Enuresis and Encopresis

Question 1

Bedwetting is considered normal in children under what age?

Answer 1

Children under 5 years old.

Question 2

What is assessed for children under 5 who presents with enuresis?

Answer 2

Signs of constipation is assessed as constipation can be a cause of soiling or wetting.
Parents are also asked if toilet training is done.

Question 3

What questions are asked during the initial consultation period for enuresis?

Answer 3

Initially, ask if there is any daytime symptoms (such as urine frequency or urgency, slow urine stream).
Also ask if the child has been dry previously for 6 months or more.
Also ask about the pattern of bed wetting:
1. How many nights in a week does bedwetting occur?
2. How many times per night does bedwetting occur?
3. Does there seem to be a large volume of urine?
4. At what time does bed wetting usually occur at?
5. Does the child wakes up after wetting the bed?

Question 4

What are the questions asked to assess morning symptoms of enuresis?

Answer 4

1. Are there any situations associated with morning symptoms?
2. Does the child avoid toilets at school or in other settings?
3. Does the child go to the toilet more or less frequently as compared to his/her peers?

Question 5

What medication is given for a short-term control of bed-wetting, such as being on school trips?

Answer 5

Desmopressin

Question 6

What is the mechanism of action of desmopressin?

Answer 6

Desmopressin reduces the volume of urine. It is an antidiuretic.

Question 7

What is secondary enuresis and what concerns does it raise?

Answer 7

Secondary enuresis is bedwetting after >6 months of dryness.

It raises concerns of worries, abuse or illness.

Question 8

What medical conditions are associated with Secondary Enuresis?

Answer 8

Diabetes, Diabetes Insipidus, Urinary tract infection, Constipation, Family problems or psychological problems (either behavioural or emotional)

Question 9

When is Oxybutynin prescribed?

Answer 9

Oxybutynin reduces detrusor muscle instability in children with small bladder capacity.

Question 10

What are the symptoms suggesting detrusor instability?

Answer 10

Daytime frequency and urgency

Question 11

List the daytime symptoms of Enuresis.

Answer 11

1. Urgency
2. Frequency (passing urine >7 times/day)
3. Pain on urinating
4. Abdominal straining or poor urinary stream
5. Passing urine fewer than 4 times in a day

Question 12

What are the possible causes of primary enuresis without daytime symptoms?

Answer 12

• Sleep arousal difficulties: Unable to wake up to noise, from sensation of a full bladder or bladder contractions.
• Polyuria
• Bladder dysfunction, such as a small bladder capacity or overactive bladder.

Question 13

What are the causes of primary enuresis with daytime symptoms?

Answer 13

• Overactive bladder
• congenital malformations such as an ectopic ureter
• Neurological disorders such as neurogenic bladder
• Less commonly, UTI or constipation