Enuresis

Question 1

What percentage of children <9 bedwet?

Answer 1

8%

Question 2

What are things to determine in the history?

Answer 2

1. Severity
2. ?UTI
3. ?Overactive bladder (frequency at night, and daytime symptoms - frequency, wetting, urge)
4. ?Obstruction (straining, poor stream)
5. Toileting patterns (avoiding certain toilets, only occurring in specific circumstances)
6. Fluids (?restricting ?polydipsia)
7. ?constipation (straining, soiling) or diabetes

Question 3

When is a urinalysis indicated

Answer 3

• symptoms new in the last few days
• suggestion of UTI
• suggestion of diabetes
• daytime symptoms

Question 4

What to look for on examination?

Answer 4

• BP, height, weight (poor growth/loss of weight/HTN are red flags)
• Palpable bladder
• Faecal mass
• External genitalia (and perianal area if constipation present)
• Lower back / spine for asymmetrical gluteal fold (occult spinal dysraphism or tethered cord)p
• Lower limb neuro examination

Question 5

General management?

Answer 5

• Advice re constipation
• Advice re adequate fluid intake, avoid caffeinated beverages
• Advice re toileting (e.g. on breaks, before bed)
• Reward systems to help with above
• Alarm therapy (plus rewards)
• Desmopressin (if alarm failed or unsuitable or short term gain is needed)