Day and night time wetting Flashcards
What is enuresis?
Involuntary urination
What is enuresis?
Involuntary urination
Nocturnal vs diurnal enuresis
Nocturnal - at night
Diurnal - during day
What is normal stages of childhood to control nocturnal vs diurnal enuresis?
Under 5 both considered normal
Most children control dirunal enuresis by 3-4 years old
What is primary nocturnal enuresis
Child never managed to be dry at nigth
What is the most common cause of primary nocturnal enuresis
Variation on average development esp under 5 years
FH of delayed dry nights
What is the most common cause of primary nocturnal enuresis
Variation on average development esp under 5 years
FH of delayed dry nights
Reassurnance will resolve
Other causes of primary enuresis
Overactive bladder
Fluid intake
Failure to wake
Secondary
What is an overactive bladder?
Frequent small volume urination prevents the development of bladder capacity
What can have an espeically diuretic effect at bedtime?
Fizzy drinks, juice, caffeine
What causes failure to wake to wee?
Due to particuarly deep sleep and underdeveloped bladder signals
Secondary causes of primary enuresis
Chronic constipation, UTI, learning disability or cerebral palsy
What is the initial management of primary nocturnal enuresis?
Establish underlying cause by keeping a 2 week diary of toileting, fluid intake and bedwetting episodes
Establish patterns and areas for change
Management of primary nocturnal enuresis
Reassure if under 5 that will resolve
Lifestyle chagnes
Encouragement and positive reinforcement
Underlying/exacerbating factors eg constipation
Enuresis alarms
Pharmacological
Lifestyle changes for primary enuresis
reduced fluid intake in the evenings, pass urine before bed and ensure easy access
What is secondary enuresis?
When a child starts wetting the bed when they have previously been dry for at least 6 months
Cuases secondary enuresis
UTI
Constipation
T1DM
new psychological problems
Maltreatment
When to especially think about safeguarding with bedetting
Deliberate bedwetting
Punishment for bedwetting depite parental education
Unexplained sexondary nocturnal enuresis
Types of incontinence in diurnal enuresis
Urge incontinence
Stress incontinence
What is urge incontinence
Overactive bladder gives little warning before emptying
Stress incontinence
Leakage of urine during physical exertion, coughing or laughing
Other causes of diurnal enuresis other than incontinence?
Recurrent UTI
Pscyhosocial probelms
Constipation
What is an enuresis alarm?
Makes a noise at the first sign bed wetting waking child and stopping them from urinating
Pharmacological treatment for enuresis
Desmopressin
Oxybutinin
Imipramine
What is desmopressin?
Analogue vasopressin - ADH
Reduces volume urine produced by kindeys
Taken at bedtime with intention of reducing nocurnal enuresis
What is oxybutinin?
Anticholinergic mediation reduces contractility of the bladder - helpful in urge incontinence
What is impramine?
TCA - unclear MOA
