How Is Enuresis Diagnosed
Your childs health care provider will ask about your childs medical history. Make sure to tell the health care provider:
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If other members of the family have had enuresis
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How often your child urinates during the day
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How much your child drinks in the evening
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If your child has symptoms such as pain or burning when urinating
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If the urine is dark or cloudy or has blood in it
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If your child is constipated
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If your child has had recent stress in his or her life
The health care provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a medical problem, such as an infection or diabetes.
Reflection On The Article
As LoeningBaucke stresses in the article, the problem with literature review has been the lack of an agreed set of definitions for constipation. The Paris consensus has improved on the Rome II definitions and she has shown how valuable it is to apply these even in a retrospective notes survey.1 Her study also avoids the problem of extrapolating data from a referral centre to the whole community. As with any epidemiological study there may be characteristics of the community being studied that limit its generalisability. LoeningBauckes population is based on a university and so may not have an average socioeconomic profile. A population based study in the UK showed a prevalence in 7.5year old children of infrequent daytime faecal incontinence of 6.8% and of severe incontinence of 0.8%.2
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Causes Of Urinary Incontinence In Children
The pattern of incontinence helps the doctor determine the likely cause. If the child has never had a consistent dry period during the day, the doctor may consider the possibility of a birth defect, an anatomic abnormality, or certain behaviors that can lead to incontinence.
Several uncommon but important disorders affect the normal anatomy or function of the bladder, which can lead to urinary incontinence. For example, a spinal cord defect such as spina bifida Neural Tube Defects and Spina Bifida Neural tube defects are a certain type of birth defect of the brain, spine, and/or spinal cord. Neural tube defects can result in nerve damage, learning disabilities, paralysis, and death. The… read more can cause abnormal nerve function to the bladder and lead to incontinence. Some infants have a birth defect that prevents the bladder or urethra from developing completely, leading to nearly constant urine loss . Another type of birth defect causes the tubes that connect the kidneys to the bladder to end in an abnormal location in the bladder or even outside the bladder , causing incontinence to the bladder . People… read more ). Some children have an overactive bladder that easily spasms or contracts, causing incontinence, whereas others may have difficulty emptying their bladder.
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Should You See A Doctor About Urinary Incontinence In Children
You should see your GP for advice about treatment and management if your child is older than five years and:
- is experiencing urinary incontinence more than once a month
- has never had a period of dryness.
When you see the GP, the GP might start by doing a physical examination of your childs tummy, lower back and genitals. The GP might also test your childs urine.
The GP might refer your child to a continence nurse or medical specialist.
How Is Enuresis Diagnosed In A Child
Many children may have enuresis from time to time. It can take some children longer than others to learn to control their bladder. Girls often have bladder control before boys. Because of this, enuresis is diagnosed in girls earlier than in boys. Girls may be diagnosed as young as age 5. Boys are not diagnosed until at least age 6.
Your childs healthcare provider will ask about your childs health history. Tell the healthcare provider:
-
If other family members have had enuresis
-
How often your child urinates during the day
-
How much your child drinks in the evening
-
If your child has symptoms such as pain or burning when urinating
-
If the urine is dark or cloudy or has blood in it
-
If your child is constipated
-
If your child has had recent stress in his or her life
The healthcare provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a health problem, such as an infection or diabetes.
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Tips For Parents And Carers
As a first step, watch your child and take note of their bladder and bowel behaviour over a few days.
- How often does your child go to the toilet?
- How often is your child wetting?
- What happens when they wet?
- How often do their bowels open and is it difficult for your child?
- How much does your child drink?
- What type of fluids is your child drinking and when?
Once you have monitored your child for a few days, you are now ready to visit a health professional who will undertake the following:
- a detailed medical history
What Causes Daytime Wetting
Daytime wetting can be caused by any of the following:
- The child ignores the urge to urinate. As a result, the bladder becomes too full, causing urine leakage.
- The child has an overactive bladder and cannot get to the toilet in time.
- The child has an underactive bladder and does not have the urge to use the bathroom.
- The child may be suffering from dysfunctional elimination syndrome, in which the bladder muscles and nerves are not working together. The muscles may tighten, stopping the flow of urine when there is still urine in the bladder.
- Some neurologic and developmental conditions can cause poor bladder control.
- The child is suffering from constipation and the full bowel is pressing on the bladder.
- The child is suffering from a urinary tract infection.
Children are often mistakenly blamed for being lazy or seeking attention when they have daytime wetting episodes. However, this is not usually the case and other causes should be explored.
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Getting To The Bottom Of The Issue
When children are incontinent during the day, it’s generally because of a functional bowel or bladder disorder. Successful treatment calls for a systematic evaluation to identify the disorder, followed by behavioral modification and medication. Strong motivation is a must.
