Enuresis and Encopresis (2)

Question 1

Enuresis:
What is this?

What are the types?

What is the Secondary nocturnal type?
→ What are causes of this?

Answer 1

➊ Involuntary passage of urine in absence of physical cause from 5 yrs

➋ Nocturnal (bedwetting), Diurnal, Primary, Secondary

➌ Child begins wetting the bed when they’ve previously been dry for 6+ months
→ UTI, Constipation, T1DM, Abuse

Question 2

What are the first things to do in managing these pts?
→ How does it progress over time?

What is the 1st line management option?

What are the other options of management?

Answer 2

➊ • Explain cause – Not the child’s fault. Bladder just gets so full that it can’t hold it in anymore
• Reassure parents – Very common in those under 5 yrs, and usually resolves over time
→ They develop an increased bladder capacity, produce less urine at night, or learn to wake to the sensation of a full bladder

➋ Nocturesis Alarm (detects water in the underwear and activates an alarm, which alerts the child that they need to go to the bathroom) - generally very effective

➌ • Behavioural approaches – Diaries, Reward chart
• Desmopressin (ADH to reduce urine production) can be given if failed or rapid control is needed

Question 3

Encopresis:
What is this?

What is the most common cause of it?

What are other causes?

How is it managed?

Answer 3

➊ Repeated and involuntary passing of stool into clothing i.e. soiling

➋ Chronic constipation, which leads to faecal impaction with overflow

➌ Developmental delay, Constipation, Anxiety, Abuse

➍ Treat constipation, reward toileting rather than cleanliness, Safeguarding if appropriate