Urinary incontinence resident survival guide (pediatrics)

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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