Urinary incontinence resident survival guide (pediatrics): Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(7 intermediate revisions by one other user not shown)
Line 24: Line 24:
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Treatment|Treatment]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Treatment|Treatment]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Do's|Do's]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Dos|Dos]]
|-
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Don'ts|Don'ts]]
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Urinary incontinence resident survival guide (pediatrics)#Don'ts|Don'ts]]
Line 30: Line 30:


==Overview==
==Overview==
[[Urinary incontinence]] in [[children]] is a very familiar finding and complaint amongst [[patients]] and their caregivers. It is broadly classified into [[physiological]] and [[pathological]] with its various subdivisions. The [[causes]] of [[urinary incontinence]] in [[children]] are identified based on the sub-classification of [[pathological]] [[Urinary incontinence|incontinence]]. The focus is to eliminate any [[potential]] organic [[Causes|cause]] of [[Urinary incontinence|incontinence]] and to classify and identify the type of functional [[Urinary incontinence|incontinence]] using detailed [[History and Physical examination|history]] and [[Non-invasive (medical)|non-invasive]] [[Procedure|procedures]]. Identify any [[comorbidities]] which are mostly [[psychological]] occurring alongside [[Urinary incontinence|incontinence]]. Fundamental [[diagnosis]] includes taking a detailed [[History and Physical examination|history]] using a standardized [[questionnaire]]. The primary aim of a [[physical examination]] is to look for possible organic [[causes]] of [[Urinary incontinence|incontinence]] and [[comorbidities]]. [[Urinalysis]] is essential to rule out [[urinary tract infections]]. [[Ultrasonography]] is a useful tool when further [[diagnostics]] is required especially in situations of a likely organic [[Causes|cause]] or a lack of response to [[therapy]]. Uroflowmetry and [[Urodynamics|urodynamic]] studies are additional [[diagnostic]] studies that can be employed. Urotherapy encompasses all non-[[pharmacological]] and non-[[surgical]] [[treatment]] methods employed in the [[treatment]] of [[urinary incontinence]] in [[children]]. [[Desmopressin]] and [[oxybutynin]] are common [[drugs]] used for the [[pharmacological]] management of [[urinary incontinence]] in [[children]]. [[Surgery]] is not routinely employed as a form of [[treatment]], it might be of importance in correcting some organic [[causes]] of [[urinary incontinence]] in [[children]].
[[Urinary incontinence]] in [[children]] is a very familiar finding and complaint amongst [[patients]] and their caregivers. It is broadly classified into [[physiological]] and [[pathological]] with its various subdivisions. The [[causes]] of [[urinary incontinence]] in [[children]] are identified based on the sub-classification of [[pathological]] [[Urinary incontinence|incontinence]]. The focus is to eliminate any [[potential]] organic [[Causes|cause]] of [[Urinary incontinence|incontinence]] and to classify and identify the type of functional [[Urinary incontinence|incontinence]] using detailed [[History and Physical examination|history]] and [[Non-invasive (medical)|non-invasive]] [[Procedure|procedures]]. Identify any [[comorbidities]] which are mostly [[psychological]] occurring alongside [[Urinary incontinence|incontinence]]. A fundamental [[diagnosis]] includes taking a detailed [[History and Physical examination|history]] using a standardized [[questionnaire]]. The primary aim of a [[physical examination]] is to look for possible organic [[causes]] of [[Urinary incontinence|incontinence]] and [[comorbidities]]. [[Urinalysis]] is essential to rule out [[urinary tract infections]]. [[Ultrasonography]] is a useful tool when further [[diagnostics]] is required especially in situations of a likely organic [[Causes|cause]] or a lack of response to [[therapy]]. Uroflowmetry and [[Urodynamics|urodynamic]] studies are additional [[diagnostic]] studies that can be employed. Urotherapy encompasses all non-[[pharmacological]] and non-[[surgical]] [[treatment]] methods employed in the [[treatment]] of [[urinary incontinence]] in [[children]]. [[Desmopressin]] and [[oxybutynin]] are common [[drugs]] used for the [[pharmacological]] management of [[urinary incontinence]] in [[children]]. [[Surgery]] is not routinely employed as a form of [[treatment]], it might be of importance in correcting some organic [[causes]] of [[urinary incontinence]] in [[children]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===


