Introduction[edit | edit source]Bed wetting and daytime leakage can occur in children and adults. These can both be categorized under the umbrella term, urinary incontinence. For children, urinary incontinence is the most common urinary symptom and can be expected during the potty-training years. After the fifth year of life, the causes of incontinence are no longer considered physiological. Although varied with age and between genders, bladder control often stabilizes within the 3rd to 6th year of life.[1][2][3] Show
Urinary incontinence is any involuntary or uncontrollable leakage of urine. This can occur during the day, known as daytime urinary incontinence. Urinary incontinence can also occur at night. It is known as nocturnal enuresis or enuresis nocturna when one is unable to wake up to urinate. When one is able to wake up from sleep in order to urinate, it is known as nocturia.[4] A child can also have a mix of nocturnal enuresis and daytime urinary incontinence, known as a dual diagnosis.[2] Within the paediatric population, any of these can occur. Urinary incontinence can be divided into further subcategories, which are classified below:
Pathophysiology[edit | edit source]While pediatric urinary incontinence can come from both structural and functional causes, nocturnal enuresis and daytime urinary incontinence primarily derive from functional causes. One common functional cause of nocturnal enuresis and daytime urinary incontinence is urinary tract infections (UTI) due to the impact on inflammation and irritation leading to incontinence. Incontinence can also be influenced by mood disorder. These can include attention deficit hyperactivity disorder, anxiety, and when a child is placed in a stressful life event.[2] Paediatric monosymptomatic enuresis nocturna is mainly caused by the inability to wake up from a full bladder due to altered perception of bladder fullness or no perception of it at all, and an imbalance in bladder capacity and urine production. Majority of these children produce high volumes of urine due to a lack of circadian rhythm of vasopressin, which goes beyond the bladder capacity. The result is bed wedding. This process is known as nocturnal polyuria. Another cause of this could be detrusor overactivity and lack of relaxation resulting in a lower functional bladder capacity.[4] Finally, high arousal threshold can be a contributing factor.[6] The main cause of paediatric non-monosymptomatic urinary incontinence is often due to bladder dysfunction. This can be due to nocturnal detrusor hyperactivity, which is seen as lowered bladder capacities or abnormal urodynamics.[7] Constipation can create bladder distortion from a full rectum resulting in a decrease in bladder capacity.[8] Associated Risk Factors[edit | edit source]There are a number of risk factors associated with pediatric urinary incontinence. Some of these include:[1] [4][9]
Assessment[edit | edit source]History Taking[edit | edit source]Finding out key information from the child and caregiver.
Bladder Diary[edit | edit source]A two-to-three-day diary from day to night.
Questionnaires[edit | edit source]
Physical Exam[edit | edit source]For children, there is an emphasis on external examination, unless an internal exam is deemed necessary.
Urinalysis[edit | edit source]Usually unnecessary for monosymptomatic enuresis but can be indicated for non-monosymptomatic enuresis and a lack of therapy response. Identifies infection, renal damage, or diabetes[2] Other[edit | edit source]Additional workups indicated by non-monosymptomatic enuresis or a lack of therapy response:
Treatment[edit | edit source]Management is dependent on the results of the assessment in determining the root cause of the incontinence between functional, structural, or anatomical cause. The earlier treatment starts in life, the better. Because daytime urinary incontinence and nocturnal enuresis are due to functional causes, this is what we will focus on. For both daytime urinary incontinence and nocturnal enuresis, any issues with constipation should be targeted first. Furthermore, behavioural and psychological comorbidities should be addressed as well.[2] [6] Daytime Urinary Incontinence[edit | edit source]
Nocturnal Enuresis[edit | edit source]
Why It Matters[edit | edit source]Pediatric urinary incontinence is impactful to both the child involved and their family. It requires extra planning, care, and preparation for day to day living from everyone involved. For the child, incontinence can have a lot of negative connotations and cause a decrease in quality of life. This could result in social isolation and low self-esteem. There is a high rate of comorbid emotional distress in children suffering from incontinence. The diagnostic criteria are met in 20 to 40% of children with daytime urinary incontinence and 20 to 30% of children with nocturnal enuresis meet the diagnostic criteria for psychiatric disorders.[11] A lack of education on this topic leads parents down a path of the ‘wait and see’ approach. This is based on the assumption that the incontinence is normal and will resolve as the child gets older. Unfortunately, many children continue to suffer from continued symptoms into their adulthood with worsened symptoms. This can be prevented with access to the necessary education and resources about the abnormalities within paediatric urinary incontinence. References[edit | edit source]
Which characteristic is associated with the urge urinary incontinence?Urge Incontinence
It is characterized by abrupt urgency, frequency, and nocturia; the volume of leakage may be small or large. The term overactive bladder refers to a condition with frequency, nocturia, and urgency or urge UI, or both.
Which condition might the nurse identify as a cause of polyuria?Some frequently occurring causes of polyuria are the consumption of large amounts of fluids, the use of diuretic medications, renal disease, psychogenic polydipsia which is a psychiatric mental disorder causing excessive thirst, sickle cell, anemia diabetes mellitus and diabetes insipidus.
Which type of incontinence is most likely to be associated with a urinary tract infection?Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries. Overflow incontinence happens when your bladder doesn't empty all the way.
What are two clinical examples of impaired urination?Identify causes of impaired urinary elimination.
UTIs, cystitis, multiple sclerosis, tetraplegia, dementia, an enlarged prostate, stroke, urologic surgeries, and chronic kidney disease are a few examples that contribute to impaired urinary elimination.
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