Daytime wetting past the age of continence is never normal. This age varies with the child, with most children gaining control of urine during the day before they stop wetting at night. A few children develop urinary continence during the day at 18 months, while others are 4 years old before they achieve this control.1 By 5 years of age, 92% of children are consistently dry and 95% have been dry during the day for extended periods of time.2 During toilet training children have intermittent problems with wetting, and these transitional difficulties do not need treatment. In deciding if a child needs evaluation for urinary incontinence, pediatricians should consider the child’s overall level of development and maturity and any other medical problems that may influence continence.
What Is Pediatric Incontinence
Heres how urination normally works for children and adults, too. The bladder, a small balloon-shaped organ receives and stores urine produced by the kidneys. The bladder muscles remain relaxed while the bladder fills with urine. Then when its convenient, the bladder contracts and empties through the urethrawhere sphincters and pelvic floor muscles loosen to allow the urine pass and tighten afterwards to stop it.
But when children have urinary incontinence, they involuntary release urine even after being toiled-trained. It may occur during the day or night. Most children are potty-trained by age 5, and those who arent fully trained by then or who continue to have accidents may have an underlying medical condition or other issue that is causing the problem. If a child between the ages of 5 and 18 has two or more wetting episodes a month, he or she may benefit from treatment to gain bladder control.
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What Causes Overactive Bladder In Children
Children with overactive bladders have a need to urinate more often than usual because their bladder muscles have uncontrollable spasms. The muscles surrounding the urethra the tube from the bladder that urine passes through can be affected. These muscles are meant to prevent urine from leaving the body, but they may be overridden if the bladder undergoes a strong contraction.
Urinary tract infections can cause a need to urinate as the urinary tract becomes inflamed and uncomfortable. Certain neurological conditions may cause these symptoms.
Another cause of overactive bladder is a condition called pollakiuria, or frequent daytime urination syndrome. Children who have pollakiuria urinate frequently. In some cases, they may urinate every five to 10 minutes or urinate between 10 and 30 times a day. This condition is most common among children aged 3 to 8 and is present only during waking hours. There are no other symptoms present. Doctors believe that pollakiuria is related to stress. Usually, the condition goes away after two to three weeks without requiring treatment.
Other causes of overactive bladder in children include:
- consumption of caffeine, which increases urine output and can cause spasms in the bladder muscle
- consumption of ingredients that a child may be allergic to
- events that cause anxiety
- refraining from completely emptying the bladder when on the toilet
- obstructive slep apnea
When Can I Expect My Children To Stop Having Bowel Or Bladder Leaks
Every child is different. Depending on the bowel or bladder issue affecting your children and the length of time your children have had leaks, it may take several weeks to months to see improvements. Most children complete the program in six to eight months.
Working on the physical therapy techniques at home, as well as at physical therapy sessions, can improve results. Discuss bathroom habits and tips with teachers and day care providers to reinforce proper use during time away from home.
Dont wait until your child grows out of it to address bowel and bladder issues. Education, lifestyle and diet modification, and proven treatment techniques can resolve, or significantly decrease, occurrence of bowel and bladder issues affecting children.
JonPaul Dragseth is a physical therapist specializing in treating children with bowel and bladder dysfunction in Eau Claire, Wisconsin.
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How Does Constipation Affect Children
Children have a smaller abdomen and pelvis area than adults. As the rectum and colon fill with stool, it can press on or block the bladder from emptying completely during urination. It also can limit the amount of urine the bladder can hold. The stool may push on the bladder, causing it to squeeze and leak, which children will not be able to control or stop.
Constipation often is multifactorial, and can be difficult for parents and caregivers to identify.
How Functional Disorders Cause Wetting
Urinary incontinence may be caused by uncommon anomalies such as ectopic ureter, neurogenic bladder, epispadias, posterior urethral valves, or strictures. Daytime wetting may also result from physical or sexual abuse, but this is rare. Most often children who wet during the day have normal urinary anatomy and nervous systems. In the vast majority, a functional disorder of bowel or bladder, a combination of behavioral and physiologic dysfunction, is causing the incontinence, not an anatomic or neurologic problem . Urinary incontinence is much more common in girls than in boys.
Daytime wetting is often only one symptom of a dysfunctional voiding problem. Children who wet during the day commonly suffer from recurrent urinary infection, nighttime incontinence, hydronephrosis, and persistent vesicoureteral reflux. Pediatricians may refer a child with recurrent infections to a urologist without realizing that the infections are caused by an underlying bladder dysfunction. Frequently, children who have functional voiding disorders also have bowel problems, such as constipation and encopresis. Because this combination is so common, the child with incontinence should be evaluated simultaneously for dysfunctional bladder and bowel.3 Treatment of functional bladder problems without attention to the bowel often fails.