*Life-threatening [[causes]] include [[conditions]] that may [[result]] in death or permanent [[disability]] within 24 hours if left untreated but are not common. However, there are possible [[causes]] that could result in [[disability]] if left untreated and are considered red flags. These include:
*Life-threatening [[causes]] include [[conditions]] that may [[result]] in death or permanent [[disability]] within 24 hours if left untreated, but are not common. However, there are possible [[causes]] that could result in [[disability]] if left untreated and are considered red flags. These include:
**[[Sexual assault|Sexual abuse]]
**[[Sexual assault|Sexual abuse]]
**[[Neurological]] [[impairment]] especially of the [[lower extremities]] suggesting possible [[Spinal cord|spinal]] dysraphisms
**[[Neurological]] [[impairment]] especially of the [[lower extremities]] suggesting possible [[Spinal cord|spinal]] dysraphisms
Line 83: Line 83:
==FIRE: Focused Initial Rapid Evaluation==
==FIRE: Focused Initial Rapid Evaluation==


*The focus is to eliminate any potential organic [[Causes|cause]] of [[Urinary incontinence|incontinence]] and to classify and identify the type of functional [[Urinary incontinence|incontinence]] using detailed [[history]], [[physical examination]] and non-invasive [[procedures]].
*The [[Focusing|focus]] is to eliminate any [[potential]] organic [[Causes|cause]] of [[Urinary incontinence|incontinence]] and to classify and identify the type of functional [[Urinary incontinence|incontinence]] using detailed [[history]], [[physical examination]] and non-[[invasive]] [[procedures]].
*Identify any [[comorbidities]] which are mostly [[psychological]] occurring alongside [[Urinary incontinence|incontinence]]. <ref name="pmid21977217">{{cite journal| author=Schultz-Lampel D, Steuber C, Hoyer PF, Bachmann CJ, Marschall-Kehrel D, Bachmann H| title=Urinary incontinence in children. | journal=Dtsch Arztebl Int | year= 2011 | volume= 108 | issue= 37 | pages= 613-20 | pmid=21977217 | doi=10.3238/arztebl.2011.0613 | pmc=3187617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21977217  }} </ref>
*Identify any [[comorbidities]] which are mostly [[psychological]] occurring alongside [[Urinary incontinence|incontinence]].<ref name="pmid21977217">{{cite journal| author=Schultz-Lampel D, Steuber C, Hoyer PF, Bachmann CJ, Marschall-Kehrel D, Bachmann H| title=Urinary incontinence in children. | journal=Dtsch Arztebl Int | year= 2011 | volume= 108 | issue= 37 | pages= 613-20 | pmid=21977217 | doi=10.3238/arztebl.2011.0613 | pmc=3187617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21977217  }} </ref>
*Features of importance include:  
*Features of importance include:  
**Weight loss
**[[Weight loss]]
**Hypertension (kidney disease)
**[[Hypertension]] ([[kidney disease]])
**Enlarged tonsils
**[[Tonsils hypertrophy|Enlarged tonsils]]
**Slow growth
**[[Slow]] [[growth]]
**Breathing through the mouth
**[[Breathing]] through the [[mouth]]
**Spinal [[malformations]] in the lumbosacral region such as sacral dimple, hair tufts.
**[[Spinal cord|Spinal]] [[malformations]] in the [[Lumbosacral trunk|lumbosacral region]] such as [[sacral dimple]], [[hair]] tufts
**Mass on [[palpation]] of the [[abdomen]] suggesting [[fecal impaction]]
**[[Mass]] on [[palpation]] of the [[abdomen]] suggesting [[fecal impaction]]
**[[Genital]] region abnormalities such as [[labial]] synechiae, anal soilage and/or excoriations
**[[Genital area|Genital region]] [[abnormalities]] such as [[labial]] synechiae, [[anal]] [[Soiling|soilage]] and/or [[Excoriation|excoriations]]
**Asymmetric reflexes of the [[lower extremities]].
**Asymmetric [[reflexes]] of the [[lower extremities]]
**[[Urinalysis]]:essential to rule out [[Urinary tract infections|urinary tract infection]]; changes in [[urine]] [[specific gravity]] suggesting [[diabetes insipidus]] and [[glucosuria]] for [[diabetes mellitus]]
**[[Urinalysis]]: Essential to rule out [[Urinary tract infections|urinary tract infection]] and changes in [[urine]] [[specific gravity]] suggesting [[diabetes insipidus]] and [[glucosuria]] for [[diabetes mellitus]]


