Urinary incontinence in children

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Urinary incontinence in children Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Prevention

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

Urinary incontinence in children is a very familiar finding and complaint amongst patients and their caregivers. The earliest documentation of urinary incontinence dates back to 1550 BC in the Ebers papyrus. It is broadly classified into physiological and pathological with its various subdivisions and nocturnal enuresis can be categorized into primary and secondary. The pathophysiology of urinary incontinence in children, particularly enuresis can be described as increased urine production at night, reduced bladder capacity at night, and awakening disorder. The causes of urinary incontinence in children are identified based on the sub-classification of pathological incontinence. Differentials include diabetes mellitus, diabetes insipidus, and urinary tract infection. Children achieve the ability to control their bladder between the ages of 3 and 6 years. This begins initially during the daytime and nighttime control is achieved a lot later. Nocturnal enuresis is seen more frequently in boys. There is no documented racial predilection for enuresis. Some risk factors include, age less than 5 years, positive family history, family size, and birth order. Certain complications are poor self-esteem and inability to socialize with peers. Prognosis is generally good due to the high chances of spontaneous resolution at the rate of 15% per year. 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. 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 but it might be of importance in correcting some organic causes of urinary incontinence in children. There are no documented primary preventive measures available for urinary incontinence in children.

Historical Perspective

Classification

Classification of Urinary Incontinence in Children
Types of urinary incontinence Details
Physiological[3]
Pathological[3][4][5] 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):

Pathophysiology

Causes

Differentiating urinary incontinence from other Diseases

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Ultrasound

CT scan

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

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