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Bedwetting - Enuresis: involuntary wetting during sleep. - Coggle Diagram
Bedwetting - Enuresis: involuntary wetting during sleep.
Classification.
In children under 5, more than twice a week with no congenital or acquired defects of the CNS.
Primary with daytime symptoms: continence never achieved and includes daytime symptoms of urgency, frequency, abdominla straining, daytime wetting, poor urinary stream or pain when passing.
Primary without daytime symptoms: overnight continene has not been achieved but has no daytime symptoms.
Secondary: bedwetting occurs after the child has been dry overnight for a t least 6 months.
Causes
Primary without daytime symptoms: sleep arousal difficulties, polyuria or bladder dysfunction either overactive or small capacity.
Primary with daytime symptoms: overactive bladder, structural abnormalities, neurological disorders, UTI's or chronic constipation.
Secondary: often underlying cause such as diabetes, uti, constipation, psychological issues or family problems.
RISK FACTORS: Family history, male gender, developmental delay, constipation/faecal incontinence, psychological or behavioural disorders or sleep apnoea or upper airway obstructive symptoms.
IMPACT: can have a deep impact on a child or young person's emotional and social wellbeing as well as their behaviour. Can also be stressful for the parents or carers of the young person.
Assessment
If child is under 5 years, enquire about toilet training, if it's been attempted, if not ask why.
Determine type of bedwetting by asking: about the presence of daytime symptoms, ask about urgency/frequency/daytime wetting/abdominal straining, poor urinary stream, pain when passing, urinary frequency and if continence has ever been achieved during the day or night.
Consider the possibility of child maltreatment dependant on symptoms.
Do not perform routine urinalysis on children unless symptoms started in the previous few days/weeks. There are daytime symptoms or signs of ill health or signs of UTI.
Where possbile include child or young person in assessment to ask their understanding/thoughts on symptoms.
Assess pattern, frequency, quantity of urine passed. Ask about fluid volume intake through the day. Ask anout home environment, easy access to a toilet?
Assess reason for consultation, main concern.
Advise to keep a 2 week diary of fluid intake and bedwetting/toileting pattern.
Assess for possible underlying causes, constipation/uti/congenital malformations.
Management
Refer to specialist for further investigation if clinically indicated.
Treat underlying condition if clinically indicated.
Escalate to appropriate specialist if child maltreatment suspected.
Provide reassurance to young person/child/parent/carer, advise is not the childs support. Provide support and sign pst for further information.
Provide diet and lifestyle advice, encourage child/young person to empty bladder fully throughout the day and before bed. Advise to avoid caffiene based drinks/fizzy drinks.
Encourage a positive reward system for dry nights and maintaining a good fluid intkae. Discourage punishment as can humiliate child and reduce self esteem.