[54] Daytime Enuresis Flashcards
What is daytime enuresis?
Lack of bladder control in a child old enough to be continent (e.g. over 3-5 years)
What is usually present alongside daytime enuresis?
Nocturnal enuresis
What are the causes of daytime enuresis?
- Psychogenic
- UTI
- Neurogenic bladder
- Congenital anomalies
- Constipation
- Urgency incontinence
What is the most common cause of daytime enuresis in children?
Psychogenic
How can a neurogenic bladder cause daytime enuresis?
- Spastic bladder that empties suddenly
- Large hypotonic bladder which fills to capacity then overflows
What congenital anomalies can lead to daytime enuresis?
- Ectopic ureter in girls
- Posterior urethral valve in boys
What needs to be established when taking a history?
- Primary or secondary enuresis?
- Is the child every dry?
- Are there any other symptoms?
What is primary enuresis?
When bladder control has not yet been established
What is secondary enuresis?
When there is relapse after control of bladder had occured
What other symptoms may be present?
- Dysuria
- Frequency
- Haematuriea
- Co-existing bowel or gait difficulties
What might dysuria, frequency and heamaturia suggest?
UTI
What might co-existing bowel or gait difficulties suggest?
Neurogenic bladder
What areas should be examined when assessing for daytime enuresis?
- Genitalia
- Abdomen
- Anus
- Legs
- Observe urinary stream (if possible)
What signs may indicate a neuropathic bladder?
- Distended bladder
- Abnormal perineal sensation
- Abnormal anal tone
- Abnormal leg reflexes and gait
- Lipoma/hairy patch/spinal deformity suggesting spina bifida occulta
What investigations should be undertaken when assessing daytime enuresis?
Urine dipstick with MCS
What additional investigations can be considered in daytime enuresis?
- USS
- Urodynamic studies
- X-ray of spine
- MRI scan
What can USS be used to show?
Bladder pathology e.g. incomplete bladder emptying or thickening of the bladder wall
What can a spine x-ray show?
Abnormalities of the vertebral column
What can an MRI scan be used for?
Confirming or excluding spinal defect e.g. tethering of the spinal cord
How can children with psychogenic daytime enuresis be helped to control their bladder?
- Star charts
- Bladder training
- Pelvic floor exercises
What should always be treated if present alongside daytime enuresis?
Constipation
What can be used to alert parents and child to enuresis when there is lack of attention to bladder sensation?
A portable alarm with a pad in the pants that is activated by urine
What can be considered if conservative management options fail?
Pharmacological treatment with anticholinergics
What anticholinergic can be used to treat daytime enuresis?
Oxybutynin
What effect do anticholinergics have?
Dampen down bladder contractions
What do congenital anomalies require?
Surgical interventions
What are the complications of daytime enuresis?
Psychosocial problems
