The document provides guidelines for the practical management of enuresis. It defines enuresis as involuntary wetting during sleep by children over 5 years old without underlying medical issues. Primary enuresis involves never achieving nighttime continence, while secondary occurs after a period of being dry at night. Evaluation involves assessing the pattern of bedwetting, fluid intake, bladder diary, and psychology. Treatment is stepped, starting with general advice, alarms, and desmopressin as first-line options before considering second-line anticholinergics or third-line tricyclic antidepressants if needed. The goals are increasing dry nights and reducing the emotional impact.
Evidence based management of enuresis in childrenGirish Bhatt
This document discusses evidence-based management of enuresis. It defines enuresis and classifies it as monosymptomatic or non-monosymptomatic. Prevalence is noted to be 3.8-20% in India. Pathophysiology is multifactorial involving genetic and developmental factors. Evaluation involves history, voiding diary, physical exam and some investigations. Management includes non-pharmacological approaches like motivation therapy and alarm therapy as first-line. Pharmacological options include desmopressin, which is effective but relapses occur after stopping, and anticholinergics which are useful for overactive bladder symptoms. Refractory cases may require tricyclic antidepressants. The document
The document discusses two cases of bedwetting or nocturnal enuresis in children. It then provides background information on nocturnal enuresis, including definitions, prevalence, risk factors, types, pathophysiology and diagnostic criteria. Nocturnal enuresis is defined as involuntary voiding during sleep after a child reaches 5 years of age. It affects 15-20% of children at age 5 and 5-10% at age 10. Boys are more commonly affected than girls. Family history is positive in about 50% of cases. The causes of nocturnal enuresis include delayed maturation of the brain mechanisms that inhibit bladder contractions during sleep, small bladder capacity, nocturnal excess urine production,
1. Nocturnal enuresis, or bedwetting, affects up to 20% of children at age 5 and is typically caused by delayed maturation of bladder control mechanisms.
2. Family history is a strong predictor, with a 44% risk if one parent was enuretic and 77% if both parents were.
3. Treatment includes limiting evening fluids, waking the child to void, alarms, and in some cases medication like desmopressin to reduce urine production overnight.
This document provides an overview of childhood enuresis (bedwetting), including definitions, epidemiology, etiology, clinical manifestations and diagnosis, and treatment options. It defines primary and secondary enuresis and notes that psychological problems are usually a result rather than a cause. Treatment options discussed include supportive management, alarm therapy, desmopressin, anticholinergic medications like oxybutynin, and imipramine. Alarm therapy and desmopressin are identified as the most effective evidenced-based treatments.
This document provides information about enuresis or bedwetting in children. It defines enuresis and describes the types as nocturnal or diurnal. Normal bladder development and toilet training are discussed. Epidemiology notes the prevalence is highest in young boys and declines with age. Etiology may involve biological, emotional, and learning factors as well as familial patterns. Evaluation includes history, exam, urinalysis, and ultrasound. Treatment begins with lifestyle changes but may involve alarms or medications like desmopressin if needed. The long-term goal is to improve the child's well-being and self-esteem.
Nocturnal enuresis, also known as bedwetting, is involuntary voiding of urine during sleep in children over 5 years old. It can be primary, meaning the child has never been consistently dry for 6 months, or secondary where they were previously dry. Causes include maturational delay, genetics, small bladder capacity, abnormal ADH secretion, and sleep/arousal disorders. Evaluation involves history, exam, and urinalysis but not typically imaging. Treatment includes general measures, non-pharmacological options like bladder training and enuresis alarms, and pharmacological options like desmopressin, oxybutynin, or imipramine short term. Enuresis alarms are most effective
Nocturnal enuresis, or bedwetting, is involuntary urination during sleep that occurs in approximately 15% of children aged 5 and 5% of children aged 10. It can be caused by delayed development of bladder control mechanisms or small bladder capacity. Evaluation involves screening for secondary causes and treatment primarily focuses on behavior modification techniques like bladder training and alarms or drug therapy with desmopressin or imipramine if needed. Prognosis is generally good as the majority of cases resolve spontaneously by adolescence.
Nocturnal enuresis, or bedwetting, is uncontrolled urination during sleep after a certain age. It is more common in boys than girls and has both genetic and developmental factors. The pathogenesis is multifactorial, involving premature or insufficient bladder training as well as circadian hormone abnormalities or sleep disturbances. Treatment includes imipramine, desmopressin, or anticholinergic drugs. A new concept proposes that urinary continence relies on an inherent strong internal urethral sphincter and an acquired ability to maintain sympathetic tone in the sphincter during waking hours.
Evidence based management of enuresis in childrenGirish Bhatt
This document discusses evidence-based management of enuresis. It defines enuresis and classifies it as monosymptomatic or non-monosymptomatic. Prevalence is noted to be 3.8-20% in India. Pathophysiology is multifactorial involving genetic and developmental factors. Evaluation involves history, voiding diary, physical exam and some investigations. Management includes non-pharmacological approaches like motivation therapy and alarm therapy as first-line. Pharmacological options include desmopressin, which is effective but relapses occur after stopping, and anticholinergics which are useful for overactive bladder symptoms. Refractory cases may require tricyclic antidepressants. The document
The document discusses two cases of bedwetting or nocturnal enuresis in children. It then provides background information on nocturnal enuresis, including definitions, prevalence, risk factors, types, pathophysiology and diagnostic criteria. Nocturnal enuresis is defined as involuntary voiding during sleep after a child reaches 5 years of age. It affects 15-20% of children at age 5 and 5-10% at age 10. Boys are more commonly affected than girls. Family history is positive in about 50% of cases. The causes of nocturnal enuresis include delayed maturation of the brain mechanisms that inhibit bladder contractions during sleep, small bladder capacity, nocturnal excess urine production,
1. Nocturnal enuresis, or bedwetting, affects up to 20% of children at age 5 and is typically caused by delayed maturation of bladder control mechanisms.
