273: PEDIATRIC URINARY INCONTINENCE

CONDITION/DISORDER SYNONYMS

• Urinary incontinence

  • Enuresis

  • Urge urinary incontinence

  • Overactive bladder

  • Giggle incontinence

  • Nocturnal enuresis

• Dysfunctional voiding, dysfunctional elimination syndrome

ICD-9-CM CODES

• 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

ICD-10-CM CODES

• 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

PREFERRED PRACTICE PATTERNS¹

• 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

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• 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.

General Considerations

• 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.

Demographics

• 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

CLINICAL ...