Secondary daytime and nighttime enuresis

Specialty: Pediatrics.

• Childhood secondary urinary incontinence
• regression of urinary sphincter control

Why it occurs

• Urinary tract infection (acute cystitis or urethritis that irritates the bladder mucosa causing detrusor spasms and incontinence)
• Diabetes Mellitus Type 1 (osmotic polyuria secondary to hyperglycemia exceeds the bladder capacity and voluntary control of the child)
• Psychological disorders or life stressors (separation anxiety, bullying, physical or sexual abuse, birth of a sibling that cause behavioral regression)
• Severe chronic constipation with fecal impaction (the giant fecal mass in the rectum mechanically compresses the bladder, reducing its functional capacity and stimulating involuntary contractions)
• Late-onset neurogenic bladder or occult spinal dysraphism (tethered cord or syringomyelia that progressively alters bladder innervation)

Initial workup

Detailed physical examination that includes abdominal palpation (bladder or fecal masses), detailed lumbar-sacral inspection, and thorough neurological examination of the lower extremities. Immediate urine analysis using a dipstick (to urgently rule out glycosuria, ketonuria, proteinuria, leukocyturia and nitrites). Urine culture on sample collected by clean urination. Kidney and bladder ultrasound with assessment of post-void residual (to rule out urinary tract malformations or voiding dysfunction). Magnetic Resonance (MRI) of the lumbosacral spine if spinal pathology is suspected.

Standard management

• Treatment depends strictly on the diagnosed cause. insulin — immediate treatment of choice for type 1 diabetes mellitus, prescribed exclusively by pediatric endocrinology
• Amoxicillin-Clavulanic Acid or Cefuroxime axetil — oral antibiotics of choice for confirmed UTI; amoxicillin-clavulanate at a dose of 40-50 mg/kg/day divided every 8 hours for 7-10 days
• Polyethylene glycol 3350 — if severe constipation coexists; maintenance dose of 0.4 g/kg/day
• Oxybutynin (anticholinergic indicated for detrusor instability in selected non-organic refractory cases; dose of 0.1 to 0.2 mg/kg/day orally).