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CONDITION/DISORDER SYNONYMS
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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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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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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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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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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.
Enuresis: At age 5, 15% to 25% of children wet the bed.