Medically Speaking: Enuresis (Nighttime Bedwetting), Jacqueline Guarino Broda, PA-C

Summary

Jackie Guarino Broda, a physician assistant in urology, discusses enuresis, commonly known as bedwetting, affecting children over six. She covers the definition, background, evaluation, and treatment options in the Texas Children's Hospital's Voiding Improvement Program. The talk emphasizes the importance of understanding the condition's causes, such as nocturnal polyuria and detrusor overactivity, and the impact on children's social lives. Various therapies, including enuresis alarms and medication, are presented, highlighting the need for a tailored approach considering the child's and family's needs and motivations.

Takeaways

• 🧑‍⚕️ Jackie Guarino Broda is a physician assistant in urology, focusing on enuresis (bedwetting) in children.
• 🛏️ Enuresis is a common issue, especially around school times, affecting children's participation in activities like sleepovers and camps.
• 👦 MG, a 9-year-old patient, experiences nightly bedwetting, causing anxiety about social events and school.
• 💧 Enuresis is defined as involuntary nighttime urination in children over six years old, with different types including primary and secondary.
• 👨‍👩‍👧‍ Bedwetting can have significant psychological and financial impacts on children and families, including laundry costs and embarrassment.
• 🧬 Enuresis has a genetic component, with higher likelihood if parents or relatives had it, but can occur in any child.
• 🌙 Nocturnal polyuria is a key factor in enuresis, possibly linked to reduced nighttime vasopressin secretion.
• 🚫 Bedwetting is not a result of poor parenting or laziness; it's a medical condition with various causes.
• 🏥 The Voiding Improvement Program (VIP) clinic specializes in treating enuresis with a comprehensive evaluation and tailored treatment plans.
• 📋 Voiding charts are essential tools for tracking symptoms and patterns to inform treatment strategies.
• 🛎️ Treatment options include enuresis alarms, desmopressin, and other medications, with the alarm offering the highest cure potential but requiring commitment.

Q & A

What is the main topic of the video script?

The video script discusses enuresis, also known as nighttime bedwetting, focusing on its definition, background, evaluation, and treatment options in pediatric urology.

Who is Jackie Guarino Broda and what is her role in the video?

Jackie Guarino Broda is a physician assistant in the division of urology at Texas Children's Hospital, and she is the speaker in the video, providing information about enuresis.

What is the significance of the Voiding Improvement Program (VIP) clinic mentioned in the script?

The VIP clinic is a specialized clinic at Texas Children's Hospital dedicated to patients with diagnoses such as enuresis, aiming to improve their condition through targeted treatment and support.

Why is enuresis a concern during the back-to-school season?

Enuresis becomes a concern during the back-to-school season because children may want to participate in social events like sleepovers or campouts, and they might feel embarrassed or anxious about bedwetting incidents.

How does enuresis impact a child and their family?

Enuresis can significantly affect a child's self-esteem and social life, causing them to hide their condition or avoid social events. It also puts stress on families, who may feel helpless and burdened by the extra laundry and costs associated with managing enuresis.

What is the medical definition of enuresis according to the script?

Enuresis is defined as discrete episodes of wetting at nighttime in a child who is six years or older, with the condition being classified as monosymptomatic nocturnal enuresis if it occurs without daytime symptoms.

What are some common causes of enuresis mentioned in the script?

Some common causes of enuresis include nocturnal polyuria, detrusor overactivity, high arousal threshold, small functional bladder capacity, constipation, stress, obstructive sleep apnea, and other comorbidities.

Why is it important to address daytime symptoms before treating nighttime enuresis?

It is important to address daytime symptoms first because they may be indicative of an underlying issue that, if unresolved, could complicate the treatment of nighttime enuresis.

What is the role of vasopressin in relation to nocturnal polyuria and enuresis?

Vasopressin plays a crucial role in reducing urine production at nighttime. Children with nocturnal polyuria may lack the increase in vasopressin that typically occurs at night, leading to increased urine production and potentially contributing to enuresis.

What is the significance of a thorough evaluation in the treatment of enuresis?

A thorough evaluation helps in understanding the patient's overall health, developmental milestones, urinary and bowel habits, and any potential contributing factors. This information is vital for creating a personalized treatment plan.

What are the first-line therapies offered for enuresis in the script?

The first-line therapies for enuresis mentioned in the script include the use of enuresis alarms and desmopressin (an antidiuretic hormone), both of which aim to reduce the frequency of bedwetting incidents.

How does the enuresis alarm work and what is required for its effective use?

The enuresis alarm works by detecting moisture in the child's underwear and triggering an alarm to wake the child. For effective use, the alarm must be used consistently every night for several months, and parents may need to assist children with a high arousal threshold to wake up and use the bathroom.

What precautions should be taken when using desmopressin?

Desmopressin should be taken an hour before bedtime with a sip of water, and the patient should avoid drinking water until waking up in the morning or at least eight hours later to prevent hyponatremia, a potentially serious side effect.

What is the role of oxybutynin in the treatment of enuresis?

Oxybutynin is an anticholinergic medication that can be used as a second-line therapy for enuresis. It works by decreasing bladder spasms and increasing the functional bladder capacity, helping to reduce leakage.

What is the significance of involving other specialties in the treatment of enuresis?

Involving other specialties such as endocrine, ENT, or psychiatry can be crucial for addressing any underlying conditions or comorbidities that may be contributing to enuresis, ensuring a comprehensive approach to treatment.

How does the script emphasize the importance of patient and family education in managing enuresis?

The script emphasizes the importance of educating patients and their families about enuresis, its causes, and treatment options. This education helps to alleviate guilt, remove misconceptions, and empower them to make informed decisions about their treatment.