2. Family history is a strong predictor, with a 44% risk if one parent was enuretic and 77% if both parents were.
3. Treatment includes limiting evening fluids, waking the child to void, alarms, and in some cases medication like desmopressin to reduce urine production overnight.
This document provides an overview of childhood enuresis (bedwetting), including definitions, epidemiology, etiology, clinical manifestations and diagnosis, and treatment options. It defines primary and secondary enuresis and notes that psychological problems are usually a result rather than a cause. Treatment options discussed include supportive management, alarm therapy, desmopressin, anticholinergic medications like oxybutynin, and imipramine. Alarm therapy and desmopressin are identified as the most effective evidenced-based treatments.
This document provides information about enuresis or bedwetting in children. It defines enuresis and describes the types as nocturnal or diurnal. Normal bladder development and toilet training are discussed. Epidemiology notes the prevalence is highest in young boys and declines with age. Etiology may involve biological, emotional, and learning factors as well as familial patterns. Evaluation includes history, exam, urinalysis, and ultrasound. Treatment begins with lifestyle changes but may involve alarms or medications like desmopressin if needed. The long-term goal is to improve the child's well-being and self-esteem.
Nocturnal enuresis, also known as bedwetting, is involuntary voiding of urine during sleep in children over 5 years old. It can be primary, meaning the child has never been consistently dry for 6 months, or secondary where they were previously dry. Causes include maturational delay, genetics, small bladder capacity, abnormal ADH secretion, and sleep/arousal disorders. Evaluation involves history, exam, and urinalysis but not typically imaging. Treatment includes general measures, non-pharmacological options like bladder training and enuresis alarms, and pharmacological options like desmopressin, oxybutynin, or imipramine short term. Enuresis alarms are most effective
Nocturnal enuresis, or bedwetting, is involuntary urination during sleep that occurs in approximately 15% of children aged 5 and 5% of children aged 10. It can be caused by delayed development of bladder control mechanisms or small bladder capacity. Evaluation involves screening for secondary causes and treatment primarily focuses on behavior modification techniques like bladder training and alarms or drug therapy with desmopressin or imipramine if needed. Prognosis is generally good as the majority of cases resolve spontaneously by adolescence.
Nocturnal enuresis, or bedwetting, is uncontrolled urination during sleep after a certain age. It is more common in boys than girls and has both genetic and developmental factors. The pathogenesis is multifactorial, involving premature or insufficient bladder training as well as circadian hormone abnormalities or sleep disturbances. Treatment includes imipramine, desmopressin, or anticholinergic drugs. A new concept proposes that urinary continence relies on an inherent strong internal urethral sphincter and an acquired ability to maintain sympathetic tone in the sphincter during waking hours.
This document discusses childhood bedwetting or enuresis. It notes that bedwetting is common in children under 12 years old and more common in boys. The main causes of primary nocturnal enuresis are a small bladder capacity, decreased awareness of a full bladder while sleeping, excess urine production at night, and genetic factors. Management options include reassurance, timed toilet visits, limiting fluids before bed, enuresis alarms, dry bed training, and short-term drug treatments like desmopressin or imipramine. Enuresis alarms are the most effective long-term treatment, helping over 60% of children become dry, while drug treatments only treat symptoms temporarily.
This document discusses nocturnal enuresis (bedwetting). It begins with physiological details about the anatomy of the urinary bladder. It then discusses various causes of bedwetting including idiopathic, genetic factors, constipation, urinary tract infections, diabetes, sleep disorders, small bladder capacity, dysfunctional voiding, and neurological issues. Diagnosis involves a thorough history and physical exam plus a urinalysis. Treatment options discussed include behavioral modification, bedwetting alarms, and medication like desmopressin.
Enuresis| bed wetting - a detailed medical study martinshaji
Night time loss of bladder control, or bed-wetting, usually in children. Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder.
please comment
thank you
This document discusses enuresis (bed-wetting) in children. It defines the different types of enuresis and describes normal bladder development and toilet training. The epidemiology of enuresis is presented, noting that prevalence is higher in boys and decreases with age. Etiology involves biological, emotional, and learning factors, with some evidence of genetic links. Evaluation includes history, exam, urinalysis and ultrasound to rule out underlying causes. Treatment begins with lifestyle changes and rewards, and may involve alarms or medications like desmopressin or imipramine if needed. The goal is to encourage dryness and self-esteem while allowing for the high rate of spontaneous remission.
This document provides information about nocturnal enuresis (bedwetting), including its definition, epidemiology, etiology, diagnosis, and treatment. Nocturnal enuresis is defined as involuntary voiding during sleep at least twice a week for at least three months in a child aged 5 years or older. It affects more boys than girls and is often familial. Primary enuresis is caused by delayed cortical maturation while secondary enuresis can be caused by medical conditions. Treatment involves pharmacotherapy with desmopressin, imipramine, or anticholinergics as well as behavioral techniques like conditioning and alarms.
Nocturnal enuresis is defined as the repeated involuntary discharge of urine during sleep after a child is developmentally expected to attain bladder control. It is diagnosed when a child voids twice a week for at least 3 months and experiences distress. Nocturnal enuresis is more common in boys than girls and affects around 15-20% of 5 year old children, with 90% experiencing the persistent type. Causes include genetic factors, physiological immaturity, psychological stress, and organic issues like urinary tract infections. Treatment begins with behavioral modifications like rewards, scheduled voiding, and alarms, with medication options if unsuccessful.
