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Differential diagnosis
- Primary
- Secondary
- Diabetes
- UTI
- Constipation
- Excessive fluid intake
- Psychological
Data gathering
- Red flags – frequency/thirst/weight loss, previously been dry
- Others – daytime wetting, fluid intake, dysuria, bowels, social stress, general (growth, pregnancy, birth, development)
- Examination – height, weight (centile chart), abdo, urine dip
Clinical management
- Explanation
- urine stretches the bladder as it fills, when it stretches to a point, the nerves send a message to the brain saying it needs to be emptied, if the child is asleep, the brain does not hear the message but the bladder empties anyway.
- Different reasons include infection, constipation, fizzy drinks, psychological factors
- Treatment
- Lifestyle
- Patient reassurance – remind the child it is not their fault and not to be punished
- Avoid fizzy/caffeinated drinks before bedtime
- Go to toilet before bed – reward system
- Leave bathroom light on at night
- Waterproof mattress cover
- Refer enuresis clinic
- Bed wetting alarm – teaches child to wake and go to toilet before bladder is full
- Desmopressin – reduces amount of urine made at night, offered if over 7yrs old or for short term improvement
- Follow-up / Safety net – come back if not improving