Enuresis
last authored: Oct 2009, David LaPierre
Introduction
Enuresis is involuntary urinary incontinence in a child >5 years old, not due to neurological or structural geniturinary tract abnormality
It is very common, occurring in 10% of 6 year olds, 3% of 12 year olds, and 1% of 18 year olds.
It should be evaluated if there is dysuria, a change in colour, odor, or stream.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.
Causes and Risk Factors
Primary noctural enuresis occurs only at night. It is more common in boys, and with family history. It is a developmental problem.
Secondary enuresis develops after a child has had bladder control for >3 months. It often occurs following stress: arrival of sibling, loss, family discord. Engrossed attention on something else can also cause it.
It can also follow UTI, DM, DI, neurogenic bladder, cerebral palsy, sickle cell disease, seizures, or pinworms.
Diurnal enuresis occurs during the day and usually also at night. Children are often timid and shy. Rule out ectopic ureteral site or neurogenic bladder.
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Treatments
With primary nocturnal enuresis, time and reassurance are key. Bladder retention exercises and scheduled toileting.
Wet alarms have a70% success rate.
Medications (DDAVP) are rarely used.
Dirurnal enuresis should be treated with encouragement and support. The child should gently be reminded to go to toilet.
Consequences and Course
Resources and References
Topic Development
created:
authors:
editors:
reviewers:
 |