This document provides an overview of voiding disorders in children, including definitions, classifications, pathogenesis, evaluation, and treatment approaches. It discusses specific disorders like dysfunctional voiding, overactive bladder, and their potential long-term outcomes. Evaluation involves history, physical exam, urinalysis, ultrasound, and sometimes urodynamics. Treatment focuses on lifestyle changes, bladder retraining, physiotherapy, and medications to manage specific symptoms like urinary frequency or incontinence.
Encopresis refers to the passage of feces into inappropriate places after age 4. There are two subtypes: retentive encopresis with constipation and overflow incontinence, and nonretentive encopresis without constipation. The first step in managing encopresis is assessing fecal retention through rectal examination or abdominal x-rays. The combination of constipation management and simple behavior therapy is successful in the majority of cases, though it may take months for soiling to fully stop.
This document discusses enuresis, or involuntary voiding of urine during sleep beyond the age of 5. It defines primary and secondary enuresis and describes the typical achievement of bladder control by age. Treatment options discussed include behavioral interventions, alarm therapy, pharmacotherapy using drugs like DDAVP and antidepressants, and rarely surgery. The overall approach emphasizes a multifaceted treatment tailored to each child, with the goal of solving the problem through a positive attitude and commitment from the child, parents, and pediatrician.
Constipation in Infants & Children By Dr. Vivek Rege
Pediatric Surgeon & Pediatric Urologist, BhatiaHospital, Saifee Hospital, Fortis Hospitals, B J Wadia Hospital for Children
ABSTRACT:
Nocturnal enuresis or night time urinary incontinence, commonly called bedwetting or sleep wetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Bedwetting is a common childhood urologic complaint and one of the most common pediatric health issues. Enuresis is notoriously difficult to treat and is frequently related to psychological factors. The emotional impact of enuresis on a child and family is considerable. Children with enuresis are commonly punished and are at risk for emotional and physical abuse. Numerous studies of children with enuresis report feelings of embarrassment and anxiety, loss of self-esteem, and effects on self-perception, interpersonal relationships, quality of life, and school performance. The condition can be successfully treated with homoeopathic medicines but require a long term follow – up. The present article focuses on management of this medical condition with our medicines.
constipation in children , pediatric constipation , management of constipation in children , understanding constipation , causes of constipation in children , functional constipation in children , treatment of constipation ,approach to constipation in children ,constipation in infants
This document discusses nocturnal enuresis (bedwetting) in children and urine retention in adults. It outlines several potential causes, including hormonal problems, bladder problems, genetics, sleep problems, and psychological problems. It then describes four main treatment lines - vasopressin-related drugs, antispasmodic agents, antidepressants, and odor modifiers. Specific drugs are discussed for each treatment line along with their mechanisms of action and dosages. Side effects and cautions are also provided. Urine retention in adults can be caused by obstruction, nerve problems, medications, or weakened bladder muscles. Treatment involves catheterization, urethral stents, medications to relax the bladder or prostate, and hormonal
This document discusses constipation in children. It defines constipation and notes that approximately 5% of schoolchildren suffer from it. The majority of cases are functional rather than organic causes. A history and physical exam are important to evaluate for constipation. Functional constipation is usually due to a low fiber diet, lack of exercise, painful bowel movements causing withholding, and a cycle that perpetuates harder stools. Organic causes include conditions like Hirschsprung's disease. Treatment aims to soften stool and promote motility through diet changes, behavioral modifications, stool softeners, and laxatives. Complications can include fecal impaction if left untreated.
Diarrhea is defined as an increase in stool frequency or liquidity. For infants it is considered diarrhea if there are more than 3 watery stools per day, while for older children it is 3 or more loose stools per day. The causes of diarrhea include viral, bacterial, and parasitic infections. Rotavirus is the most common cause of acute diarrhea in children. Treatment involves oral rehydration with solutions like ORS as well as continued feeding. For some cases antibiotics or zinc may be used. Prevention strategies include vaccines, handwashing, safe water, and breastfeeding.
This document provides information on acute gastroenteritis in children. It defines acute diarrhea as the passage of loose or watery stools three or more times in a 24 hour period for up to 14 days. It notes that diarrhea is a leading cause of death among children under 5 years old globally and in India. The document discusses the causes, clinical presentation, assessment and management of acute diarrhea including use of oral rehydration solution and zinc supplementation. It also covers prevention of diarrhea and malnutrition in children.
Neonatal seizures, dr amit vatkar, pediatric neurologistDr Amit Vatkar
In the presentaion i will give you a brief idea to apprach, diagnosis and management of neonatal seizures.
The most prominent feature of neurologic dysfunction in the neonatal period is the occurrence of seizures. Determining the underlying etiology for neonatal seizures is critical. Etiology determines prognosis and outcome and guides therapeutic strategies.
Neonatal seizures, dr amit vatkar, pediatric neurologist
This document provides information on childhood constipation, including its definition, diagnosis, and treatment. Constipation is defined as delayed or difficult defecation for two or more weeks. Diagnosis involves taking a detailed history and performing a physical exam. Treatment involves disimpaction followed by maintenance therapy, focusing on dietary changes, behavioral modifications, and medications like polyethylene glycol or lactulose. Special considerations for infants less than 1 year include increased fluid intake and avoiding certain laxatives.
