Flashcards in Bedtime and daytime wetting Deck (17):
Nocturnal enuresis in normal children
Can be due to delayed development of normal sphincter control
Primary vs secondary enuresis
Primary is when has never developed dryness, secondary is wetting in a child who was dry
How common is primary enuresis, gender discrepancy
10% 6 year old and 3% of 12 year olds
Causes of primary enuresis (6)
Delayed maturation (familial)
Reduced bladder awareness
Polyuria due to diabetes or renal disease
Causes of secondary enuresis (4)
Causes of diurnal enuresis (7)
Congenital abnormalities->ectopic ureter
Psychogenic due to stress
Has the child ever been dry
If so at what age
Was there a trigger that led to wetting again (birth of a sibling)
Anything to suggest stress as a cause
Possibility of sexual abuse
Any symptoms of UTI
Polyuria, polydipsia, weight loss
History of diabetes, renal disease
How have the parents dealt with the bed wetting, criticise, punish
What have the parents tried- fluid restriction, sitting on toilet at night, star charts
What is the pattern of wetting- nocturnal, day and night, urgency, dribbling incontinence
Features suggesting neuropathic bladder.
Any evidence of neurological or congenital abnormality? Check leg reflexes and perineal sensation
Check for evidence of spina bifida occulta- lipoma/hairy patch over sacral area.
Is there a palpable fecal mass
Evidence of renal disease
Check for hypertension
Investigations and outcomes
Urine dipstick- glucose
Renaln USS and isotope if ectopic ureter ++suspected
Management of primary nocturnal enuresis
Generally wait until age 7- when child can take more responsibility, reward/star charts at night
Enuresis alarm->wakes child when begins urinating->wake up and go. Works within a couple of weeks.
Try to avoid nappies and pull-ups, can delay time to dry. Cannot use alarm with nappies/pull ups
Bladder training->unrestricted fluids during the day to teach children to deal with a full bladder. If dry for 7 nights, give extra fluid at night for "overlearning"
Avoid caffeinated drinks and fruit juice
Lifting is avoided as teaches child to go to toilet while half asleep
ADH- tablets at night->when alarm fails. Use for 3 months then taper.
Parent information on causes of bed wetting
Some of the possible factors are:
Genetic tendency. Bedwetting does tend to run in families. If one or both parents wet the bed when they were children, then it is quite likely to occur in their children.
Smallish bladder capacity.
Kidneys continue to produce a lot of urine at night (most people make less urine when they are asleep).
Parent information about when to see a doctor
At least 6 yo
Punish or feel you may punish child for bedwetting
Childs wets/bowel movements in pants during the day
Causes of daytime wetting without NE
Urge incontinence->overactive bladder. Use oxybutynin (anticholinergic)
Dysfunctional voiding->poor coordination between detrusor and bladder neck activity with poor relaxation of external sphincter during voiding
Neurological and urological pathology
Poor detrusor and sphincter coordination
Upper tract dilitation
Teach->pelvic floor relaxation, ensuring optimal voiding techniques
Acquisition of bladder and bowel control
Most children are unable to obtain bowel and bladder control until 24 to 30 months. The average age of toilet-training is 27 months.
Indicators child may be ready for toilet training
Your child should be able to:
Walk well in order to get to the potty chair.
Tell you when there is a need to go to the potty.
Control the muscles used for going to the potty.