Wetting and Soiling: Paediatric Incontinence Flashcards
What is enuresis?
Bed wetting during sleep after age of 5
Still very prevalent after 7
What is meant by monosymptomatic NE?
Only wetting during the night, never during the day
What is secondary NE?
NE that restarts around 6 months of dryness
What specific factors do you take on Hx?
Day time wetting
Other daytime lower urinary tract symptoms
What is the pathophysiology of NE
High nocturnal urine production
Small nocturnal functional bladder capacity
Inability to wake up to bladder fullness
What is the diurnal pattern of urine production?
Circadian production of ADH so as to reduce urine production at night
What are some non-ADH causes of nocturnal polyuria?
Increased intake
Abnormal renal sodium handling
Which subgroup of children are more likely to have daytime symptoms?
Those with small, overactive bladders
When do you start treating?
Usually at 7 when self esteem issues start to occur
What can you tell a child with NE?
Reassure that it’s not their fault
Explain that it’s inherited
Discuss the prevalence
How is MNE Mx, first line? What are the success rates?
Bedwetting alarms for 8-12 weeks
80%
What is the second line treatment for NE?
If polyuric - consider desmopressin
If day symptoms - consider anti-cholinergics
What do you tell parents when they take desmopressins?
Don’t drink fluids after taking it
Take one hour before bed
Pass dilute urine before sleeping
Does fluid restriction work?
Nope
At what age do you worry about daytime wetting?
After aged 4
What are the causes of daytime wetting?
Overactive detrusor
Dysfunctional voiding
How can the pattern of urine flow indicate pathology?
Stop and start - classic for dysfunctional voiding
How are overactive bladders treated?
Anticholinergic - Oxybutynin 5mg bd
SE: Anti SLUD, mood change, blurred vision, blood nose
How are dysfunctional bladders treated?
Pelvic floor physio
What causes soiling?
Commonly constipation (incomplete emptying)
Rarely
- Neurological
- Congenital
- Inflammatory
- Psychogenic
What are some red flags for constipation?
Onset before 1 month Delayed passage of meconium Ribbon stools Abdominal distension and vomiting Growth faltering Protective concerns Neurological - LL Abnormality of anus, buttocks, sacrum
Until what ages is faecal incontinence normal
4
What is the pathophysiology of faecal incontinence?
Anismus/withholding
Rectal hyposensitivity
Toilet phobia
What is the utility of AXR in constipation?
Not useful
How is constipation Mx?
Regular toileting - maximise emptying, squat posture, feet supported, back straight, legs apart, bulge tummy, 15-20minutes after a meal
Laxatives to clear out and sometimes maintenance
What laxatives do you use?
Lubricants - mineral oils
Stimulants - senna, bisacodyl,
Stool softers - coloxyl, paraffin
Osmotic laxatives - movicol or osmolax
