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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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  • 596.5 Other functional disorder of the bladder
  • 788.3 Urinary incontinence
  • 788.31 Urge incontinence
  • 788.34 Incontinence without sensory awareness
  • 788.36 Nocturnal enuresis
  • 788.39 Other urinary incontinence

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  • N33 Bladder disorders in diseases classified elsewhere
  • N39.41 Urge 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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Description

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  • Involuntary loss of urine control during the daytime in a child older than 5 years old (or mental age of 5) and/or during the nighttime in a child older than 6 years old2
  • 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 flow of urine, initiate voiding by relaxing external urethral sphincter, and cortically inhibit a bladder contraction 5
  • Rule out lower urinary tract infections
    • 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 old (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 urgency6
  • Eneuresis: 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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Signs and Symptoms 8

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  • Loss of urine without meaning to urinate
  • Bed wetting
  • Urgency: sudden unexpected need to urinate, after age 5
  • Nocturia: nighttime voids after age 5, normal = 0
  • Hesitancy: slow initiation of void after age 5
  • Straining: abdominal pressure during void
  • Weak stream: decreased force of flow
  • Intermittency: bursts of urine during voiding, physiological up to age 3 if no straining; after 3 is always considered dysfunctional
  • Holding maneuvers: strategies to postpone voiding, after age 5

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Functional Implications9

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  • Increased ...

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