This document discusses enuresis (bedwetting) in children. It covers the epidemiology, etiology, pathophysiology, clinical features, diagnosis and treatment of the condition. Enuresis is defined as repeated bedwetting in children over 5 years old. It occurs most commonly in boys and prevalence decreases with age. Treatment involves behavioral modifications like fluid restrictions and alarm therapy, as well as medications like desmopressin if needed. A positive attitude from parents and motivation from the child are important for treatment success.
This document discusses enuresis, or bedwetting, in children and adolescents. It defines enuresis as the involuntary release of urine during sleep, usually during the first third of the night. The document outlines the causes of enuresis including anatomical, endocrine, psychiatric, and sleep issues. It describes how enuresis should be evaluated through history, physical exam, and testing. Treatment options are also discussed including behavioral therapies, medication, and age-appropriate approaches. Statistics on the prevalence of bedwetting at various ages are presented in both paragraph and graph form. The conclusion emphasizes that enuresis can impact a person's life and should be properly diagnosed and treated based on their age.
This document discusses childhood bedwetting or enuresis. It notes that bedwetting is common in children under 12 years old and more common in boys. The main causes of primary nocturnal enuresis are a small bladder capacity, decreased awareness of a full bladder while sleeping, excess urine production at night, and genetic factors. Management options include reassurance, timed toilet visits, limiting fluids before bed, enuresis alarms, dry bed training, and short-term drug treatments like desmopressin or imipramine. Enuresis alarms are the most effective long-term treatment, helping over 60% of children become dry, while drug treatments only treat symptoms temporarily.
This document discusses nocturnal enuresis (bedwetting). It begins with physiological details about the anatomy of the urinary bladder. It then discusses various causes of bedwetting including idiopathic, genetic factors, constipation, urinary tract infections, diabetes, sleep disorders, small bladder capacity, dysfunctional voiding, and neurological issues. Diagnosis involves a thorough history and physical exam plus a urinalysis. Treatment options discussed include behavioral modification, bedwetting alarms, and medication like desmopressin.
Enuresis| bed wetting - a detailed medical study martinshaji
Night time loss of bladder control, or bed-wetting, usually in children. Sometimes enuresis is also called involuntary urination. Nocturnal enuresis is involuntary urination that happens at night while sleeping, after the age when a person should be able to control his or her bladder.
please comment
thank you
This document discusses enuresis (bed-wetting) in children. It defines the different types of enuresis and describes normal bladder development and toilet training. The epidemiology of enuresis is presented, noting that prevalence is higher in boys and decreases with age. Etiology involves biological, emotional, and learning factors, with some evidence of genetic links. Evaluation includes history, exam, urinalysis and ultrasound to rule out underlying causes. Treatment begins with lifestyle changes and rewards, and may involve alarms or medications like desmopressin or imipramine if needed. The goal is to encourage dryness and self-esteem while allowing for the high rate of spontaneous remission.
This document provides information about nocturnal enuresis (bedwetting), including its definition, epidemiology, etiology, diagnosis, and treatment. Nocturnal enuresis is defined as involuntary voiding during sleep at least twice a week for at least three months in a child aged 5 years or older. It affects more boys than girls and is often familial. Primary enuresis is caused by delayed cortical maturation while secondary enuresis can be caused by medical conditions. Treatment involves pharmacotherapy with desmopressin, imipramine, or anticholinergics as well as behavioral techniques like conditioning and alarms.
Nocturnal enuresis is defined as the repeated involuntary discharge of urine during sleep after a child is developmentally expected to attain bladder control. It is diagnosed when a child voids twice a week for at least 3 months and experiences distress. Nocturnal enuresis is more common in boys than girls and affects around 15-20% of 5 year old children, with 90% experiencing the persistent type. Causes include genetic factors, physiological immaturity, psychological stress, and organic issues like urinary tract infections. Treatment begins with behavioral modifications like rewards, scheduled voiding, and alarms, with medication options if unsuccessful.
This document provides an overview of voiding disorders in children, including definitions, classifications, pathogenesis, evaluation, and treatment approaches. It discusses specific disorders like dysfunctional voiding, overactive bladder, and their potential long-term outcomes. Evaluation involves history, physical exam, urinalysis, ultrasound, and sometimes urodynamics. Treatment focuses on lifestyle changes, bladder retraining, physiotherapy, and medications to manage specific symptoms like urinary frequency or incontinence.
Encopresis refers to the passage of feces into inappropriate places after age 4. There are two subtypes: retentive encopresis with constipation and overflow incontinence, and nonretentive encopresis without constipation. The first step in managing encopresis is assessing fecal retention through rectal examination or abdominal x-rays. The combination of constipation management and simple behavior therapy is successful in the majority of cases, though it may take months for soiling to fully stop.
This document discusses enuresis, or involuntary voiding of urine during sleep beyond the age of 5. It defines primary and secondary enuresis and describes the typical achievement of bladder control by age. Treatment options discussed include behavioral interventions, alarm therapy, pharmacotherapy using drugs like DDAVP and antidepressants, and rarely surgery. The overall approach emphasizes a multifaceted treatment tailored to each child, with the goal of solving the problem through a positive attitude and commitment from the child, parents, and pediatrician.
