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Enuresis - so Secondary enuresis is when a child goes...

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Enuresis Enuresis is the inappropriate voiding of urine at an age where bladder control would normally be expected. Background Children usually learn to be dry by day at the age of 2 years, and are dry by night at around 3 years. At 4 years 75% of children are dry by both day and night. Most children who wet have intermittent enuresis and it is very rare to encounter children of school going age who have never had a dry night. Enuresis has two forms – nocturnal enuresis is ‘bedwetting’ with daytime dryness while daytime enuresis implies a child who has episodes of wetness both day and night. It is important to establish which of these two problems is present as the latter is more likely to have an organic cause. Nocturnal enuresis is a more common problem than diurnal enuresis. Nocturnal enuresis Divided into two types: primary nocturnal enuresis (PNE) and secondary nocturnal enuresis. Primary bed- wetting is defined as a problem when a child continues to bedwet when considered old enough not to do
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Unformatted text preview: so. Secondary enuresis is when a child goes through an extended period of dryness at night (roughly six months or more) and then begins to bed-wet again. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection. Epidemiology Nocturnal enuresis is quite common: 15% of 5 year olds & 5% of 10 year olds suffer from this problem. However, it is important to note that only about 5% of children over 4 stop bed-wetting with no help. Causes Psychological distress: stress, lack of family function, bullying, abuse, Lack of parental approval Genetics: delay in acquiring sphincter competence (ask about family Hx – usually +ve) Medical conditions: diabetes mellitus, diabetes insipidus, UTI, Feacal retention/constipation (reduces bladder size) Inability to wake to full bladder sensation Low functional bladder capacity Inadvertent behaviour reinforcement (Let into parents bed after wetting)...
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