==Complete Diagnostic Approach==
==Complete Diagnostic Approach==
Shown below is an algorithm summarizing the diagnosis of [[urinary incontinence]] in [[children]] according to the International Children's Continence Society guidelines.<ref name="HjalmasArnold2004">{{cite journal|last1=Hjalmas|first1=K.|last2=Arnold|first2=T.|last3=Bower|first3=W.|last4=Caione|first4=P.|last5=Chiozza|first5=L.M.|last6=von GONTARD|first6=A.|last7=Han|first7=S.W.|last8=Husman|first8=D.A.|last9=Kawauchi|first9=A.|last10=Läckgren|first10=G.|last11=Lottmann|first11=H.|last12=Mark|first12=S.|last13=Rittig|first13=S.|last14=Robson|first14=L.|last15=Walle|first15=J. Vande|last16=Yeung|first16=C.K.|title=NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY|journal=Journal of Urology|volume=171|issue=6 Part 2|year=2004|pages=2545–2561|issn=0022-5347|doi=10.1097/01.ju.0000111504.85822.b2}}</ref>
*Shown below is an [[algorithm]] [[Summarizing statistical data|summarizing]] the [[diagnosis]] of [[urinary incontinence]] in [[children]] according to the International Children's Continence Society guidelines:<ref name="HjalmasArnold2004">{{cite journal|last1=Hjalmas|first1=K.|last2=Arnold|first2=T.|last3=Bower|first3=W.|last4=Caione|first4=P.|last5=Chiozza|first5=L.M.|last6=von GONTARD|first6=A.|last7=Han|first7=S.W.|last8=Husman|first8=D.A.|last9=Kawauchi|first9=A.|last10=Läckgren|first10=G.|last11=Lottmann|first11=H.|last12=Mark|first12=S.|last13=Rittig|first13=S.|last14=Robson|first14=L.|last15=Walle|first15=J. Vande|last16=Yeung|first16=C.K.|title=NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY|journal=Journal of Urology|volume=171|issue=6 Part 2|year=2004|pages=2545–2561|issn=0022-5347|doi=10.1097/01.ju.0000111504.85822.b2}}</ref>




{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | | | | | | | | | |A01=•Detailed history:<br>• Questionnaires for [[defecation]] and soiling, voiding, wetting should be used}}
{{familytree | | | | | | | | | A01 | | | | | | | | | | | | |A01=•Detailed history:<br>• Questionnaires for [[defecation]] and soiling, voiding, [[wetting]] should be used}}
{{familytree | | | | | | |,|-|-|+|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|+|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | B01 | |!| | B02 | | | | | | | | | | | | |B01=•Establish [[bedwetting]] at night time only|B02=• Preclude day [[symptoms]] ([[urgency]], [[frequency]])<br>• [[Urinary tract infections]]<br>• Other [[disease]] pathologies}}
{{familytree | | | | | | B01 | |!| | B02 | | | | | | | | | | | | |B01=•Establish [[bedwetting]] at night time only|B02=• Preclude day [[symptoms]] ([[urgency]], [[frequency]])<br>• [[Urinary tract infections]]<br>• Other [[disease]] pathologies}}
{{familytree | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | |}}
{{familytree | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | |}}
{{familytree | | | | C01 | | | C02 | | | C03 | | | | | | | | | | |C01=•Establish nighttime [[urine output]]: first morning void and diapers<br>• Fluid intake<br>• Wetting at night|C02=•[[Bladder]] diary:<br>• Kept for at least 3 complete days and nights, fluid intake, [[urine output]] and volumes, [[incontinence]] and defecation should be documented|C03=•Preclude [[incontinence]] during the day, [[frequency]], [[constipation]]/soiling}}
{{familytree | | | | C01 | | | C02 | | | C03 | | | | | | | | | | |C01=•Establish nighttime [[urine output]]: first morning void and diapers<br>• [[Fluid intake]]<br>• [[Wetting]] at night|C02=•[[Bladder]] diary:<br>• Keep for at least 3 complete days and nights, [[fluid intake]], [[urine output]] and volumes, [[incontinence]] and [[defecation]] should be documented|C03=•Preclude [[incontinence]] during the day, [[frequency]], [[constipation]]/soiling}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | D01 | | | | | | | | | | | | | |D01=•[[Physical examination]]}}
{{familytree | | | | | | | | | D01 | | | | | | | | | | | | | |D01=•[[Physical examination]]}}
{{familytree | | | | | | |,|-|-|+|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|+|-|-|.| | | | | | | | | | |}}
{{familytree | | | | | | E01 | |!| | E02 | | | | | | | | | | | | |E01=•Establish typical [[anatomy]]<br>• Normal psychomotor development|E02=•Preclude atypical [[anatomy]](back and [[genital]] regions, [[reflexes]] to rule out [[neurological]] anomalies)}}
{{familytree | | | | | | E01 | |!| | E02 | | | | | | | | | | | | |E01=•Establish typical [[anatomy]]<br>• [[Normal]] psychomotor [[development]]|E02=•Preclude atypical [[anatomy]](back and [[genital]] regions, [[reflexes]] to rule out [[neurological]] anomalies)}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | F01 | | | | | | | | | | | | | |F01=•Additional investigations required with high index of suspicion of other pathologies}}
{{familytree | | | | | | | | | F01 | | | | | | | | | | | | | |F01=•Additional investigations required with high index of suspicion of other pathologies}}
Line 118: Line 118:


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of urinary incontinence in children according the International Children's Continence Society guidelines.<ref name="HjalmasArnold2004">{{cite journal|last1=Hjalmas|first1=K.|last2=Arnold|first2=T.|last3=Bower|first3=W.|last4=Caione|first4=P.|last5=Chiozza|first5=L.M.|last6=von GONTARD|first6=A.|last7=Han|first7=S.W.|last8=Husman|first8=D.A.|last9=Kawauchi|first9=A.|last10=Läckgren|first10=G.|last11=Lottmann|first11=H.|last12=Mark|first12=S.|last13=Rittig|first13=S.|last14=Robson|first14=L.|last15=Walle|first15=J. Vande|last16=Yeung|first16=C.K.|title=NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY|journal=Journal of Urology|volume=171|issue=6 Part 2|year=2004|pages=2545–2561|issn=0022-5347|doi=10.1097/01.ju.0000111504.85822.b2}}</ref>
 
.
* Shown below is an [[algorithm]] [[Summarizing statistical data|summarizing]] the [[treatment]] of [[urinary incontinence]] in [[children]] according the International Children's Continence Society guidelines:<ref name="HjalmasArnold2004">{{cite journal|last1=Hjalmas|first1=K.|last2=Arnold|first2=T.|last3=Bower|first3=W.|last4=Caione|first4=P.|last5=Chiozza|first5=L.M.|last6=von GONTARD|first6=A.|last7=Han|first7=S.W.|last8=Husman|first8=D.A.|last9=Kawauchi|first9=A.|last10=Läckgren|first10=G.|last11=Lottmann|first11=H.|last12=Mark|first12=S.|last13=Rittig|first13=S.|last14=Robson|first14=L.|last15=Walle|first15=J. Vande|last16=Yeung|first16=C.K.|title=NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY|journal=Journal of Urology|volume=171|issue=6 Part 2|year=2004|pages=2545–2561|issn=0022-5347|doi=10.1097/01.ju.0000111504.85822.b2}}</ref>
{{familytree/start}}
{{familytree/start}}
{{familytree | | A01 |-|-| A02 |-| A03 | | | | | | |A01=•Nocturnal wet episodes only from history and [[bladder]] diary?|A02=No|A03=Consider a different [[diagnosis]]}}
{{familytree | | A01 |-|-| A02 |-| A03 | | | | | | |A01=•[[Nocturnal]] wet episodes only from history and [[bladder]] diary?|A02=No|A03=Consider a different [[diagnosis]]}}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | G01 | | | | | | | | | | | | | |G01=Yes}}
{{familytree | | G01 | | | | | | | | | | | | | |G01=Yes}}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | B01 |-|-| B02 |-| B03 | | | | | |B01=•Normal [[physical examination]]?|B02=No|B03=Consider a different [[diagnosis]]}}
{{familytree | | B01 |-|-| B02 |-| B03 | | | | | |B01=•[[Normal]] [[physical examination]]?|B02=No|B03=Consider a different [[diagnosis]]}}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | H01 | | | | | | | | | | | | | |H01=Yes}}
{{familytree | | H01 | | | | | | | | | | | | | |H01=Yes}}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | |!| | | | | | | | | | | | | | }}
{{familytree | | C01 |-|-|-|-|-|-|.| | | | | | |C01=•Difficulty waking up at night?}}
{{familytree | | C01 |-|-|-|-|-|-|.| | | | | | |C01=•Difficulty waking up at night?}}
{{familytree | | |!| | | | | | | F01 | | | | |F01=•'''[[Treatment]] options''':<br>• [[Patient]] education, regular fluid intake and [[urination]], optimistic attitude<br>• Plus behavior modification like alarm<br>• [[Desmopressin]] alone or with alarm<br>• Contemplate [[antimuscarinics]] alone or in combination}}
{{familytree | | |!| | | | | | | F01 | | | | |F01=•'''[[Treatment]] options''':<br>• [[Patient]] [[education]], regular [[fluid intake]] and [[urination]], optimistic attitude<br>• Plus [[behavior]] modification like alarm<br>• [[Desmopressin]] alone or with [[alarm]]<br>• Contemplate [[antimuscarinics]] alone or in combination}}
{{familytree | | |)|-|-| D01 |-|'|!| | | | | | |D01=•Increased nocturnal [[urine output]]}}
{{familytree | | |)|-|-| D01 |-|'|!| | | | | | |D01=•Increased [[nocturnal]] [[urine output]]}}
{{familytree | | |!| | | | | | | |!| | | | | | }}
{{familytree | | |!| | | | | | | |!| | | | | | }}
{{familytree | | |!| | | | | | | |!| | | | | | }}
{{familytree | | |!| | | | | | | |!| | | | | | }}
Line 139: Line 139:
{{familytree/end}}
{{familytree/end}}


