Wetting And Soiling Flashcards
When is enuresis abnormal?
Beyond age 5
Boys or girls get more enuresis?
Boys
When do you start Rx for enuresis?
Usually around age 7
Subgroups of enuresis?
Mono symptomatic: No daytime, only nighttime
Primary NE?
Never having been dry continuous for 6/12
What is secondary NE?
Relapsed after a period of at least 6 months of dryness
3 physiological of enuresis?
High nocturnal production
Small nocturnal capacity
Poor arousal from sleep?
Non-ADH causes of nocturnal polyuria?
Common: high nocturnal diet (western countries)
The interview of Nocturnal Enuresis
Reassurance that it’s NOT their fault.
Inherited
Discuss prevalence
MAnagement of Nocturnal Enuresis?
Bed alarms
How long to use bed alarm for?
8-12 weeks
Second line Rx of nocturnal enuresis?
Polyuria: desmopressin
Is reduced bladder capacity: Anticholinergics
Desmopressin is?
Synthetic ADH - sublingual, one hour before bed.
Short-term stop gap
No drinking until following morning!
What doesn’t really work for nocturnal enuresis?
Imipramine (only Rx resistant)
Waking/lifting the child
Fluid restriction
When is day wetting abnormal?
If after age 4
How to bring up day wetting?
May not volunteered
Voiding diary
Investigations for wetting?
Urinanalysis
Renal bladder ultrasound
Imaging/testing
What is dysfunctional voiding? How to ask?
Incoordination between detrusor and sphincteric
Ask about FLOW of urine.
Rx for overactive bladder?
Anticholinergic
Oxybutynin
Side effects of anticholinergics
Dry mouth Rash Constipation Mood changes Blurred vision, bloody nose
What causes soiling?
Usu. constipation: inadequate evacuation
Rare causes of soiling
Neurological
Congenital
Inflam
Psychogenic
Constipation red flags?
Before 1 month Delayed me odium Ribbon stools Abdo distension/vomiting Decrease growth Protective concerns Abnormal Neuro LL Abnormal anus, buttocks/sacrum
Def’n of fecal incontinence?
Repeated defecation into clothes in a child >4y
Boys>girls
Examination and investigation?
Motor/sensory exam
Abdo exam
PR not really
AXR not recommended
Treatments for constipation children?
Lubricants
Simultaneously: senna, bisacodyl
Stool softener: coloxel, paraffin
Osmotic laxatives: not really for maintenance, macrogol
How long does treatment last?
Around 6 months