Constipation in Infants & Children By Dr. Vivek Rege
Pediatric Surgeon & Pediatric Urologist, BhatiaHospital, Saifee Hospital, Fortis Hospitals, B J Wadia Hospital for Children
ABSTRACT:
Nocturnal enuresis or night time urinary incontinence, commonly called bedwetting or sleep wetting, is involuntary urination while asleep after the age at which bladder control usually occurs. Bedwetting is a common childhood urologic complaint and one of the most common pediatric health issues. Enuresis is notoriously difficult to treat and is frequently related to psychological factors. The emotional impact of enuresis on a child and family is considerable. Children with enuresis are commonly punished and are at risk for emotional and physical abuse. Numerous studies of children with enuresis report feelings of embarrassment and anxiety, loss of self-esteem, and effects on self-perception, interpersonal relationships, quality of life, and school performance. The condition can be successfully treated with homoeopathic medicines but require a long term follow – up. The present article focuses on management of this medical condition with our medicines.
constipation in children , pediatric constipation , management of constipation in children , understanding constipation , causes of constipation in children , functional constipation in children , treatment of constipation ,approach to constipation in children ,constipation in infants
This document discusses nocturnal enuresis (bedwetting) in children and urine retention in adults. It outlines several potential causes, including hormonal problems, bladder problems, genetics, sleep problems, and psychological problems. It then describes four main treatment lines - vasopressin-related drugs, antispasmodic agents, antidepressants, and odor modifiers. Specific drugs are discussed for each treatment line along with their mechanisms of action and dosages. Side effects and cautions are also provided. Urine retention in adults can be caused by obstruction, nerve problems, medications, or weakened bladder muscles. Treatment involves catheterization, urethral stents, medications to relax the bladder or prostate, and hormonal
This document discusses constipation in children. It defines constipation and notes that approximately 5% of schoolchildren suffer from it. The majority of cases are functional rather than organic causes. A history and physical exam are important to evaluate for constipation. Functional constipation is usually due to a low fiber diet, lack of exercise, painful bowel movements causing withholding, and a cycle that perpetuates harder stools. Organic causes include conditions like Hirschsprung's disease. Treatment aims to soften stool and promote motility through diet changes, behavioral modifications, stool softeners, and laxatives. Complications can include fecal impaction if left untreated.
Diarrhea is defined as an increase in stool frequency or liquidity. For infants it is considered diarrhea if there are more than 3 watery stools per day, while for older children it is 3 or more loose stools per day. The causes of diarrhea include viral, bacterial, and parasitic infections. Rotavirus is the most common cause of acute diarrhea in children. Treatment involves oral rehydration with solutions like ORS as well as continued feeding. For some cases antibiotics or zinc may be used. Prevention strategies include vaccines, handwashing, safe water, and breastfeeding.
This document provides information on acute gastroenteritis in children. It defines acute diarrhea as the passage of loose or watery stools three or more times in a 24 hour period for up to 14 days. It notes that diarrhea is a leading cause of death among children under 5 years old globally and in India. The document discusses the causes, clinical presentation, assessment and management of acute diarrhea including use of oral rehydration solution and zinc supplementation. It also covers prevention of diarrhea and malnutrition in children.
Neonatal seizures, dr amit vatkar, pediatric neurologistDr Amit Vatkar
In the presentaion i will give you a brief idea to apprach, diagnosis and management of neonatal seizures.
The most prominent feature of neurologic dysfunction in the neonatal period is the occurrence of seizures. Determining the underlying etiology for neonatal seizures is critical. Etiology determines prognosis and outcome and guides therapeutic strategies.
Neonatal seizures, dr amit vatkar, pediatric neurologist
This document provides information on childhood constipation, including its definition, diagnosis, and treatment. Constipation is defined as delayed or difficult defecation for two or more weeks. Diagnosis involves taking a detailed history and performing a physical exam. Treatment involves disimpaction followed by maintenance therapy, focusing on dietary changes, behavioral modifications, and medications like polyethylene glycol or lactulose. Special considerations for infants less than 1 year include increased fluid intake and avoiding certain laxatives.
This document discusses enuresis (bedwetting) in children. It covers the epidemiology, etiology, pathophysiology, clinical features, diagnosis and treatment of the condition. Enuresis is defined as repeated bedwetting in children over 5 years old. It occurs most commonly in boys and prevalence decreases with age. Treatment involves behavioral modifications like fluid restrictions and alarm therapy, as well as medications like desmopressin if needed. A positive attitude from parents and motivation from the child are important for treatment success.
This document discusses enuresis, or bedwetting, in children and adolescents. It defines enuresis as the involuntary release of urine during sleep, usually during the first third of the night. The document outlines the causes of enuresis including anatomical, endocrine, psychiatric, and sleep issues. It describes how enuresis should be evaluated through history, physical exam, and testing. Treatment options are also discussed including behavioral therapies, medication, and age-appropriate approaches. Statistics on the prevalence of bedwetting at various ages are presented in both paragraph and graph form. The conclusion emphasizes that enuresis can impact a person's life and should be properly diagnosed and treated based on their age.
This document provides an overview of encopresis, including its definition, epidemiology, etiology, clinical presentation, diagnosis, treatment, and prognosis. Encopresis is the involuntary passage of stool in children over 4 years old without direct physiological causes. It often results from chronic constipation and the retention of large stools. Diagnosis involves evaluating the child's bowel habits and conducting tests to rule out other causes. Treatment focuses on disimpaction and prevention of recurrence through increased fiber, laxatives, toilet training, and behavior therapy. Prognosis is generally good with resolution of constipation.
Wittle Leaks - GP's Guide to Management of Nocturnal Enuresis in ChildrenJohn Burke
This document presents a case of a 10-year-old girl with monosymptomatic nocturnal enuresis, or nighttime bedwetting without other urinary symptoms. Her examination and tests were normal. The document discusses the diagnosis, causes, and management options for childhood nocturnal enuresis, which commonly includes motivational therapy and enuresis alarms. Medical treatments like desmopressin may also be used but have higher relapse rates after stopping. Referral is recommended if enuresis does not improve after 8-12 weeks of treatment or if other issues are suspected.
