Wet child Flashcards
bladder function assessment in child
This non invasive urodynamics
This is called bladder function assessment
Drinking is input
Output is passing urine
Residuals – not emptying bladder
Ask to double void – and then residuals decrease
prevalence of primary monosymptomatic enuresis
5-10% of all 7 year olds
more common in boys
2-3% wet into late teens
untreated PMNE natural history
untreated 15% will get better every year
aetiology of PMNE 4
proportion with greater urine production at night than normal
lack of sleep arousal
overactive bladder
nocturnal diuresis - lack of normal circadian rythmn that results in less urine production at night affects 2/3 of children
reduced functional bladder capacity
management for PMNE
behavioural - sleep alarms, fluid intake day, regular voiding, avoid drinks before bed, void before bed,
alarm - activated when child mets, takes a few months, associated greatest long term sucess, benefit in 2/3 chidlren
drugs
desmopressin - produce results quickly but effect not sustained
3 classes of causes of urinary incontinence
functional
structural
neurogenic
features neurogenic urinary incontinence 7
history of neurological disease SB continuous incontinence straining to void abnormal strea faecal incontinence or severe constipation palpable bladder spine or buttock abnormality neurological signs or limb abnormalities
abnormal presacral dimple
40% with atypical presacral dimples found to have occult spinal dysraphism
Atypical dimple is one that is off centre, more than 2.5cm from anal verge at birth or deeper than 0.5cm
May have sacral hair tuft
need MRI
features structural cause
primary incontinence continuous duplex kidney palpable bladder labial adhesions intra labial masses bifid clitoris seen in epispadias
causes functional incontinence 6
overactive bladder dysfunctional voiding voiding deferment vaginal reflux constipation giggle incontinence
what is dysfunctional voiding
involuntary contraction of pelvic floor during voiding
mainly storage symptoms
made with non invasive bladder assessment
teaching pelvic floor relaxation
day and night incontinence history 3
primary or secondary
pattern of incontinence urgency? continuous? shortly after voiding?
giggling provoking
severity of symptoms - how often? when does it occur? how severe?
pattern of voiding questions
voiding frequency voiding behaviour drinking habits constipation urinary tract infections age at potty training antenatal history
examination features
palpable bladder palpable stool genitals epispadias mass at introitus labial adhesions meatal stenosis spine - presacral dimples, hairy tufts, sacral agenesis, abnormal gait or muscle wasting blood pressure urine dipstick
advice for bladder diary
two convenient days
every time child wees is collected
wetting episodes also noted
additional info, time, volume and type of fluid intake
