5.1 Assessment of Nocturnal Enuresis
Introduction
Bedwetting is common in childhood. 1- 2% Of children continue to have symptoms into adulthood. There are two main forms: monosymptomatic enuresis or non-mono-symptomatic enuresis. It is generally believed that bedwetting is caused by three factors, delayed maturation, small bladder volume and/or large nocturnal urine production. These factors help understand bedwetting and choose a proper treatment strategy.
Learning objectives:
The participant
- After following this lesson, can explain and name the difference between mono- and non-monosymptomatic enuresis
- Knows the pathophysiology of enuresis
- Knows the three-systems model as a theoretical framework for bedwetting
- Can apply the three systems.
Literature
Book: pediatric incontinence evaluation and clinical management: evaluation of bowel and bladder dysfunction Section 5
a. Chapter 22 Pathophysiology
b. Chapter 23 evaluation of the enuretic child
Additional literature
Nevéus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, Raes A, Tekgül S, Yang SS, Rittig S. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020 Feb;16(1):10-19. doi: 10.1016/j.jpurol.2019.12.020. Epub 2020 Jan 30. PMID: 32278657.
Bogaert G, Stein R, Undre S, Nijman RJM, Quadackers J, 't Hoen L, Kocvara R, Silay S, Tekgul S, Radmayr C, Dogan HS. Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting. Neurourol Urodyn. 2020 Feb;39(2):489-497. doi: 10.1002/nau.24239. Epub 2019 Dec 2. PMID: 31793066.
5.2 Management of Nocuturnal Enuresis
Introduction
As with daytime incontinence, the first step in the treatment of bedwetting is explanation and demystification. Treatment has two pillars: the bedwetting alarm and drug treatment. As a urotherapist, you assess which treatment is most appropriate for the child. You give advice and determine if and to what extent the child and parents need counselling. Often the guidance is sufficient with one-time instructions, in case of persistent bedwetting and/or relapse more intensive guidance is necessary
Learning objectives
The participant:
- Can explain the treatments for bedwetting
- Knows the differences monosymptomatic enuresis and non-monosymptomatic enuresis.
- Can explain which treatment is appropriate for the type of enuresis
- Can name the pharmacological effects & recommendations regarding use of desmopressin
- Can instruct child and parents on how to train with the bedwetting alarm
- Can explain and apply how a child/parent receives instructions and explanations regarding the treatment of bedwetting
- Can explain the importance of a urinary diary at the beginning of treatment
Can explain treatment for therapy-resistant group bedwetters Literature
Book: Pediatric incontinence evaluation and clinical management: evaluation of bowel and bladder dysfunction Section 5
Chapter 24 Management of monosymptomatic nocturnal enuresis
Recommended literature
- Nevéus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, Raes A, Tekgül S, Yang SS, Rittig S. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020 Feb;16(1):10-19. doi: 10.1016/j.jpurol.2019.12.020. Epub 2020 Jan 30. PMID: 32278657.
- Bogaert G, Stein R, Undre S, Nijman RJM, Quadackers J, 't Hoen L, Kocvara R, Silay S, Tekgul S, Radmayr C, Dogan HS. Practical recommendations of the EAU-ESPU guidelines committee for monosymptomatic enuresis-Bedwetting. Neurourol Urodyn. 2020 Feb;39(2):489-497. doi: 10.1002/nau.24239. Epub 2019 Dec 2. PMID: 31793066.
- Peng CC, Yang SS, Austin PF, Chang SJ. Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis. Sci Rep. 2018 Nov 13;8(1):16755. doi: 10.1038/s41598-018-34935-1. PMID: 30425276; PMCID: PMC6233184.
5.3 Specific role of pelvic floor physiotherapy
Introduction
Urotherapy is multidisciplinary in nature. Urotherapy is part of specialized pediatric pelvic physio physical therapy, and there is often overlap with the work of the psychologist/pediatrician. But if in addition to micturition or defecation there are problems with movement, or behavioural problems, the urotherapist works with or refers to the specialized physical therapist or psychologist.
Referral to a specialized physical therapist is also incentivized when targeted pelvic floor training is needed. Consider children who have difficulty selectively tightening or relaxing the pelvic floor muscles.
During this class block a physical therapist explain what targeted pelvic floor training is and where the physical therapist is complementary to urotherapy.
Learning objectives
The participant
- Can explain the additional role of physical therapy in children with incontinence
- Can consider and recommend when additional physical therapy is recommended
- Can explain what biofeedback training is
- Can explain what pelvic floor training entails and why it makes sense to apply to children with DV
Literature
Book: Pediatric incontinence evaluation and clinical management: evaluation of bowel and bladder dysfunction. Section 4
Chapter 12 Implementation of urotherapy, Wendy F. Bower Chapter 13 The concept of physiotherapy for childhood BBD, Janet W. Chase
Chapter 14 Biofeedback for the treatment of functional voiding problems, Ann Raes
5.4 Q&A Discussion/ Live session online
During this online session you will have the opportunity to ask questions based on the lectures you have attended.
