Enuresis

Enuresis

inability of a child to establish proper bladder control resulting in either daytime or nocturnal involuntary urination

By what age should children be able to establish propper bladder control?

4-5 years old

Primary enuresis

occurs in a child over five years of age, who has never been able to establish proper bladder control

Secondary enuresis

diagnosis for the child who has been able to establish proper bladder control, but who has since lapsed back to wetting the bed

What is emptying of the bladder controlled by?

detrusor and trigone muscles

What are the nerve supply to the detrusor and trigone muscles?

S2-S4 via the the sacral parasympathetic nerves

What is appropriate bladder function also controlled by?

urogenital diaphragm

What is the nerve supply of the urogenital diaphragm?

L2 spinal nerve

What is the clinical definition of primary nocturnal enuresis?

involuntary urination at night in a child who has never been consistently dry

Primary enuresis etiology

familial (MC in males), medications, link to emotional disturbances, anxiety states, ADHD, mechanical cause in the spine

Secondary enuresis etiology

related to stress, trauma, or psychological crisis

At what age is enuresis typically considered a clinical concern?

5 years

Which of the following is NOT a common contributing factor to enuresis?

C1 subluxation

What conservative approaches would you consider recommending for nocturnal enuresis?

CMT, counseling, limiting liquid intake before bed, acupuncture, relaxation therapies