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