Bladder

BED WETTING INCONTINENCE

Bed wetting or enuresis in its simplest definition means inability to control continence at night. Enuresis can be divided up into primary and secondary. Primary enuresis is defined as inability to control the bladder at night since birth. Secondary enuresis is inability to control the bladder at night intermittently. Differentiation between the two is important because treatment of the underlying cause may be different.

Primary enuresis usually revolves by 5 years of age in about 80% of children. Females may have earlier continence. After age 5, about 15% of the remaining 20% will achieve nighttime bladder control each year. Traditionally all children will have nighttime bladder control, however there is no prediction model or tests that can answer this. Family history is associated with delayed bladder control. For example if a parent or a sibling has delayed bladder control than the child can have a higher chance of also having delayed bladder control. Bladder control at night is achieved when the micturition or urination center in the brain is mature enough to allow the patient to wake up to empty his or her bladder. Treatment usually involves increasing bladder capacity to decrease the amount of urine that is generated at night. There is no surgical treatment or medication that can speed up the maturation process. However therapy can allow the patient to stay dry at night until natural maturation takes place.

Secondary enuresis is defined as a child who had nighttime bladder control, but than starts to lose control. This is usually due to a stressor that causes the child to revert back to bed wetting. This may also be due to medical conditions such as diabetes or spinal insult. This may also be medication induced.

The above is a generalization of enuresis. There is no specific algorithm work up for enuresis. Here at Pham’s Urology we treat each patient as an individual. We tailor each work up and treatment based on the child’s history, coexisting medical conditions, and parental preference.

Incontinence (wetness) is the inability to hold urine when a child cannot make it to the bathroom. Incontinence can lead to embarrassment for the child, smelly clothes, rash, and a host of other social issues. Incontinence is usually the clinical manifestations of an underlying disorder. For instance constipation, abnormal kidney development, or urinary tract infection can cause incontinence. Usually a child who is persistently incontinent after age 5, there is usually an underlying issue that is causing the incontinence. Incontinence is usually associated with urgency (sudden urges to urinate) and frequency (having to go often).

The work up for incontinence can be straight forward or can be complex. Work up involves a thorough history and physical initially. Based on the findings, appropriate labs and imaging are then ordered. Here at Pham Urology work-up and treatments are individualized for each patient. This allows more targeted and better outcomes.