[54] Daytime Enuresis

Question 1

What is daytime enuresis?

Answer 1

Lack of bladder control in a child old enough to be continent (e.g. over 3-5 years)

Question 2

What is usually present alongside daytime enuresis?

Answer 2

Nocturnal enuresis

Question 3

What are the causes of daytime enuresis?

Answer 3

• Psychogenic
• UTI
• Neurogenic bladder
• Congenital anomalies
• Constipation
• Urgency incontinence

Question 4

What is the most common cause of daytime enuresis in children?

Answer 4

Psychogenic

Question 5

How can a neurogenic bladder cause daytime enuresis?

Answer 5

• Spastic bladder that empties suddenly

- Large hypotonic bladder which fills to capacity then overflows

Question 6

What congenital anomalies can lead to daytime enuresis?

Answer 6

• Ectopic ureter in girls

- Posterior urethral valve in boys

Question 7

What needs to be established when taking a history?

Answer 7

• Primary or secondary enuresis?
• Is the child every dry?
• Are there any other symptoms?

Question 8

What is primary enuresis?

Answer 8

When bladder control has not yet been established

Question 9

What is secondary enuresis?

Answer 9

When there is relapse after control of bladder had occured

Question 10

What other symptoms may be present?

Answer 10

• Dysuria
• Frequency
• Haematuriea
• Co-existing bowel or gait difficulties

Question 11

What might dysuria, frequency and heamaturia suggest?

Answer 11

UTI

Question 12

What might co-existing bowel or gait difficulties suggest?

Answer 12

Neurogenic bladder

Question 13

What areas should be examined when assessing for daytime enuresis?

Answer 13

• Genitalia
• Abdomen
• Anus
• Legs
• Observe urinary stream (if possible)

Question 14

What signs may indicate a neuropathic bladder?

Answer 14

• Distended bladder
• Abnormal perineal sensation
• Abnormal anal tone
• Abnormal leg reflexes and gait
• Lipoma/hairy patch/spinal deformity suggesting spina bifida occulta

Question 15

What investigations should be undertaken when assessing daytime enuresis?

Answer 15

Urine dipstick with MCS

Question 16

What additional investigations can be considered in daytime enuresis?

Answer 16

• USS
• Urodynamic studies
• X-ray of spine
• MRI scan

Question 17

What can USS be used to show?

Answer 17

Bladder pathology e.g. incomplete bladder emptying or thickening of the bladder wall

Question 18

What can a spine x-ray show?

Answer 18

Abnormalities of the vertebral column

Question 19

What can an MRI scan be used for?

Answer 19

Confirming or excluding spinal defect e.g. tethering of the spinal cord

Question 20

How can children with psychogenic daytime enuresis be helped to control their bladder?

Answer 20

• Star charts
• Bladder training
• Pelvic floor exercises

Question 21

What should always be treated if present alongside daytime enuresis?

Answer 21

Constipation

Question 22

What can be used to alert parents and child to enuresis when there is lack of attention to bladder sensation?

Answer 22

A portable alarm with a pad in the pants that is activated by urine

Question 23

What can be considered if conservative management options fail?

Answer 23

Pharmacological treatment with anticholinergics

Question 24

What anticholinergic can be used to treat daytime enuresis?

Answer 24

Oxybutynin

Question 25

What effect do anticholinergics have?

Answer 25

Dampen down bladder contractions

Question 26

What do congenital anomalies require?

Answer 26

Surgical interventions

Question 27

What are the complications of daytime enuresis?

Answer 27

Psychosocial problems