Enuresis

Enuresis

primary nocturnal enuresis
daytime enuresis
1. =lack of bladder control during day in a child old enough to be continent (3-5 years)
2. nocturnal enuresis also present
3. causes
  1. lack of attention to bladder sensation
    1. manifestation of psychogenic or developmental prob
    2. may be in normal kids too busy to respond to sensation of full bladder
  2. detrusor instability
    1. =sudden urgent urge to void induced by sudden bladder contractions
  3. neuropathic bladder
    1. bladder enlarged & fails to empty properly, irreg thick wall
    2. assoc w/ spina bifida
  4. UTI
    1. rarely in absence of other sx
  5. constipation
  6. ectopic ureter
    1. causes constant dribbling, child always damp
    2. girls dry @ night but wet on getting up
      1. ectopic ureter opening into vagina
4. O/E
  1. neuropathic bladder
    1. distended bladder
    2. abnormal perineal sensation
    3. abnormal anal tone
    4. abnormal leg reflexes
    5. abnormal gait
    6. sensory loss in S2, S3 &S4 dermatomes
    7. spinal lesion
5. Ix
  1. urine sample
    1. microscopy
    2. culture
    3. sensitivity
  2. if indicated
    1. ultrasound
      1. bladder pathology
        w/ incomplete bladder emptying
        w/ thickening of bladder wall
    2. urodynamic studies
    3. X ray of spine
      1. vertebral anomaly
    4. MRI
      1. confirm or exclude non-spinal bony defect
        e.g. tethering of cord
6. Mx
  1. if neuro cause excluded
    1. star charts
    2. bladder training
    3. pelvic floor exercises
  2. treat constipation
  3. portable alarm w/ pad in pants
    1. for lack of attention to bladder sensation
  4. anticholinergics
    1. to damp bladder contractions
    2. e.g. oxybutynin
    3. if other measures fail
secondary (onset) enuresis
1. loss of previously achieved urinary continence
2. causes
  1. emotional upset
    1. commonest cause
  2. UTI
  3. polyuria
    1. from osmotic diuresis in diabetes mellitus
    2. from renal concentrating disorder e.g. sickle cell disease or chronic renal failure
3. Ix
  1. urine sample: look for
    1. infection
    2. glycosuria
    3. proteinuria
  2. assessment of renal concentrating ability
    1. measure osmolality of early morning urine sample
    2. formal water deprivation test
      1. to exclude urinary concentrating defect
      2. rarely needed
  3. ultrasound of renal tract

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	Created by v.djabatey almost 11 years ago