Urology - Enuresis Flashcards
What is enuresis?
Involuntary urination
What age do most children get control of daytime urination?
2 years
Night time by 3-4 years old
What is primary nocturnal enuresis?
Child never managed to be consistently dry at night
What is the most common cause of primary nocturnal enuresis?
Nothing abnormal, just a variation on normal development particularly if under 5
Patients will often have a family history of delayed dry nights
Reassurance is key
What are some causes of primary nocturnal enuresis?
Overactive bladder - frequent small urination prevents development of bladder capacity
Fluid intake before bed
Failure to wake - underdeveloped bladder signals in deep sleep
Psychological distress - low self esteem, pressure or stress at home
Secondary causes - chronic constipation, UTI, learning disability or cerebral palsy
What is the initial step in primary nocturnal enuresis management?
Establish underlying cause
Keep a 2 week diary of toileting, fluid intake and bedwetting episodes
Exclude underlying physical or psychological causes
How is primary nocturnal enuresis managed?
- Reassure parents of kids under 5
- Lifestyle changes, reduced fluid in evenings, pass urine before bed
- Encouragement and positive reinforcement
- Avoid blame or shame
- Avoid punishment
- Treat underlying causes
- Enuresis alarms
- Pharmacological treatment
What is secondary nocturnal enuresis?
Child begins wetting the bed after being dry for at least 6 months
What are some causes of secondary nocturnal enuresis?
- UTI
- Constipation
- T1DM
- Psychosocial problems
- Maltreatment
Always consider abuse and safeguarding with deliberate bedwetting, punishment for bedwetting or unexplained secondary nocturnal enuresis
How is secondary nocturnal enuresis managed?
Treat underlying cause
What is diurnal enuresis?
Daytime incontinence
Dry at night but incontinence during the day
More common in girls
Urge or stress incontinence
What can cause diurnal enuresis?
Recurrent UTIs
Psychosocial problems
Constipation
What is an enuresis alarm?
Makes a noise at first sign of bed wetting
Requires high level of training and commitment
Needs to be used for a prolonged period of time
Can be very helpful but can also be found to be a burden and frustrating
What pharmacological treatment is available for enuresis?
Desmopressin
ADH analogue, reduces urine volume, taken at night
Oxybutynin
Anticholinergic, reduces contractility of the bladder, useful for overactive bladder
Imipramine
TCA, helps reduce bladder and lighten sleep