Nocturnal enuresis is one of the commonest problems in childhood. This presentation contains details on prevalence, diagnostic criteria and treatment modalities.
ELIMINATION DISORDER AND EATING DISORDER.pptxNimish Savaliya
1) Elimination disorders like encopresis and enuresis are common in children and involve repeated soiling or bed-wetting past the age when continence is expected. Encopresis is often caused by chronic constipation while enuresis has genetic and developmental factors.
2) Feeding and eating disorders in children include pica, rumination disorder, and avoidant/restrictive food intake disorder. Pica involves eating non-food items and rumination involves regurgitating and rechewing food. These disorders can be caused by nutritional deficiencies, neurological issues, or psychosocial factors.
3) Treatments for these disorders include behavioral, educational, and pharmacological approaches. Behavioral treatments
Elimination disorders in pediatrics refer to problems with defecating and urinating in children. Enuresis is when a child fails to achieve nighttime bladder control by age 5. It can be primary or secondary. Encopresis is the repeated passage of feces into inappropriate places in a child over age 4. It is usually due to constipation and retention of stool (retentive encopresis). Evaluation involves assessing bowel and bladder habits, medical history, and physical exam. Treatment focuses on correcting constipation, education, behavioral modifications, and in some cases medication.
enuresis involves the inability to awaken from sleep in response to a voiding stimulus (i.e., a full bladder), coupled with excessive nighttime urine production or decreased functional capacity of the bladder
Enuresis is involuntary repeated discharge of urine after a developmental age when bladder control should be established. About 5-8% of school children are enuretic, with the incidence decreasing to 1% at age 18. Bedwetting is twice as common in males. Family history of bedwetting is positive in 70% of cases. Primary enuresis refers to those who have never been dry at night, representing 90% of cases. Nocturnal enuresis is more common than diurnal. Treatment focuses on proper evaluation, rewarding dryness, and avoiding punishment. Conditioning devices and medications like desmopressin or imipramine may help persistent cases but have high relapse rates.
Over Active Bladder ‘an enigma’ Dr Jyoti Agarwal Dr Sharda Jain Lifecare Centre
This document discusses overactive bladder (OAB), a condition that affects quality of life. It defines OAB based on symptoms as a syndrome characterized by urgency, usually with frequency and nocturia, in the absence of infection or other pathology. OAB is common but underreported and undertreated. Treatment involves behavioral modifications, pharmacotherapy such as antimuscarinics or the newer drug Mirabegron, which is better tolerated. While OAB was previously poorly understood, recent research has improved diagnosis and management, though it remains a challenging condition to treat.
Enuresis is repeated involuntary urination, typically occurring at night (nocturnal enuresis) in children age 5 and older. It can be primary, where the child has never achieved dryness, or secondary, where dryness was previously established. Causes include decreased physical development, increased nighttime urine production, inability to recognize a full bladder while sleeping, and anxiety. Diagnosis involves a medical history and physical exam to rule out underlying issues. Initial treatment focuses on lifestyle changes like proper hydration and voiding habits, as well as alarm therapy to train the child's bladder. Medications like desmopressin or anti-cholinergics may also be used, with desmopressin being
This document discusses bedwetting (enuresis) in children. It defines enuresis and notes that most children attain bladder control by age 5. It describes the different types of enuresis as primary or secondary. The causes are listed as maturational delay, hormone issues, sleep arousal problems, infections, or stress. Evaluation involves determining the type, checking for organic causes, and monitoring urine output. Treatment starts with lifestyle changes and alarm therapy. Medications like anticholinergics or desmopressin may be used if other methods don't work. The goal is to reassure the child and support attempts at bladder control rather than make them feel guilty.
This document provides an overview of common behavioral disorders in children. It discusses factors that influence child behavior such as heredity, environment and learning/conditioning. Common behavioral disorders mentioned include ADHD, autism, conduct disorders, eating disorders and sleep disorders. Specific behavioral issues seen in infancy, childhood and adolescence are also outlined. The document focuses on management of common conditions like repetitive behaviors, breath holding spells, thumb sucking, nail biting, bedwetting and enuresis. It emphasizes non-pharmacological approaches but also discusses medication options when needed. Overall the document covers a wide range of normal and abnormal behaviors seen at different developmental stages in children.
This document provides an overview of elimination disorders, specifically enuresis and encopresis. It discusses the diagnostic criteria, classifications, epidemiology, etiology, clinical presentation, course, treatment, and prognosis of each disorder. Enuresis is the repeated voiding of urine into inappropriate places, while encopresis involves repeated fecal soiling. Both disorders involve involuntary or intentional elimination issues and are commonly seen in children, with prevalence rates decreasing with age. Treatment involves behavioral, medical, and pharmacological approaches, with the goal of improving symptoms and prognosis over time.
This document discusses vesicoureteric reflux (VUR), which refers to the retrograde flow of urine from the bladder to the upper urinary tract. VUR can allow pathogens into the kidneys and cause infections and renal scarring. It is detected using cystography or radionuclide cystography and is graded based on severity. Treatment involves antibiotics to prevent infections while the reflux resolves spontaneously, though severe or persistent reflux may require surgery. Management aims to prevent infections and complications through medical or surgical means.
This document provides an overview of urinary tract infections (UTIs) in children from a surgeon's perspective. Some key points:
- UTIs are common in infants and children, especially girls under 5 years old. Boys are more commonly affected in the first year of life.
