CASE 41 - Bed Wetting

Question 1

Did I do something wrong to cause this problem?

Is my child going to get better?

Answer 1

There are few medical problems that can lead to your child’s condition, but it’s just as likely to be an isolated symptom.

Bed-wetting is much more common than most people believe, and there is no reason for you or your child to feel embarrased or guilty.

There are a number of treatment options available for this condition, and after we have run a few tests to rule out any physiologic abnormalities, I will discuss them with you.

Question 2

Specific Qs:

Answer 2

1. Have you tried any interventions or drugs in the pas?
2. How has the behavior affected the child?
3. How has the behavior affected you?
4. Have you ever punished or rewarded him?
5. Alleviating/exacerbating factors.
6. Does the problem increase in times of stress?
7. Late-night eating or drinking?
8. FHx of enuresis.
9. Environmental changes related to wetting?
10. Any major stresses?
11. Snoring?
12. Nighttime awakening?

Question 3

DDx:

Answer 3

1. Monosymptomatic 1o nocturnal enuresis.
2. UTI.
3. 2o enuresis.
4. Constipation.
5. Sleep apnea.
6. Functional bladder disorder.

Question 4

Workup:

Answer 4

1. GE.
2. UA.
3. Urine culture.
4. 1st-morning urine specific gravity.
5. US renal.
6. BUN/Cr.