==Do's==
==Dos==


*Encourage both [[patient]] and caregiver to undergo [[therapy]] and educate extensively about the causes and course of illness so as to ensure adherence to treatment modalities.
*Encourage both [[patient]] and caregiver to undergo [[therapy]] and [[Education|educate]] extensively about the [[causes]] and [[Course (medicine)|course]] of [[illness]] in order to ensure adherence to [[treatment]] [[Modality|modalities]].
*[[Treatment|Treat]] day-time [[symptoms]] prior to night-time in non-MEN.
*[[Treatment|Treat]] day-time [[symptoms]] prior to night-time in non-MEN.
*[[Fecal]] [[Urinary incontinence|incontinence]] where present should be treated first.
*[[Fecal]] [[Urinary incontinence|incontinence]] whenever present should be [[Treatment|treated]] first.
*[[Psychiatric]] [[comorbidities]] should be treated concurrently.
*[[Psychiatric]] [[comorbidities]] should be [[Treatment|treated]] [[Concurrent overlap|concurrently]].
*Higher success rates documented with combined [[treatment]] modalities.
*Higher success [[rates]] documented with combined [[treatment]] [[Modality|modalities]].
*Continuous monitoring of [[treatment]] is highly essential.<ref name="pmid21977217">{{cite journal| author=Schultz-Lampel D, Steuber C, Hoyer PF, Bachmann CJ, Marschall-Kehrel D, Bachmann H| title=Urinary incontinence in children. | journal=Dtsch Arztebl Int | year= 2011 | volume= 108 | issue= 37 | pages= 613-20 | pmid=21977217 | doi=10.3238/arztebl.2011.0613 | pmc=3187617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21977217  }} </ref>
*Continuous monitoring of [[treatment]] is highly essential.<ref name="pmid21977217">{{cite journal| author=Schultz-Lampel D, Steuber C, Hoyer PF, Bachmann CJ, Marschall-Kehrel D, Bachmann H| title=Urinary incontinence in children. | journal=Dtsch Arztebl Int | year= 2011 | volume= 108 | issue= 37 | pages= 613-20 | pmid=21977217 | doi=10.3238/arztebl.2011.0613 | pmc=3187617 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21977217  }} </ref>


==Don'ts==
==Don'ts==


*Never forget to rule out sexual [[abuse]] as a potential [[cause]] of [[urinary incontinence]] especially in [[secondary]] presentations. Failure to identify this is a catastrophic [[medical]] mistake as it is too important to neglect.<ref>https://www.merckmanuals.com/professional/pediatrics/incontinence-in-children/urinary-incontinence-in-children#v1106778</ref>
*Never forget to rule out [[Sexual assault|sexual abuse]] as a potential [[cause]] of [[urinary incontinence]] especially in [[secondary]] presentations. Failure to identify this is a catastrophic [[medical]] mistake as it is too important to neglect.<ref>https://www.merckmanuals.com/professional/pediatrics/incontinence-in-children/urinary-incontinence-in-children#v1106778</ref>


