Differentials
Congenital abnormality of the urinary tract (e.g., ectopic ureter, ureterocele, and urethral valves)
SIGNS / SYMPTOMS
Urinary tract infections, continuous incontinence or dampness, hydronephrosis, and daytime voiding dysfunction are differentiating clinical features from enuresis.
INVESTIGATIONS
Renal and bladder ultrasound; voiding cystourethrogram.
Constipation
SIGNS / SYMPTOMS
Fecal incontinence, hard stools, and blood per rectum suggest primary constipation as a possible cause for urinary symptoms.
INVESTIGATIONS
Fecal markers (radiopaque markers that are given on 3 consecutive days to evaluate constipation) and kidney, ureter, bladder x-ray, or ultrasound scan will demonstrate constipation.
Diabetes
SIGNS / SYMPTOMS
Glycosuria and polyuria. May also present with weight loss and polydipsia, which are distinguishable clinical features.
INVESTIGATIONS
Urinalysis; fasting serum glucose; HbA1c.
Detrusor overactivity
SIGNS / SYMPTOMS
Daytime urinary frequency, urgency, and possibly daytime incontinence.
INVESTIGATIONS
Urodynamics; bladder ultrasound may demonstrate a thick bladder wall.
Detrusor areflexia
SIGNS / SYMPTOMS
Daytime urinary infrequency and overflow incontinence.
INVESTIGATIONS
Urodynamics; bladder ultrasound may demonstrate thin bladder wall, enlarged bladder, or incomplete emptying.
Emotional disturbance
SIGNS / SYMPTOMS
Depression and/or defiant activity may be overriding features together with urinary symptoms; not always easy to distinguish as may occur simultaneously.
INVESTIGATIONS
Diagnosis is clinical.
Neurologic disorder leading to voiding dysfunction (i.e., spina bifida; epilepsy)
SIGNS / SYMPTOMS
Daytime voiding dysfunction primarily, as opposed to nocturnal symptoms. In spina bifida there is sacral deformity. Epilepsy is usually defined by occurrence of at least 2 unprovoked seizures and may be associated with incontinence. Consider tethered cord in cases of secondary nocturnal enuresis with new lower extremity weakness.
INVESTIGATIONS
Tests depend on underlying condition, and diagnosis may be clinical. EEG may show typical abnormalities in epilepsy. Spina bifida may be shown by x-ray, CT, or MRI scan.
Urinary tract infection
SIGNS / SYMPTOMS
Fever, dysuria, and abdominal pain.
INVESTIGATIONS
Urinalysis and urine culture will be positive for culprit microorganisms.
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