Urinary incontinence in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Anaya, M.D.[2]
Synonyms and keywords: Urinary incontinence in kids; bedwetting; enuresis; nocturnal enuresis; enuresis nocturna; monosymptomatic enuresis nocturnal (MEN); non-monosymtomatic enuresis nocturnal (non-MEN)
Overview
Historical Perspective
- Earliest documentation of urinary incontinence dates back to 1550 BC in the Ebers papyrus.
- Pliny the elder, in 77 AD wrote on how incontinence of urine in children is treated by giving boiled mice in their food.
- Paulus Bagellardus of Padua wrote on the distress experienced by parents due to bedwetting when infants after the age of 3 years 'continue to pass water in the bed' which can sometimes last beyond the period of puberty.
- In 1891, Jacobi inserted a suppository into the rectum multiple times a day for reinforcement of a supposedly weak bladder to treat enuresis. The suppository was a mixture of old sheep fat and strychnine.[1]
- Rhazes, the Persian clinician, identified some causes of enuresis in children to be:
- Bladder outlet muscle relaxation.
- Deep sleep.
- Unrestricted fluid intake prior to bedtime, etc.[2]
- Some of his treatment protocols included:
- Minimizing fluid intake before bedtime.
- Intake of substances producing fluid retention and body fluid losses.
- Use of both oral and injectable medications to the bladder through the urethra.[2]
- The term 'enuresis' was formed in 1790 which means 'to urinate within' and 'nocturnal' which means 'nighttime occurrence'. [2]
Classification
- Urinary incontinence, also known as 'bedwetting' or 'enuresis' can be classified as follows:
- Physiological urinary incontinence: It is expected and seen as a norm in the early years. Requires a minimum age of 5 years, at least one event in a month, and a minimum period of 3 months. Persisting beyond the age of 5 years is termed pathological. However, there are the 'late developers' who continue to experience physiologic urinary incontinence beyond the age of 5 years. Clinical evaluation of these kids remains normal.[3]
- Pathological urinary incontinence: This is further classified into two broad categories;
- Functional or psychosomatic urinary incontinence: includes all forms of pathological urinary incontinence without anatomic or neurologic defects. Manifestations of which have been subdivided into:
- Monosymtomatic enuresis(MEN): These kids have never had a dry period of >6 months and in the absence of any bladder dysfunction or symptoms suggestive of lower urinary tract issues.[4]
- Non-monosymptomatic enuresis nocturna(Non-MEN): diurnal presentation with an urge, frequency, and enuresis.[5] Further sub-categorized based on diurnal symptoms into:
- Overactive bladder
- Discoordinated micturition and
- Infrequent voiding.
- Organic urinary incontinence: usually uncommon. In-depth investigations needed to be identified more so in cases that have not responded to conventional treatment.[3]
- Functional or psychosomatic urinary incontinence: includes all forms of pathological urinary incontinence without anatomic or neurologic defects. Manifestations of which have been subdivided into:
- Another form of classification is based on the course of nocturnal enuresis is:
- Primary nocturnal enuresis: 6 consecutive months without ever achieving bladder control at night. Most common form.
- Secondary nocturnal enuresis: 6 consecutive months of bladder control attained before a recurrence of incontinence. Could be related to an organic or psychological cause.[5]
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Causes
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Differentiating [disease name] from other Diseases
For further information about the differential diagnosis, click here.
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop [disease name].
- [Disease name] is more commonly observed among patients aged [age range] years old.
- [Disease name] is more commonly observed among [elderly patients/young patients/children].
Gender
- Nocturnal enuresis is seen more frequently in girls.[6]
Race
- There is no racial predilection for [disease name].
- [Disease name] usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop [disease name].
Risk Factors
- Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with [disease name] remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
Diagnosis
Diagnostic Criteria
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- [Disease name] is usually asymptomatic.
- Symptoms of [disease name] may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
References
- ↑ Salmon, Michael A (2016). "An Historical Account of Nocturnal Enuresis and its Treatment". Proceedings of the Royal Society of Medicine. 68 (7): 443–445. doi:10.1177/003591577506800726. ISSN 0035-9157.
- ↑ 2.0 2.1 2.2 Changizi Ashtiyani S, Shamsi M, Cyrus A, Tabatabayei SM (2013). "Rhazes, a genius physician in the diagnosis and treatment of nocturnal enuresis in medical history". Iran Red Crescent Med J. 15 (8): 633–8. doi:10.5812/ircmj.5017. PMC 3918184. PMID 24578827.
- ↑ 3.0 3.1 Schultz-Lampel D, Steuber C, Hoyer PF, Bachmann CJ, Marschall-Kehrel D, Bachmann H (2011). "Urinary incontinence in children". Dtsch Arztebl Int. 108 (37): 613–20. doi:10.3238/arztebl.2011.0613. PMC 3187617. PMID 21977217.
- ↑ Zhu W, Che Y, Wang Y, Jia Z, Wan T, Wen J; et al. (2019). "Study on neuropathological mechanisms of primary monosymptomatic nocturnal enuresis in children using cerebral resting-state functional magnetic resonance imaging". Sci Rep. 9 (1): 19141. doi:10.1038/s41598-019-55541-9. PMC 6915704 Check
|pmc=value (help). PMID 31844104. - ↑ 5.0 5.1 Arda E, Cakiroglu B, Thomas DT (2016). "Primary Nocturnal Enuresis: A Review". Nephrourol Mon. 8 (4): e35809. doi:10.5812/numonthly.35809. PMC 5039962. PMID 27703953.
- ↑ Arda, Ersan; Cakiroglu, Basri; Thomas, David T. (2016). "Primary Nocturnal Enuresis: A Review". Nephro-Urology Monthly. 8 (4). doi:10.5812/numonthly.35809. ISSN 2251-7006.