Enuresis (Bed wetting)

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Discrete episodes of urinary incontinence during sleep in children ≥ 5 years of age.
(The occurrence of involuntary voiding  at 5 yr or more , the age when volitional control of micturition is expected.)
DEFINITION:
       Enuresis is a disorder of involuntary micturition in children who are beyond the age when normal bladder control should have been acquired.
       Enuresis refers to the wetting of one’s clothes or one’s bed past the age of 3 years.
INCIDENCE
       It is common during 4 years to 12 years age group.
       Studies suggest that 2.5 % in the age group of 0-10 years have enuresis and at age 5, it is 7 %  for males and 3 % for females.
Types
Enuresis has been classified into :
       Persistent(primary)
       Regressive (secondary)
       Nocturnal
       Diurnal
ETIOLOGY
       Genetic
       Psychological
       Physiological
       Organic
       Excess fluid intake
       Enuresis related to stress/trauma
       Psychological crisis
       UTI
       Urethritis
       Diabetes
       Seizures
       Neurogenic bladder
       obstruction
CLINICAL FEATURES
       Incontinence
       Dysuria
       Haematuria
       Straining on urination
       Dribbling
       Stress incontinence( with coughing, lifting or running)
       Poor bowel control
       Continuous dampness
INVESTIGATIONS
       Full medical history
       Genital and neurological examination
       Urinalysis for albumin, sugar, microscopy, and culture
       if the child has UTI,  he should be further evaluated by USG, cysto urethrogram and uro dynamic studies.
TREATMENT
       Pharmacologic
       TCA (imipramine )
      Antidiuretics (desmopressin)
      Antispasmodics
      Combination of behavior and pharmacological modalities

       Non-Pharmacologic
      Behaviour Modification (positive reinforcement ,token etc)
      Parental Counselling
      Waking schedule treatment
      Bladder Exercises
      Retention control training
      Alarm Device
 Alarm Device




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notes.nursium.com: Enuresis (Bed wetting)
Enuresis (Bed wetting)
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