Rex Browne Anne Street Medical Centre

PHOs and capitation based funding wencourage GPs to adopt a broader view of health that includes:  Health screening and prevention.  Increased funding for children

Bedwetting is an orphan specialty falling between:  Urology  Paediatrics  Psychology  General Practice

Start with listening first.

A minimal examination would be  Observation of body habitus and nutritional state  Observation of self confidence, posture, and gait

 Psychosocial issues  Polyuria secondary to other illness  Neurological causes  Bladder based problems

Where there is suspicion of underlying problems  Abdominal palpation of bowel, bladder and kidneys.  Genital check, spine, neurological  Nose and throat check.  Urinalysis  Ultrasound

Bedwetting Assessment Urinary Infection Constipation Mono symptomatic Nocturnal Enuresis enuresis Child less than 7 yrs Not motivated Treat as per UTI guidelines Treat Inform, Advise and Reassure Episodic Needs ( 6 yrs or older) Offer Desmopressin Cure! Complex Enuresis Refer to Urologist or Paediatrician Enuresis Alarm with support program failed Bedwetting persists Relapse Repeat Spontaneous

 Persisting bedwetting  Incontinence in later life  Infertility in boys In association with the use of pull-ups

 Taking away the trainer wheels.  Scheduled waking.  Alarm training and variations thereof.

Enuresis consultant. Practice Nurse with an interest