
Concluding message
Childhood NE is a risk factor for several different types of pelvic floor dysfunction.  Earlier studies have reported that childhood NE is a risk factor for UI but this study has demonstrated that childhood NE is also a risk factor for genital prolapse and fecal incontinence  In addition childhood NE  was shown to be a risk factor for all three subtypes of UI. Childhood enuresis should therefore be taken into account in the construction of antenatal prediction models for birth-related late PFDs.
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<span class="text-strong">Funding</span> ALF Funding Sweden <span class="text-strong">Clinical Trial</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Regional Ethics committee in Gothenburg (EPN) <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes