Enuresis

Enuresis usually refers to nighttime urinary incontinence in girls age 5 and older and boys age 6 and older. This sign rarely continues into adulthood but may occur in some adults with sleep apnea. It’s most common in boys and may be classified as primary or secondary. In primary enuresis, a child has never achieved bladder control; in secondary enuresis, a child who achieved bladder control for at least 3 months has lost it.

Factors that may contribute to enuresis are delayed development of detrusor muscle control, unusually deep or sound sleep, organic disorders (such as a urinary tract infection [UTI] or obstruction), and psychological stress. Psychological stress, probably the most important factor, commonly results from the birth of a sibling, the death of a parent or loved one, divorce, or premature, rigorous toilet training. The child may be too embarrassed or ashamed to discuss his bed-wetting, which intensifies psychological stress and makes enuresis more likely—thus creating a vicious circle.

History and physical examination

When taking a history, include the parents as well as the child. First, determine the number of nights each week or month that the child wets the bed. Is there a family history of enuresis? Ask about the child’s daily fluid intake. Does he drink much after supper? What are his typical sleep and voiding patterns? Find out if the child has ever had control of his bladder. If so, try to pinpoint what may have precipitated enuresis, such as an organic disorder or psychological stress. Does the bed-wetting occur both at home and away from home? Ask the parents how they have tried to manage the problem, and have them describe the child’s toilet training. Observe the child’s and parents’ attitudes toward bed-wetting. Finally, ask the child if it hurts when he urinates.

Next, perform a physical examination to detect signs of neurologic or urinary tract disorders. Observe the child’s gait to check for motor dysfunction, and test sensory function in the legs. Inspect the urethral meatus for erythema, and obtain a urine specimen. A rectal examination to evaluate sphincter control may be required.

Medical causes

Detrusor muscle hyperactivity

Involuntary detrusor muscle contractions may cause primary or secondary enuresis associated with urinary urgency, frequency, and incontinence. Signs and symptoms of UTI are also common.

Urinary tract obstruction

Although it usually causes daytime incontinence, this disorder may also produce primary or secondary enuresis as well as flank and lower back pain; upper abdominal distention; urinary frequency, urgency, hesitancy, and dribbling; dysuria; diminished urine stream; hematuria; and variable urine output.

UTI

In children, most UTIs produce secondary enuresis. Associated features include urinary frequency and urgency, dysuria, straining to urinate, and hematuria. Low back pain, fatigue, and suprapubic discomfort may also occur.

Special considerations

Provide emotional support to the child and his family. Encourage the parents to accept and support the child. Tell them how to manage enuresis at home. (See Helping your child have dry nights.)

Bladder training may help control enuresis caused by detrusor muscle hyperactivity. An alarm device may be useful for children ages 8 and older. This moisture-sensitive device fits in his mattress and triggers an alarm when moistened, waking the child. The alarm conditions him to avoid bed-wetting and should be used only in cases in which enuresis is having adverse psychological effects on the child. Pharmacologic treatment with imipramine, desmopressin, or an anticholinergic may be helpful.

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Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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