Enuresis

Definition

    • Urinary incontinence in child >5yo

History

    • Secondary (after >6mo of bladder control)
    • Frequency of wetting the bed (severity suggests prognosis)
    • Drinking habits
    • UTI
      • Dysuria, Change in urine colour, odour, stream
    • Neurological
      • Change in gait or stool incontinence
    • Overactive bladder
      • Diurnal enuresis (daytime)
        • Frequency of leakage
      • 8+ voids/day
      • Sudden urgent need to urinate
    • Stool history (Constipation, encopresis)

Physical Exam

    • Weight, Height
    • Abdominal exam
    • Genital examination
      • Rule out anatomical pathology (phimosis, labial agglutination)
    • Lumbosacral spine
      • r/o occult spinal dysraphism
    • Neuro exam (r/o hammer/claw toes)
    • Consider DRE r/o constipation

Primary nocturnal enuresis

    • Treatment
      • Reassurance (15% resolve spontaneously each year)
      • Behaviour modification
        • Limit fluids/caffeine
        • Void prior to sleep
        • Ensure easy access to toilet
        • Remove diapers
        • Include child in morning cleanup in non-punitive manner
        • Motivational therapy (eg. star chart)
        • Bladder retention exercises
        • Scheduled toileting overnight
      • "Wet" alarm wakes child upon voiding (70% success)
        • Consider referral if inadequate response to enuresis alarm
      • Medications (for sleepovers or camp)
        • DDAVP 0.2mg PO qHS (up to 0.6mg)

Secondary or Diurnal enuresis

    • Causes
      • Stress
      • UTI
      • Constipation
      • Endocrine
        • DM
        • DI
      • Neurogenic bladder
      • CNS
        • CP
        • Seizures
      • Pinworms