![]() ![]() ![]() Behavioural modification is standard initial management including:.Initial (standard) management Behavioural modification Consider in children with established daytime incontinence, review and repeat ultrasound if it is not adequate or recent.Indicated when failing initial behavioural management, or if there are red flags present (e.g.Renal tract ultrasound (with pre and post void residual) Urinalysis and culture repeat urinalysis if previous UTIs or concern about possible renal/metabolic disease. ![]() Neurology - assessment of lower limbs, observation of gait.Lower Back/Spine – exclude occult spinal dysraphism/tethered cord.Exclude epispadias opening on the dorsal surface of the penis in boys or a patulous urethra in girls may suggest a female epispadias.Inspection of perineum and external genitalia (and perianal area if constipation also present).Abdomen – distended bladder, renal mass, faecal mass.Height, weight, BP – growth faltering / loss of weight / hypertension.Polydipsia or polyuria Consider possible causes (diabetes mellitus, diabetes insipidus, renal tubular disease, psychogenic)Ī focused physical examination will assist in identifying underlying conditions/causes of incontinence.Excessive tiredness or loss of weight consider an underlying chronic illness or renal impairment.Look for comorbidities and treat as appropriate (see Initial Management): Boys consider incomplete emptying or dysfunctional voiding.Girls consider urethral-vaginal reflux with leakage of urine from the vagina after voiding (when they stand up).Symptoms: voiding frequency, incontinence, urgency, nocturia, polyuria, holding manoeuvres (eg standing on tiptoes, crossing of the legs, or squatting with the heel pressed into the perineum), straining, weak stream, intermittency, dysuria Previously ever been dry during the day? If there has never been a period of dryness noted, or child has continuous incontinence/dribbling (not intermittent) strongly consider anatomical abnormalities Dysfunctional voiding (non-neurogenic) - an inability to relax the urethral sphincter and/or pelvic floor musculature during voiding, resulting in an interrupted urinary flow and prolonged voiding time.Underactive bladder- infrequent urination and overfilling leading to overflow incontinence.Voiding postponement- habitually delayed urination, with overfilling and leakage.Over active bladder (OAB)- urgency being the most important feature.Normal bladder capacity can be estimated prior to adolescence by the formula (age + 2) x 30 = capacity in mLįunctional causes of incontinence in children include:.Day wetting occurs in around 10 percent of 5-6 year olds, decreasing with age Daytime urinary continence is usually achieved by 4 years of age.Urinary incontinence is defined as day wetting in a child over 5 years of age that occurs more than once per month for ≥3 months The most common treatment for urinary incontinence is behaviour modification.A thorough history of voiding symptoms and a Bladder diary are essential components to assessment, directing targeted investigation and treatment.The goal of evaluation of daytime incontinence is to distinguish neurological and anatomical causes from functional causes of bladder dysfunction.Daytime urinary incontinence in school aged children is distressing and requires timely assessment and management.Constipation Nocturnal Enuresis Urinary Tract Infection Key points ![]()
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