Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Urinary incontinenceEnuresisUrge urinary incontinenceOveractive bladderGiggle incontinenceNocturnal enuresisDysfunctional voiding, dysfunctional elimination syndrome ++ 596.5 Other functional disorder of the bladder788.3 Urinary incontinence788.31 Urge incontinence788.34 Incontinence without sensory awareness788.36 Nocturnal enuresis788.39 Other urinary incontinence ++ N33 Bladder disorders in diseases classified elsewhereN39.41 Urge incontinenceN39.42 Incontinence without sensory awarenessN39.44 Nocturnal enuresisN39.498 Other specified urinary incontinenceR32 Unspecified urinary incontinence ++ Pattern 4C: impaired muscle performance1Pattern 5C: Impaired motor function and sensory integrity associated with nonprogressive disorders of the central nervous system - congenital origin or acquired in infancy or childhood +++ Description ++ 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 old2Involuntary loss of urine control accompanied by or immediately preceded by urgencyComplete voiding during or immediately after laughing3Inability 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 adultUrodynamic testingDetrusor (smooth muscle of the bladder) overactivity: high detrusor pressure during leakage episode during urodynamic testing is indicative of detrusor overactivityDetrusor 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 flow of urine, initiate voiding by relaxing external urethral sphincter, and cortically inhibit a bladder contraction 5Rule out lower urinary tract infectionsSudden onset of symptomsUrinary frequencyUrinary urgencyLower back painRule out myogenic dysfunction of the detrusor +++ Demographics ++ 21.8% of school aged children had lower urinary tract dysfunctionSymptoms 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 incontinence19.1% had holding maneuvers; strategies to postpone voiding13.7% had urinary urgency6Eneuresis: at age 5, 15% to 25% of children wet the bedWith 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 +++ Signs and Symptoms 8 ++ Loss of urine without meaning to urinateBed wettingUrgency: sudden unexpected need to urinate, after age 5Nocturia: nighttime voids after age 5, normal = 0Hesitancy: slow initiation of void after age 5Straining: abdominal pressure during voidWeak stream: decreased force of flowIntermittency: bursts of urine during voiding, physiological up to age 3 if no straining; after 3 is ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.