enuresis

Question 1

task

Answer 1

477

Question 2

BACKGROUND

Answer 2

-bedwettting in child >5years
-only night :Monosyptomatic NE
-primary NE :never been dry for at least 6/12
-2dry:dry for 6/12 now bed wetting

Question 3

d/d

Answer 3

-development delay
-short stuture, low birth weight
-clumsiness
-UTI
-Autosomal dominant inheritance
-UTI, DM. EPILEPSY, ECTOPIC URETER

Question 4

HX

Answer 4

Is he dry during the day? Has he ever been dry at
night? For at least 6 months? Is it getting worse? How
frequent does he wet his bed? Is there any change in
color or frequency of urine or painful urination?
Polydypsia or polyuria? Constipation? Stress in the
family or school? How do you react to his bedwetting?
Does he try to jiggle? Whenever he goes to the
washroom does he lose urine? Anyone else in the
family having similar condition?
‐ BINDS

Question 5

EXAM

Answer 5

General appearance
‐ Vital signs and growth chart
‐ Neurologic examination
‐ Genitalia for hypospadias
‐ Abdomen for hernia orifices
‐ BSL & dipstick

Question 6

EXPLAIN

Answer 6

Your child has a condition called nocturnal enuresis.
This is the involuntary passage of urine during sleep in
the absence of any physical activity. It could be
caused by a bladder defect when the bladder is not
mature, genetic predisposition (father), or insufficiency
of a hormone called ADH which helps regulate water.
Another would be psychosocial reasons.
‐ At this stage, I would advise you not to blame or
punish him. Encourage him by doing a star chart. He
should have a normal lifestyle. I understand that it is
difficult and embarrassing and you are washing a lot
of linen, but let me reassure that this is a manageable
condition. I would advise for you to start the alarm
clock method. You can hire it or buy it from the
pharmacy. They are very sensitive and even 1 drop of
urine can start the alarm.
-use start chart reward system, encourage
‐ Can he go for sleepovers or camping? Yes, but to
avoid the embarrassment, we can prescribe a drug
called desmopressin (ADH nasal spray). When using
it, it is advisable to not to drink fluids one hour before
and 8 hours after the spray (2 puffs per night).
-Avoid amitryptilline low response, dangerous overdose
‐ We will try it for a few weeks but if it’s not working, I
will refer you to the pediatrician.
‐ Reading material. Review in 6 weeks. Offer support.