- Evaluation of a child with UTI includes a physical exam, urine culture, and consideration of imaging like ultrasound based on factors like age, symptoms, recurrence.
- Common causes of UTIs include anatomical abnormalities like vesicoureteral reflux, posterior urethral valves, or ureteroceles.
- Treatment involves antibiotics tailored to culture results. Children with recurrent UTIs or anatomical issues may
Elimination disorders involve the inappropriate elimination of urine or feces. The main types are enuresis (bedwetting) and encopresis (fecal soiling). Enuresis involves repeated voiding of urine during sleep in children age 5 or older, while encopresis involves repeated passing of feces in inappropriate places in children age 4 or older. Both disorders are usually caused by constipation and can be treated by clearing the colon of impacted stool followed by encouraging regular bowel movements and in some cases psychotherapy.
This document provides an overview of nocturnal enuresis (bedwetting), including:
- Historical treatments included using animal organs or inducing blisters, with limited effectiveness. Psychic treatment in the 1920s showed an 87% success rate.
- Enuresis is usually due to a maturational delay and resolves naturally by age 15. Evaluation looks for underlying causes but most cases are primary nocturnal enuresis without other issues.
- Treatment focuses on education, behavioral modification using star charts and alarms, and pharmacotherapy like imipramine or desmopressin acetate. The goal is improving self-esteem until natural maturation occurs. A multimodal approach tailored to the
This slide contains information regarding Childhood Psychiatric Disorders (Enuresis, Encopresis and Pica). This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
Enuresis is evaluated by ruling out organic causes through medical history and examination. Organic causes like urinary tract infections are more common in children with both nocturnal and diurnal enuresis. Treatment involves reviewing toilet training, restricting fluids, and behavioral interventions like conditioning with alarms. Medications like imipramine may help but relapse is common after stopping. Psychotherapy alone is not effective for short-term treatment of enuresis.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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3. Micturation reflexMicturation reflex
The micturition reflex is overridden by voluntary
control. Descending pathways from the cerebral
cortex can inhibit parasympathetic neurons and
stimulate motor neurons that excite the external
urethral sphincter and thus inhibit the micturition
reflex.
5. DefinitionsDefinitions
IcontinenceIcontinence:-:- Uncontrollable leakage of urineUncontrollable leakage of urine
Continuous intermittentContinuous intermittent
•Urine leakage inUrine leakage in
discrete amountsdiscrete amounts
• Applicable toApplicable to
children more thanchildren more than
5 years5 years
Constant urine leakageConstant urine leakage
Applicable to all agesApplicable to all ages
Associated withAssociated with
congenitalcongenital
malformationsmalformations
Night -time
Enuresis
Day-
time
6. Enuresis: DefinitionEnuresis: Definition
An involuntary wetting during sleep, at leastAn involuntary wetting during sleep, at least
twice a week, in children older than 5 yearstwice a week, in children older than 5 years
of age with no congenital or acquiredof age with no congenital or acquired
defects of the centraldefects of the central nervousnervous systemsystem
7. Enuresis: ClassificationEnuresis: Classification
Primary:Primary: The child has never achieved sustainedThe child has never achieved sustained
continence at night for a period of at least 6 monthscontinence at night for a period of at least 6 months
Mono-symptomatic
Without daytime symptoms
Non-mono-symptomatic
With daytime symptoms
SecondarySecondary: Bedwetting occurs after the child has
been dry at night for more than 6 months
11. Evaluation at the first visitEvaluation at the first visit
Primary with day-
time symptoms
Primary without
day-time symptoms
Secondary
bed wetting
Duration
Daytimesymptoms
13. Evaluation at the first visitEvaluation at the first visit
Primary with day-
time symptoms
Primary without day-time
symptoms
Secondary
bed wetting
14. Assessment of PrimaryAssessment of Primary
EnuresisEnuresis
The pattern of bedwettingThe pattern of bedwetting
Assessment of fluid intakeAssessment of fluid intake
Bladder diaryBladder diary
Bowel habitsBowel habits
Psychological assessmentPsychological assessment
comorbidities
15. The pattern of bedwettingThe pattern of bedwetting
How many nights a week does bedwetting occur?
How many times a night does bedwetting occur?
Does there seem to be a large amount of urine?
At what times of night does the bedwetting occur?
Does the child wake up after bedwetting
Functional
bladder disorder
Wets the bed
most nights
Ever wets more
than once a night
Wets small volumes
Nocturnal polyuria
Wets one or two
nights
Wet Large
volumes
16. Assessment of fluid intakeAssessment of fluid intake
Age (years) Volume (mL/day)
Boys Girls
4-8 1000-1400 1000-1400
9-13 1400-2300 1200-2100
14-18 1400-2500 2100-3200
17. Bladder diaryBladder diary
Bladder capacity= 30+(30 × age )mL
Low voided volumes [maximum voided volume <70% of the
expected bladder capacity]
Nocturnal urine production > 130% of the expected bladder
capacity
18. Bowel habitsBowel habits
• Bowel movement frequency, stool consistencyBowel movement frequency, stool consistency
• Faecal incontinenceFaecal incontinence
21. Assessment of PrimaryAssessment of Primary
EnuresisEnuresis
• Good historyGood history
• Physical examinationPhysical examination (bad general ,external(bad general ,external
genitalial neurological(occult spina bifidagenitalial neurological(occult spina bifida))
22. Assessment of PrimaryAssessment of Primary
EnuresisEnuresis
• Urine analysisUrine analysis
• Urine osmolalityUrine osmolality
• Lumbo-sacral x-rayLumbo-sacral x-ray
• Abdominal ultrasonographyAbdominal ultrasonography
• VCUGVCUG
• Urodynamic studyUrodynamic study
23. • Urine analysisUrine analysis (when):?(when):? if secondary , bad health, UTI??if secondary , bad health, UTI??
