Enuresis

Question 1

When do most children achieve day and night time continence?

Answer 1

3-4 years of age

Question 2

What is enuresis

Answer 2

Involuntary discharge of urine by day or night or both in a child aged 5 years or older in the absence of congenital or acquired defects of the nervous system or urinary tract

Question 3

Primary vs secondary enuresis?

Answer 3

Primary - child never achieved continence

Secondary - child has been dry for at least 6 months

Question 4

What are potential causes of daytime enuresis?

Answer 4

Lack of attention to bladder sensation - developmental/psychogenic
Detrusor instability
Bladder neck weakness
Neuropathic bladder weakness
UTI
Constipation
Ectopic ureter causing constant dribbling

Question 5

What investigation in enuresis?

Answer 5

Any abnormal perineal sensation, anal tone or abnormal leg reflexes - for spinal lesson
MSU for MC&S
US for bladder/renal pathology
Urodynamic studeis
MRI for spinal defects

Question 6

What advise for enuresis?

Answer 6

Fluid intake - not 2h before bed
Diet
Toileting behaviour - before bed
Stop punishments

Question 7

What first line management for nocturnal enuresis?

Answer 7

Star chart - star awarded for agreed behaviour - helping to change the sheets, using toilet to pass urine before sleep (not dry nights)

Question 8

What is Mx for children under the age of 7?

Answer 8

Enuresis alarm
If child does not respond to star chart
Sensor placed in childs pants which sound alarm when it is wet
Alarm must wake child who gets out of bed, goes to pass urine, returns and helps to remake a wet bed

May take several weeks to achieve dryness

Question 9

What is Mx for children over the age of 7?

Answer 9

Desmopressin - synthetic ADH analogue
If treatment with alarm is unsuccessful, unacceptable or short-term relief is required
Fluid intake restricted after use