Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.
Urinary incontinence, both in the day and at night, is common in school-aged children and can be very distressing for children and their families. An accurate history together with a thorough physical examination is essential for assessing and diagnosing urinary incontinence. Conservative treatment should be offered to all children. If that fails, treatment with anticholinergic drugs could be tried in those with daytime urinary incontinence and overactive bladder. After addressing any daytime bladder symptoms, treatment with alarm therapy is recommended for children with nocturnal enuresis. Desmopressin is another option. During the day, voiding occurs when children synchronously contract their detrusor muscle and relax their urinary sphincters and pelvic floor muscles (usually in response to the sensation of bladder fullness). This allows the free flow of urine until the bladder is empty. At night, with adequate bladder storage and urine concentration, children usually sleep through the night without needing to urinate, but have the ability to wake up to void when they sense bladder fullness. Bladder capacity increases with age in children. The normal expected bladder capacity up to the age of 12 is calculated as (age + 1) x 30 mL (with 400 mL being expected for those older than 12 years). 10 Normal daytime voided volumes are usually 65-150% of expected bladder capacity. These measures are the most useful indicator of bladder function. Usually children produce less urine at night in response to the circadian variation in the amount of arginine vasopressin released by the pituitary gland. 11 Nocturnal polyuria is overnight urine volumes greater than 130% of expected bladder capacity. Assessment An accurate history, including family history, together with a thorough physical examination is essential to evaluate children with urinary incontinence and decide on treatment choices. This includes a detailed history of wetting, toileting patterns including voiding frequency, symptoms of urgency, comorbidities and psychosocial factors. 8 A bladder diary provides objective documentation of bladder function. Recording night-time urine volumes and incontinence episodes over seven nights is helpful to evaluate enuresis. Night-time urine volumes are estimated by adding the net nappy weight and the first morning voided volume. To evaluate daytime
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.