• No radiologyNo radiology
• No urodynamic studyNo urodynamic study
24. Should a 5-year-old child be activelyShould a 5-year-old child be actively
treated for enuresis?treated for enuresis?
If primary nocturnal enuresis is not distressing to the child,
treatment is unnecessary, although parents should be reassured
about their child’s physical and emotional health and counseled
about eliminating guilt, shame, and punishment. (Grade B)
25. Response:14 consecutive dry nights or a 90% ↓in no of wet nights/
week
Partial response:Symptoms improved but 14 consecutive dry
nights or a 90%↓in no of wet nights/ week
has not been achieved
26. Children under 5 years
Children more than 5
years
Treatment of PrimaryEnuresisTreatment of PrimaryEnuresis
29. General
DietFluid
intake
Toilet
pattern
Lifting
and
walking
Reward
advice
•Not the child's fault
•No punishment
•Reassurance (dry after a
given time)
•Children change their
bedding
Healthy diet
with no
restriction
Avoid caffeine-
based drinks
before going to
bed
urinate at
regular interval
during the day
and befor sleep
•Safe the bed only
positive rewards for agreed behaviour rather than dry
nights( fluid-toilet –management)
30. First line treatment
Alarm Desmopressin
an alarm is considered inappropriate, particularly if:
◆ bedwetting is very infrequent (that is, less than 1–2 wet beds per
week)
◆ the parents or carers are having emotional difficulty coping with the
burden of bedwetting
rapid-onset and/or short-term improvement in
bedwetting is the priority of treatment or
− an alarm is inappropriate or undesirable (see
recommendation
Alarm is the first line for
families who are well
motivated and well
informed
Do not exclude alarm treatment as an option for children and young
people with:
● daytime symptoms as well as bedwetting
● secondary onset bedwetting
31.
32. Start desmopressin
treatment
Is complete dryness
achieved after 1–2 weeks?
Assess response at
4 weeks
Continue
treatment for
3 months Stop
desmopressin for
1 week to check
whether dryness
has been
achieved(grdual)
Consider increasing dose
(240 –400)
assessment of factors
associated with poor
response
(adhernce,30%sleep
apnea ,constipation
, underlying disease
(urological proplems)
or social and emotional
factors
yes No
Respons
e
Partial
Increase the dose
Give the drug 1–2 hours
before bedtime restrict fluid
Continue treatment for
another 6 months
No
33. Management ofManagement of
RecurrencesRecurrences
• Another course of desmopressin (repeated courses may beAnother course of desmopressin (repeated courses may be
used)used)
• Regular withdrawal of desmopressin (for 1 week everyRegular withdrawal of desmopressin (for 1 week every
3 months)3 months)
• Gradual withdrawal of desmopressin rather than stopping itGradual withdrawal of desmopressin rather than stopping it
suddenly (increase of 'no-medication days' over an 8-weeksuddenly (increase of 'no-medication days' over an 8-week
period)period)
• Using an enuresis alarmUsing an enuresis alarm
36. Anticholinergic Drugs
bedwetting that has partially responded to desmopressin
alone
bedwetting that has not responded to desmopressin alone
bedwetting that has not responded to an alarm combined
with desmopressin
Do not use an anticholinergic:
● alone for children and young people with
bedwetting without daytime symptoms
● combined with imipramine
37. Oxybutynin: 5mg
assess 1–2 month?
Continue treatment for
3 months with
Gradual tapering
Respons
e
Partial
Continue treatment for
another 6 months
Have the greatest chance of success in the child with signs of detrusor
overactivity, i.e. low daytime voided volumes.
Repeated courses can be used
Doses can be doubled in over 12 years children
The main side effects are dry mouth, headaches, constipation, retention
of urine and very occasionally unusual behaviour or night terrors
40. ImipramineImipramine
How Is It Given?How Is It Given?
• Start as a low dose (25 mg for children > 6 years, 50
to 75 mg for children > 11 years) and increase
fortnightly to the maximum dose allowed for the age
of the child (50 mg in children 7 to 12 years of age
and up to 75 mg in older children)
• The single daily dose should be given around 3
hours before sleep
• A course of treatment should last for 3 months
maximum before reducing the dose slowly and
stopping it for a week or so to assess progress
41.
42. Take Home MessegeTake Home Messege
• The initial evaluation of the enuretic child should
focus on good history and with no radiology or
invasive procedures
• The first step in assessment is to exclude underlying
disorders, such as diabetes, kidney disease or
urogenital malformations
• The main goals of treatment are to increase the
number of dry night and to alleviate the emotional
impact of enuresis
43. Take Home MessegeTake Home Messege
• Positive reward systems have a better impact on the
enuretic child (Grade B)
• Bladder training, retention control training, and dry
bed training are no longer recommended
44. Take Home MessegeTake Home Messege
• Therapy is a stepwise process. Partial response is
better than no response
• The first-line treatment is the enuresis alarm or
desmopressin
• In therapy resistant cases occult constipation needs
to be ruled out
• The second line of therapy is anticholinergic
treatment combined with desmopressin
45. Take Home MessegeTake Home Messege
• In situations when all other treatments have failed,
imipramine treatment is warranted, provided the
cardiac risks are taken into account