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Is Bedwetting Related To Overactive Bladder In Children
Yes. Some of the same conditions or circumstances that increase the likelihood of nighttime incontinence may in combination with infrequent urination result in incontinence during the day. These conditions and circumstances include pressure from a hard bowel movement or other causes listed above.
Another cause of nighttime incontinence is related to the antidiuretic hormone , which the body produces to slow urine production. Children tend to produce more ADH at night, so there is less need to urinate. If the body does not produce enough ADH, the production of urine may not slow and the bladder may overfill, leading to bedwetting.
Some other potential causes of bedwetting include:
- Stress and life changes like a new sibling, changes in living circumstances
- Sleep disruptions
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How Is Daytime Wetting Evaluated
The provider will do a physical exam and obtain family and medical history. The provider will also ask the parents how often the child is dry, when wetting happens, how often it happens, and any other symptoms the family notices.
Additional tests to evaluate daytime wetting may include:
- X-rays of the abdomen
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When To Seek Medical Advice
See a GP if you have any type of urinary incontinence. Urinary incontinence is a common problem and you should not feel embarrassed talking to them about your symptoms.
This can also be the first step towards finding a way to effectively manage the problem.
The GP may also suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.
Find out about diagnosing urinary incontinence.
How Is Urinary Incontinence Diagnosed
The first stage in diagnosis is where the doctor records a clinic history of when the leakage started and how often it happens. They will usually carry out a physical examination to see if the bladder feels hard because it is full of urine or if there are any signs of constipation. They may also carry out an ultrasound scan of the bladder and kidneys.
Parents may find it helpful to keep a bladder diary for a few days there are lots of examples online but the basic information you should record is the volume of fluids drunk, the volume of wee passed as well as details of any accidents and what the child was doing at the time.
Bladder function assessment may also be helpful this is a combination of tests that are used to examine the childs urinary system and how it is working in close detail. These tests are usually carried out over a period of up to five hours, involving using a special uroflow toilet, which takes lots of measurements as the child is weeing. Next, they will do an ultrasound scan of the childs bladder to see if it is empty or not. These two tests uroflow and bladder ultrasound are repeated two to three times to get a full picture of the childs weeing.
Some children may benefit from having a micturating cystourethrogram , which is a scan that shows how well the childs bladder works. It is used to diagnose why the child may have urinary tract infections. It is also used to show up any abnormalities with the childs urinary system.
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How Common Is Urinary Incontinence In Children
Studies indicate that 20% of all 5-year-old children and 10% of 7-year-olds wet the bed, and of these, up to 20% also have some degree of daytime incontinence. In addition, nocturnal enuresis is more common in boys, and diurnal incontinence is more common in girls. Secondary enuresis accounts for about one-quarter of all cases and is most often associated with some psychological stressor or anxiety.
What Is Urinary Incontinence
Urinary incontinence is the loss of bladder control. In children under age 3, its normal to not have full bladder control. As children get older, they become more able to control their bladder. When wetting happens in a child who is old enough to control his or her bladder, its known as enuresis. Enuresis can happen during the day or at night. Enuresis can be frustrating. But its important to be patient and remember that its not your childs fault. A child does not have control over enuresis. And there are many ways to treat enuresis and help your child.
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What Additional Methods Can Be Used To Treat Bedwetting
In the vast majority of children, bedwetting improves on its own over time, so treatment is not needed. If bedwetting is a significant problem for a child, there are seevralk ways to apprioach bedwetting
Cut back on their liquid intake well before bedtime, particularly anything that includes caffeine. Encourage your child to not only use the bathroom 15 minutes before bed, but again just before you tuck them in. Often times, they pee only enough so they no longer feel the urge and may not be emptying their bladder. Remove any sleep disrupters from their room, like pets or electronics.
Another treatment for bedwetting is a moisture alarm. This device includes a water-sensitive pad with a wire connected to a control unit. When moisture is detected, an alarm sounds, waking the child. In some cases, another person may need to be in the room to waken the child if they do not do so on their own.
Setting an alarm so the child wakes up to urinate – timed voiding – may also work to reduce bedwetting at night.
If these methods aren’t working, medication Increasing levels of ADH might help treat nighttime incontinence. Desmopressin, or DDAVP, is a synthetic version of ADH. This drug, which is approved for use in children, comes in pills, nose drops, or nasal spray.
In addition, the drug imipramine can be used. This medication affects the brain as well as the bladder. According to researchers, an estimated 70% of kids who wet the bed may be helped by the use of these drugs.