Rex BrowneAnne 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 perUTI 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