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Aim: To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic., Methods: We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December 2014. A random sample of 1000 children was selected from 2022 patient records, and data were collected on weight, height, age, gender, UI parameters, bowel habits and medical history. Associations between predictors (weight categories, gender, snoring, constipation, faecal incontinence) and outcomes (daytime urinary incontinence (DUI) and nocturnal enuresis (NE)) were examined using χ 2 tests and logistic regression analysis., Results: A total of 862 children were included in the study; 54% were male, and 28% were overweight/obese. No evidence of difference was found between the underweight/normal and overweight/obese weight children with NE (34 vs. 39%), DUI (7 vs. 9%) or combined NE and DUI (58 vs. 52.1%), P = 0.23. The frequency of NE (83 vs. 82%, P = 0.56) and DUI (52 vs. 58%, P = 0.20) was similar between the weight groups., Conclusion: In a large cohort of children presenting to a tertiary incontinence clinic, weight was not associated with the type or frequency of UI., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background and Objectives: General practitioners (GPs) often see children with enuresis and daytime urinary incontinence, and adults with persistent enuresis. The aim of this study was to assess Australian community health practitioners' knowledge and experiences with managing these conditions., Method: Health practitioners were surveyed about their knowledge and experience managing urinary incontinence that begins in childhood. Associations between participant characteristics and knowledge/experience were examined using chi-square tests., Results: The 1495 participants were mostly female, experienced, GPs who worked in a metropolitan area and/or saw patients with incontinence infrequently, but felt knowledgeable and confident about management of incontinence. Correct survey answers were given by 93% of participants for managing enuresis, 81% for daytime urinary incontinence (with 18% choosing inappropriate and potentially dangerous responses), and 61% for managing enuresis that has persisted into adulthood., Discussion: Better education is needed for GPs regarding management of urinary incontinence that begins in childhood, particularly for daytime incontinence in children and enuresis that persists into adulthood.

Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare outcomes between alarm monotherapy and multi-modal treatment for enuresis and to identify predictors of treatment failure. Consecutive children with enuresis were referred to an alarm clinic or a multi-disciplinary clinic and followed over 1 year. In the alarm clinic, children received bed alarm therapy for 3 months. In the multi-disciplinary clinic, children were assessed and advised regarding fluid consumption, with treatment of daytime bladder symptoms and bowel dysfunction. Persisting enuresis after daytime symptoms were addressed were treated with alarm therapy. From January 2003 to December 2004, 269 children were referred - 86 to the alarm clinic and 183 to the multi-disciplinary clinic (of which 56% received alarm therapy). Groups were similar at baseline (mean age 9 years, 65% boys and 86% primary monosymptomatic nocturnal enuresis), but more from the multi-disciplinary clinic had previously received enuresis treatment (79% vs 59% p=0.001). There was no difference in outcomes between groups at completion of treatment (51% versus 66% dry, p=0.07) and at 12 months (65% versus 60%, p=0.7), but more from the multi-disciplinary clinic were lost to follow-up. Those who received multi-modal treatment incorporating alarm therapy had improved outcomes compared with alarm monotherapy (78% versus 51% dry, p=0.01). Children previously treated with desmopressin (OR 0.11), bladder training (OR 0.35) or who had a history of soiling at presentation (OR 0.28) were less likely to respond to treatment. It was concluded that, in a multi-modal treatment approach, delayed commencement of alarm therapy may affect treatment outcomes. [ABSTRACT FROM AUTHOR]