ENURESIS (BEDWETTING)

By following the innervation of the bladder from its termination to the spinal cord, brain, and “supratentorium,” one can develop an extensive list of possibilities for this mischievous condition. Thus, anatomy is the key and the mnemonic MINT is the door. Termination. The bladder and entire urinary tract should be suspect for pathology in any case of enuresis beyond the age of 6. M—Malformations include phimosis, small urinary meatus, and vesicoureteral reflux.

I—Inflammatory conditions form the largest group and include balanitis, urethritis, cystitis, and pyelonephritis. If a child develops chronic nephritis at an early age, his or her bladder simply may be too small to retain the polyuria during sleep. N—Neoplasms are an unlikely cause in children, but they occur in adults. T—Trauma from a vesical calculus or other foreign bodies inserted into the bladder must also be considered. Postprostatectomy enuresis should be considered here in the adult. Spinal cord. The following are included in this group: M—Malformations such as spina bifida I—Inflammatory conditions such as poliomyelitis and transverse myelitis N—Neoplasms such as spinal cord tumors T—Traumatic conditions such as fracture, hematomyelia, and herniated discs Brain. This is an important group of conditions to consider, if only briefly, because if the patient has a form of epilepsy, a cure may be easily obtained. Other neurologic conditions include mental retardation, multiple sclerosis, general paresis, brain tumors, and chronic encephalitides. Supratentorium. A child may react violently to the pressure of toilet training by deliberately wetting the bed; this bedwetting may also be a way of getting back at generally strict parents or a way of getting their attention. Recent studies show that a child should not be considered a bedwetter until after the age of 6. Parents who put that label on a child too early may assure that the enuresis will continue for emotional reasons. Labeling the child as a bedwetter at any age is not a solution to, but an aggravation of the problem.

Approach to the Diagnosis

From the above discussion it should be obvious that simple bedwetting prior to age 6 may not require a workup at all. After that age a careful examination of the urine, including smear and culture for bacteria, should be done. An intravenous pyelogram and voiding cystogram are usually necessary. If these suggest a congenital lesion or are negative, cystoscopy may need to be done. An x-ray film for spina bifida and a sleep electroencephalogram (EEG) are probably worthwhile if urologic investigation is negative.

Other Useful Tests

1. Urology consult
2. Psychiatry consult
3. Examination of urinary sediment (urinary tract infection [UTI])
4. Sonogram (test for residual urine)
5. Cystometric tests (neurogenic bladder)
6. Psychometric testing (psychiatric disorder)

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Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Enuresis

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Enuresis

• Back to symptom: Enuresis: Introduction (review 71 causes)
• Next Book Extract About Enuresis: Enuresis (The 5-Minute Pediatric Consult)
• All Book Extracts: All Online Book Extracts for Enuresis

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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