Enuresis Flashcards
Define enuresis.
The involuntary passage of urine during sleep after the age when continence is anticipated.
Explain the aetiology/risk factors for enuresis.
General: May be primary (never achieved night-time continence) or secondary (recurrence having been dry for >6/12).
International Children’s Continence Society terminology: Monosymptomatic (absence of daytime voiding symptoms) and non-monosymptomatic (subtle daytime symptoms).
Developmental: Immature bladder control (with daytime frequency), disorder affecting arousal from sleep.
Environmental: Stress, family break-up, maternal separation, moving to a new house, birth of a younger sibling, hospital attendance.
Abuse: Sexual, physical, emotional.
Structural: Decreased bladder capacity, congenital anomalies (ectopic ureter/posterior urethral valves/urethral diverticulum/congenital stricture).
Medical: Urinary tract infections, constipation, epilepsy, occult spina bifida, diabetes mellitus/insipidus, hyperthyroidism, neurogenic bladder.
Summarise the epidemiology of enuresis.
More common in males than females.
What are the presenting symptoms of enuresis?
Need to ask about fluid and diet intake. Voiding diary, family history and stress factors.
Medical: Frequency, Nocturia, urgency, daytime incontinence, changing of clothes, thirst and polyuria.
Social: Abuse and family stresses.
What are the clinical signs of enuresis?
Hard stool in the abdomen
Patulous anus
What are investigations for enuresis?
Full neurological examination
Urine: MC&S.
Imaging: Bladder USS (pre-voiding capacity/wall thickness/residual volume).
What is the management for enuresis?
Reassurance is first line. Treat any medical or surgical course.
Bladder training, regular daytime voiding plans.
Alarm therapy.
Desmopressin in situations where patient is away from home.
What are complications associated with enuresis?
Low self-esteem and psychological problems.
What is the prognosis of enuresis?
Spontaneous resolution
