Incontinence

I've just spent several hours going over a Pediatrics and Review article about incontinence. I spent some time pondering it because the general message seemed to be that a lot of incontinence is secondary, you work it up with a urine analysis and culture, and you treat most secondary incontinence with behavioral modification and a bowel regimen. In the end, though, it goes off the deep end talking about various types of daytime wetness (no longer called diurnal enuresis), and how some of them can progress to eventual renal failure.

Finally, I looked up the renal section in my trusty board review book...and it's not even mentioned. Must not be important on the boards. Still, a lot of parents come in for incontinence involving stool or urine or both. So it was useful. I think that in the future, I will a) do an H and P b) get a u/a, urine culture, and voiding bladder ultrasound to look at the postvoid residual, c) work the child up further if the postvoid residual is significant.

Abbreviations: U/A, UCx, PVR