Evaluation

Kiddoo (2012) does a nice job synthesizing what evaluation needs to occur in a child that presents with bedwetting. Often times families tell me that their primary provider is not worried about their bedwetting and they’ve done nothing to diagnose or treat them. This often times is not true. A well-child examination and relationship with the patient will give you 90% of the information you need to evaluate a bedwetter.

  • History: If you’ve been seeing your provider for a while they know your families general medical history and any other concerning problems that your child has. If it’s a new provider they should ask if your child has any daytime urinary symptoms, history of urinary tract infections, history or current constipation, spinal issues, problems walking or kicking a soccer ball. Reviewing current sleep patterns and problems such as snoring is also important.
  • Social History: It’s important to know if there are any stressors in the child’s life that might be contributing. I also like to know if the wetting is affecting the child emotionally.
  • Examination: They should have their abdomen palpated, back, and genitals examined. They will look for generalized edema. Also, watch the child walk around the room to identify gait abnormalities.
  • Testing: Children that have no other symptoms should have a urinalysis completed and nothing more. This is adequate to look for infection, glucose in the urine and protein in the urine.

Often times primary care providers have been seeing their patients throughout their childhood and they already have the information they need about the child. They’ve been collecting this information in pieces throughout the years. It’s rare that I find something on exam that the primary provider has missed when it’s come to bedwetting. The part that is lacking is the amount of time the primary care provider can spend with the family educating them about the treatment options. That’s where we come in. All the information we have here is based on the latest literature. Once you have been reassured by your primary provider that there are no red flags it’s Time to be Dry.

Kiddoo D. A. (2012). Nocturnal enuresis. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(8), 908-11.

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