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
Do's
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 subclassification 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. 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. Might be of importance in correcting some organic causes of urinary incontinence in children.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated are not common. However, there are possible causes that could result in disability if left untreated and are considered red flags. These include:

These are considered to be of particular concern when encountered in practice.

Common Causes

These causes are based on the classification of urinary incontinence in children.

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

FIRE: Focused Initial Rapid Evaluation

Complete Diagnostic Approach

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Treatment

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Do's

  • 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.
  • Treat day-time symptoms prior to night-time in non-MEN.
  • Fecal incontinence where present should be treated first.
  • Psychiatric comorbidities should be treated concurrently.
  • Higher success rates documented with combined treatment modalities.
  • Continuous monitoring of treatment is highly essential.[1]

Don'ts

References

  1. 1.0 1.1 1.2 1.3 1.4 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. 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. https://www.merckmanuals.com/professional/pediatrics/incontinence-in-children/urinary-incontinence-in-children#v1106778