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CONDITION/DISORDER SYNONYMS

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  • Urinary incontinence

    • Enuresis

    • Urge urinary incontinence

    • Overactive bladder

    • Giggle incontinence

    • Nocturnal enuresis

  • Dysfunctional voiding, dysfunctional elimination syndrome

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ICD-9-CM CODES

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  • 596.5 Other functional disorder of the bladder

  • 788.3 Urinary incontinence

  • 788.31 Urge incontinence

  • 788.32 Incontinence without sensory awareness

  • 788.36 Nocturnal enuresis

  • 788.39 Other urinary incontinence

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ICD-10-CM CODES

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  • N33 Bladder disorders in diseases classified elsewhere

  • N39.41 Urge urinary incontinence

  • N39.42 Incontinence without sensory awareness

  • N39.44 Nocturnal enuresis

  • N39.498 Other specified urinary incontinence

  • R32 Unspecified urinary incontinence

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PREFERRED PRACTICE PATTERNS1

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  • 4C Impaired Muscle Performance1

  • 5C Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—congenital origin or acquired in infancy or childhood

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PATIENT PRESENTATION

A 9-year-old girl who is undergoing physical therapy treatment for gait training and strengthening after hospitalization for meningitis frequently interrupts therapy sessions with urgent requests to go to the bathroom, and then stays in the bathroom for 10 minutes or more. Her school teacher recently reported to her mother this same behavior at school.

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KEY FEATURES

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Description
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  • Involuntary loss of urine control during the daytime in a child older than 5 years (or mental age of 5) and/or during the nighttime in a child older than 62

  • Involuntary loss of urine control accompanied by or immediately preceded by urgency

  • Complete voiding during or immediately after laughing3

  • Inability to relax the external sphincter during voiding in children with no evidence of neurologic abnormality4

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Essentials of Diagnosis
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  • Voiding record observed and recorded by an adult.

  • Urodynamic testing

    • Detrusor (smooth muscle of the bladder) overactivity: High detrusor pressure during leakage episode during urodynamic testing is indicative of detrusor overactivity.

    • Detrusor sphincter dyssynergia (DSD): Simultaneous contraction of the external urinary sphincter and detrusor during an attempt to void.

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General Considerations
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  • The fully toilet-trained child has the ability to stop and start the flow of urine, initiate voiding by relaxing external urethral sphincter, and cortically inhibit a bladder contraction.5

  • Rule out lower urinary tract infections (UTIs).

    • Sudden onset of symptoms

    • Urinary frequency

    • Urinary urgency

    • Lower back pain

  • Rule out myogenic dysfunction of the detrusor.

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Demographics
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  • 21.8% of school aged children had lower urinary tract dysfunction.

  • Symptoms were most frequent in girls (p < 0.001), children aged 6 to 8 years (p < 0.028), and attended the school with the lowest social level (p < 0.001).

  • 30.7% had diurnal urinary incontinence.

    • 19.1% had holding maneuvers; strategies to postpone voiding

    • 13.7% had urinary urgency.6

  • Enuresis: At age 5, 15% to 25% of children wet the bed.

    • With each year of maturity, the percentage of bed-wetters declines by 15%: 8% of 12-year-old boys and 4% of 12-year-old girls are enuretic, only 1% to 3 % of adolescents are still wetting their bed.7

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CLINICAL ...

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