==References==
==References==
Line 159: Line 159:
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Up-To-Date]]

Latest revision as of 12:57, 9 April 2021



Resident
Survival
Guide

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)

Urinary incontinence resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Dos
Don'ts

Overview

Urinary incontinence in children is a very familiar finding and complaint amongst patients and their caregivers. It is broadly classified into physiological and pathological with its various subdivisions. The causes of urinary incontinence in children are identified based on the sub-classification of pathological incontinence. The focus is to eliminate any potential organic cause of incontinence and to classify and identify the type of functional incontinence using detailed history and non-invasive procedures. Identify any comorbidities which are mostly psychological occurring alongside incontinence. A fundamental diagnosis includes taking a detailed history using a standardized questionnaire. The primary aim of a physical examination is to look for possible organic causes of incontinence and comorbidities. Urinalysis is essential to rule out urinary tract infections. Ultrasonography is a useful tool when further diagnostics is required especially in situations of a likely organic cause or a lack of response to therapy. Uroflowmetry and urodynamic studies are additional diagnostic studies that can be employed. Urotherapy encompasses all non-pharmacological and non-surgical treatment methods employed in the treatment of urinary incontinence in children. Desmopressin and oxybutynin are common drugs used for the pharmacological management of urinary incontinence in children. Surgery is not routinely employed as a form of treatment, it might be of importance in correcting some organic causes of urinary incontinence in children.

Causes

Life Threatening Causes

Common Causes

Classification of Urinary Incontinence in Children
Types of urinary incontinence Details
Physiological[1]
Pathological[1][2][3] Organic:
  • Usually uncommon.
  • In-depth investigations needed to be identified more so in cases that have not responded to conventional treatment.
Functional or psychosomatic: Monosymtomatic enuresis (MEN):
Non-monosymptomatic enuresis Nocturna (Non-MEN):

FIRE: Focused Initial Rapid Evaluation

Complete Diagnostic Approach


 
 
 
 
 
 
 
 
•Detailed history:
• Questionnaires for defecation and soiling, voiding, wetting should be used
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Establish bedwetting at night time only
 
 
 
 
• Preclude day symptoms (urgency, frequency)
Urinary tract infections
• Other disease pathologies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Establish nighttime urine output: first morning void and diapers
Fluid intake
Wetting at night
 
 
Bladder diary:
• Keep for at least 3 complete days and nights, fluid intake, urine output and volumes, incontinence and defecation should be documented
 
 
•Preclude incontinence during the day, frequency, constipation/soiling
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Establish typical anatomy
Normal psychomotor development
 
 
 
 
•Preclude atypical anatomy(back and genital regions, reflexes to rule out neurological anomalies)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Additional investigations required with high index of suspicion of other pathologies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

 
Nocturnal wet episodes only from history and bladder diary?
 
 
No
 
Consider a different diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal physical examination?
 
 
No
 
Consider a different diagnosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Difficulty waking up at night?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment options:
Patient education, regular fluid intake and urination, optimistic attitude
• Plus behavior modification like alarm
Desmopressin alone or with alarm
• Contemplate antimuscarinics alone or in combination
 
 
 
 
 
 
 
 
 
 
•Increased nocturnal urine output
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
•Multiple nightly wet episodes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Dos

Don'ts

References

  1. 1.0 1.1 1.2 1.3 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.
  2. 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.
  3. 3.0 3.1 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.
  4. 4.0 4.1 Hjalmas, K.; Arnold, T.; Bower, W.; Caione, P.; Chiozza, L.M.; von GONTARD, A.; Han, S.W.; Husman, D.A.; Kawauchi, A.; Läckgren, G.; Lottmann, H.; Mark, S.; Rittig, S.; Robson, L.; Walle, J. Vande; Yeung, C.K. (2004). "NOCTURNAL ENURESIS: AN INTERNATIONAL EVIDENCE BASED MANAGEMENT STRATEGY". Journal of Urology. 171 (6 Part 2): 2545–2561. doi:10.1097/01.ju.0000111504.85822.b2. ISSN 0022-5347.
  5. https://www.merckmanuals.com/professional/pediatrics/incontinence-in-children/urinary-incontinence-in-children#v1106778