Investigating the Association Between Pinworm Infection and Nocturnal Enuresis in Children: Evidence from Scotch Tape Testing and Clinical Risk Factors

Abstract

Background: Nocturnal enuresis is a common and multifactorial condition in childhood, while Enterobius vermicularis remains an important parasitic infection among children. Although previous studies have suggested a possible association between pinworm infection and nocturnal enuresis, direct evidence remains limited, particularly in the Libyan context. Contemporary pediatric guidance emphasizes that nocturnal enuresis should be assessed as a multifactorial condition rather than attributed to a single cause.

Problem: The relationship between laboratory-confirmed E. vermicularis infection and nocturnal enuresis has not been sufficiently investigated among Libyan children. In particular, limited evidence is available regarding whether pinworm infection is statistically associated with nocturnal enuresis and how this relationship relates to demographic and clinical characteristics.

Objectives: This study aimed to determine the prevalence of E. vermicularis infection among children, examine its association with nocturnal enuresis, assess differences according to age, sex, and residential area, and investigate the relationships between nocturnal enuresis and selected clinical factors, including family history, nocturnal perianal itching, constipation, and urinary tract infection.

Methods: A cross-sectional descriptive-analytical study was conducted at the Children’s Clinic of Zliten Medical Center, Libya, from January to August 2026. The study included 100 children. Demographic and clinical information was collected using a structured questionnaire. E. vermicularis infection was assessed using the perianal Scotch Tape Test, followed by microscopic examination of the specimens. Data were analyzed using SPSS. Frequencies and percentages were calculated, while Chi-square or Fisher’s exact tests were used to assess associations. Statistical significance was set at p < 0.05.

Results: The prevalence of E. vermicularis infection was 34%, while nocturnal enuresis was reported among 74% of the children. All 34 children who tested positive for E. vermicularis had nocturnal enuresis. A statistically significant association was identified between E. vermicularis infection and nocturnal enuresis (Fisher’s exact test, p < 0.001), supporting the study hypothesis. No statistically significant associations were identified between nocturnal enuresis and sex, age, or residential area. Nocturnal perianal itching was significantly associated with nocturnal enuresis, while UTI was also significantly associated with enuresis in the study analysis. Constipation and family history did not show statistically significant associations.

Conclusions: The findings indicate a significant association between laboratory-confirmed E. vermicularis infection and nocturnal enuresis among children attending the Children’s Clinic of Zliten Medical Center. However, the cross-sectional design does not establish causality. The findings also reinforce the multifactorial nature of nocturnal enuresis and the importance of considering associated urinary and clinical factors.

Recommendations: Routine clinical assessment for pinworm infection may be considered when children with nocturnal enuresis present with nocturnal perianal itching. Larger multicenter and longitudinal studies using standardized clinical definitions, repeated parasitological testing, and multivariable analysis are recommended to determine whether the observed association persists after adjustment for potential confounding factors.