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Important aspects of the history for a child with enuresis

Important aspects of the history for a child with enuresis
Historical feature Possible significance
Daytime symptoms Dysfunctional voiding
Lower urinary tract symptoms (voiding ≥8 or ≤3 times per day, hesitancy, straining, weak stream, intermittent stream, incomplete emptying, postmicturition dribble, genital or lower urinary tract pain) Dysfunctional voiding or anatomic abnormality (eg, posterior urethral valves)
Prolonged period of dryness (>6 months) Secondary enuresis more often associated with psychologic comorbidities
Frequency of episodes Nightly enuresis is associated with persistence
Change in frequency of episodes over time The natural history is of spontaneous resolution
Approximate volume of enuretic void Estimate of bladder capacity
Fluid intake diary May suggest etiology of nocturnal polyuria (increased afternoon/evening fluid intake; diabetes mellitus; diabetes insipidus; psychogenic polydipsia)
Stooling history Constipation may contribute to decreased bladder capacity
Review of systems May identify previously undiagnosed medical condition that contributes to enuresis
- Snoring - Obstructive sleep apnea
- Weight loss, fatigue - Diabetes, kidney disease
- Gait abnormalities - Spinal dysraphism
- Staring spells - Seizure disorder
- Perianal itching, vulvovaginitis - Pinworms
- Excessive thirst, nighttime drinking - Diabetes, kidney disease, psychogenic polydipsia
Family history of enuresis Genetic factors may be contributing
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