Hot Topic - East Scotland Postgraduate GP Unit热门话题-东苏格兰研究生GP单元.pptVIP

Hot Topic Enuresis Definition Uncontrolled/Involuntary passage of urine by day/night/both Children aged 5 or over In absence of physical disease DSMM defines nocturnal enuresis as wetting at least x2/wk in the above group Day or night? 85% nocturnal enuresis Daytime enuresis more likely associated with pathology Potentially large effect on family Bullying, problems with schoolwork, social life Nocturnal enuresis Common - approx 15% of children experience it, rising to 75% if both parents had it. Disorder of sleep arousal, a low nocturnal bladder capacity and nocturnal polyuria History needs to distinguish b/w primary and secondary nocturnal enuresis. Primary - bladder control has never been achieved Secondary - lost after having had bladder control for at least 6 months Nocturnal enuresis 15% of 5 year olds 5% of 10 year olds Teenagers 1-2% occasionally wet the bed Yearly spontaneous remission rate is 15% Usually can be considered a variation of the normal rate of maturation Girls usually ahead of boys 23% of nocturnal enuresis is associated with encopresis and daytime incontinence Contributing factors Genetics - 70% have +ve family history Caffeine Emotional stress ADHD, premature delivery Organic pathology Disturbed sleep, mother young or smoker Organic causes 1-2% have underlying physical cause UTI Chronic constipation Bladder overactivity Diabetes Renal failure Congenital anomalies eg ectopic ureter Neurological disorders eg neural tube defect Sleep apnoea Assessment - History Age of child Nocturnal or daytime or both? Primary or secondary? Other urinary symptoms? (UTI, bladder overactivity) Hx of constipation/soiling? Sx of diabetes or of sleep apnoea? Family history? Girls: early morning wetting? (ectopic ureter) PMHx Assessment - history How many dry nights past wk/month? Any potential causes of emotional distress Fluid intake at bedtime Diet - caffeine containing foods eg chocolate Impact on family Any strategies tried so far, ways parents resp