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Enuresis

Enuresis (incontinence)

Daytime continence is usually acquired between the ages 3 and 4, nocturnal continence between the ages 5 and 7. Wetting  at an older age is considered pathological.

An incontinent patient is first examined by a GP. The GP refers a patient to a children’s urologist only if there is a suspicion of a urinary tract malformation or a neurology disorder, or if there are signs of dysfunctional urination (difficult urination, intermittent or weak urine stream, difficulty starting the urine stream, a sense of incomplete bladder voiding) or if there are recurring urinary tract infections.

Nocturnal enuresis or an overactive bladder, without the complicating factors described above, can be treated by a GP. If nocturnal enuresis persists for over 12 months in spite of the patient receiving basic treatment, or symptoms of an overactive bladder are present for over 3-6 months, it is recommended that the patient is referred to a specialized outpatient department.

Before the first examination

Enuresis can be treated at home before the first examination by following a treatment regimen. It consists of a fluid intake regime adjustment, i.e. drinking smaller amounts more frequently, with a higher intake in the morning and a limited intake in the evening; drinking only small amounts after 6 p.m. if the child is thirsty. Ask the child to void his or her bladder before going to bed. In case of bed-wetting, a child can be woken up 2-3 hours after falling asleep. It is important to avoid irritant drinks, especially before bedtime (coke, tea, etc…). Try to introduce a varied diet to eliminate constipation – reduce fried food, introduce more vegetables, fibre and yoghurts.

The first examination by a children’s urologist

You should bring a referral letter from your GP or documentation of your child’s treatment history for the first examination. We also recommend that you bring the results of urine analysis and the fluid intake and voiding record (micturition diary).

The micturition diary should show the records for two days (over a weekend if possible). A child should eat and drink as normal. Write down the times in the diary when the child drinks and the amount they drink in a day. On the same days, measure and record the amount of urine at each voiding along with the time of voiding. It is also important to write down the nightly amount of urine. We also write down day and/or night time wetting. If a child wears a nappy for sleeping, we weigh it when it is dry and again after it has been wet. We then record the difference on a card.

We also monitor a child’s stools – frequency, consistence (solid, watery…), whether their underwear is soiled or if there is constipation.

The first visit generally includes an interview about difficulties, an assessment of the micturition diary, the detection of bad habits in fluid intake, and urinating difficulties or problems with stools. The child should drink before the examination as we perform a so called uroflowmetry, which consists of voiding into a toilet equipped with a special sensor which reads the speed and amount of the urine stream. Next, an ultrasound examination of kidneys and bladder is performed. The best suitable treatment is proposed based on the finding. The first step is the drinking and voiding regime adjustment and diet modification to ease constipation. Another possibility is pharmacotherapy, i.e. prescription of medicines. In the case of persistent problems, a urologist may refer the patient for a specialized examination.

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