by Diane K. Newman, DNP, FAAN, BCB-PMD
Bedwetting can be a sign of bladder dysfunction in a child older than six. A pediatric urologist should evaluate children who have any signs or symptoms of bladder dysfunction, including bedwetting (nocturnal enuresis) that persists beyond the age of six years, or daytime incontinence past the normal age of potty training.
Bedwetting evaluation
As part of an evaluation, the urologist will ask for a medical history about both parents and the child. The general history includes information about bowel function (constipation or fecal soiling), menstrual and sexual function (teenagers), family-related disorders, neurologic diseases and congenital abnormalities. Regulating the bowels can decrease daytime urgency and bedwetting. An extremely important part of the history is the child's psychosocial status and family situation since bladder problems, especially bed wetting, are early signs of child abuse.
A daily diary that includes any signs and symptoms related to the child's voiding and wetting the bed can be helpful. The diary should include daytime voiding, especially urinary urgency, daytime incontinence or wetting accidents, fluid intake and any medications the child is taking.
The doctor may ask parents about the child's voiding habits as certain awkward positions may affect bladder emptying (for example, sitting on the toilet with legs crossed activates the pelvic floor muscles, which prevents the flow of urine from the bladder). Often the doctor will recommend that the parents observe the child during voiding to determine possible problems with the child's position.
The doctor will perform a general examination of the child including reflexes, the abdomen, genitalia and rectal area.
Initial tests include a urine test for infection, post-void residual measurement (the amount of urine left in the bladder after voiding), x-rays to determine urine flow (voiding cystourethrogram - VCUG), and an ultrasound to detect any serious problems in the bladder or kidneys. More invasive urodynamic tests may be necessary in children who have more complex problems.
References
1. Berry, AK. Helping Children with Nocturnal Enuresis. AJN.2006;106(8):58-65.
Posted August 2006
Updated January 2009
