Enuresis Flashcards
Define
2 types?
Involuntary urination
Nocturnal - bedwetting
Diurnal - daytime wetting
Primary enuresis - what is it?
Causes? - 2
Child who has never been dry
Benign developmental delay (normal up to age 5) or part of global delay such as Down’s.
Secondary enuresis - what is it?
Causes
New onset in a child who has been dry >6months
Pathology - UTI
Abuse
Psychological problems
What to ask in Hx?
What do large volumes early in the night suggest?
What does irregular variable volumes at night suggest?
What does daytime wetting suggest?
When How often? How much? Are they drinking to much? Is it situational? - e.g. at school Were they previously dry and are there new stressors?
Simple bedwetting
Overactive bladder
Overactive bladder, UTI or DM
Associated symptoms
What does urgency and dysuria suggest?
What does thirst and weight loss suggest?
UTI
DM
Investigations
When check for UTI and DM?
Onset recent
There is daytime wetting
Other S+S suggestive of disease
Management - Basics
What can be considered for the young and older children?
When is no treatment needed?
Reassure could and avoid blaming or shaming.
Nappies
Waterproof bed protection
Nocturnal enuresis if age <5 yrs old
Management - Behavioural - 1st line
What is done?
Encourage behaviour changes with praise and reward systems
Avoid excess fluid during the day and especially before bed
Void regularly during the day to avoid bed wetting.
Management - Alarm training
Alarm triggered by wet bed is highly effective.
Gets the child to the toilet
Management - Medical
3 lines of medical treatment
Desmopressin (ADH)
Imipramine (TCA)
Oxybutynin (Anticholinergic)
Daytime wetting in a child over 5 yrs old suggests ……
UTI and needs secondary referral
What is soiling?
The escape of faeces into the underlying
