Some Factors Contributing to Enuresis
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Infrequent, hard-pebble, or very large stools Encopresis Abdominal discomfort History of a constipating diet (eg, excessive milk and dairy, few fruits and vegetables) | Usually clinical evaluation alone (including stooling diary) Sometimes abdominal x-ray | |
Increased urine output due to any cause (eg, diabetes mellitus, argininevasopressin deficiency [central diabetes insipidus], nephrogenic diabetes insipidus, excessive water intake, sickle cell disease or trait) | Vary by disorder | For diabetes mellitus, serum glucose For diabetes insipidus, serum and blood osmolality and possibly urine sample For sickle cell, sickle cell testing |
Maturational delay | No diurnal incontinence More common among boys and heavy sleepers Possible family history of bed-wetting | Clinical evaluation alone |
History of snoring with pauses in breathing that last 15 seconds or longer followed by loud snorts Excessive daytime sleepiness Enlarged tonsils/adenoids | Polysomnography | |
Spinal dysraphism (eg, spina bifida, tethered cord, occult defects), leading to urinary retention | Obvious vertebral defects, protruding meningeal sac, lumbosacral dimple or hair tuft, lower-extremity weakness, decreased sensation in lower extremities Absence of ankle jerk reflex, cremasteric reflex, and anal wink | Lumbosacral x-rays For occult conditions, spinal MRI |
Stress | School difficulties, social isolation or difficulties, family stress (eg, divorce, separation) | Clinical evaluation alone (including voiding diary) |
Dysuria, hematuria, frequency, urgency Fever Abdominal pain | Urinalysis Urine culture For patients with pyelonephritis, ultrasonography and voiding cystourethrogram |