nocturnal enuresis, constipation and soiling Flashcards
1
Q
what kind of causes are there for enuresis?
A
- detrusor instability
- UTI
- constipation
- IDDM
- abuse
- emotional/ behavioural
- neurological (spinal tethering)
- anatomical
2
Q
What are the 4Ts for diabetes in children?
A
- tired, toilet, thirsty, thin
3
Q
Definition of nocturnal enuresis?
who is it more common in?
A
- involuntary voiding of urine during sleep
- at least twice a week
age >5 - no congenital defects
(more common in boys)
4
Q
how do you achieve dryness (4 fold)?
A
- ability to wake to full bladder sensations (alarm)
- adequate functional bladder capacity (increase daytime fluid and regulate toileting)
- arginine vasopressin (desmopressin, oxybutinin)
- psychological well-being and motivation
5
Q
what kind of precipitating/ maintaining factors are there?
A
- refer diabetes urgently
- treat constipation
- address bullying
- consider abuse
- stop inadvertent reinforcement (ABC chart)
6
Q
What advice should you give to parents?
A
- remove nappies, pull ups and bedding protection
- discourage punishment
- no lifting
- reassure, support and explain
- ERIC.co.uk
7
Q
what is a good star chart/ behavioural technique to use?
A
- ” A CICC”
- achievable
- clear
- immediate
- consistent
- contingent
8
Q
how does the “alarm system” work?
A
- from age 7
- “conditioning technique”
- 70% dry within 2 months
- need frequent follow up
- don’t use when parental intolerance
9
Q
from what age can drugs be given?
for how long?
what should you advise against when giving desmopressin?
A
- not under 7 generally
- short term (holidays, sleepovers)
- no excessive drinking and illness
10
Q
what other drugs can be given apart from desmopressin?
what is the worry with one of them?
A
- imipramine (used in enuresis clinics, more side effects)
- oxybutinin
11
Q
summary of management?
A
- check for organic causes below 5
- 5-7 star charts alarms etc
- above 7 then consider medications
