Bed wetting (enuresis) Flashcards
What question do we ask in bed wetting with regards to primary vs secondary enuresis
Have they always been wetting their bed or have they had periods of no wetting?
=> Always wetting - Primary
=> Only just started - Secondary
What question do we ask in bed wetting with regards to sleep?
Are they a heavy / deep sleeper that they’re hard to wake up?
What happens in bed wetting if conservative efforts failed before medication?
Enuresis alarm
What 2 drugs can be given in bed wetting?
Oxybutynin
Desmopressin
How does oxybutynin work?
Relaxes the bladder reducing unwanted contractions
How does Desmopressin work?
Calms down an overactive bladder
Keeps water in the body
How to screen for urge + stress incontinence?
Do you get daytime wetting?
If Pt has daytime + nocturnal wetting, what is this called
Mixed incontinence of Urge / Stress + Nocturnal Enuresis
enuresis focussed hx
ever been continent? (1ry vs 2ry)
daytime incontinence? (urge/stress/mixed)
every night? heavy sleeper?
drinking habits? (what & when & how much)
toileting habits
soiling/constipation
what happens when episode occurs?
impact on life
what family tried?
enuresis red flags
dysuria
weight loss
polydipsia
stress/abuse/bullying
explain enuresis (& reassure)
involuntary wetting
during sleep
twice a week
normal till age 5, common
potential enuresis causes
sleep difficulties
small & overactive bladder
lifestyle advice & steps
good daytime fluid intake
voiding before bed
double-voiding
star charts: set clear goals w/ appropriate awards, place star immediately, do not take stars away (eg for wet nights)
interventions steps
enuresis alarm
desmopressin for short-term purposes (ideally in >5)
manage constipation
structure for enuresis hx & counselling
focussed hx
red flags
explain + reassure
potential causes
lifestyle advice & steps
intervention steps
safety-net
