Bedwetting in General Practice

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Bedwetting inGeneral Practice

• Rex Browne
• Anne Street Medical Centre

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Is bedwetting still a GP issue?

• PHOs and capitation based funding wencourage GPs
  to adopt a broader view of health that includes
• Health screening and prevention.
• Increased funding for children

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Is there an Enuresis Specialist?

• Bedwetting is an orphan specialty falling
  between
• Urology
• Paediatrics
• Psychology
• General Practice

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Who to Cure?
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How to Cure

• Start with listening first .

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Examination

• A minimal examination would be
• Observation of body habitus and nutritional state
• Observation of self confidence, posture, and gait

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Complex Enuresis

• Psychosocial issues
• Polyuria secondary to other illness
• Neurological causes
• Bladder based problems

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Detailed examination

• Where there is suspicion of underlying problems
• Abdominal palpation of bowel, bladder and
  kidneys.
• Genital check, spine, neurological
• Nose and throat check.
• Urinalysis
• Ultrasound

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Bedwetting Guidelines
Bedwetting Assessment
Urinary Infection
Treat as per UTI guidelines
Bedwetting persists
Constipation
Treat
Refer to Urologist or Paediatrician
Complex Enuresis
failed
Repeat
Mono symptomatic Nocturnal Enuresis
Enuresis Alarm with support program
Relapse
Cure!
Spontaneous
Child less than 7 yrs
Inform, Advise and Reassure
Not motivated
Episodic Needs (6 yrs or older)
Offer Desmopressin
enuresis
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Risks of Not treating
In association with the use of pull-ups

• Persisting bedwetting
• Incontinence in later life
• Infertility in boys

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Treatment Options

• Taking away the trainer wheels.
• Scheduled waking.
• Alarm training and variations thereof.

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The rest of the team

• Enuresis consultant.
• Practice Nurse with an interest

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Is there a void in your life?
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My personal interest
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Early Days
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Trying Harder
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Really Advanced
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