There is a wide variety of causes responsible for Nighttime incontinence. Such causes and risk factors can be classified on the basis of origin that is primary causes and secondary causes. Primary causes are those which have no already known cause or disease directly responsible for this disorder and it is known as idiopathic causation.
Who Is At Risk For Night Time Incontinence?
Nighttime incontinence risk factors include genetic inheritance, presence of family history in upper generations or siblings, psychological disturbances, low self-esteem, introvert personality, autistic disorders, etc.
Other causes are those which act as precipitating cause responsible for the condition, few of which are, urinary tract infections, bladder inflammation, neurogenic bladder, dysfunctional voiding of urine, type 1 diabetes mellitus, congenital urinary tract abnormalities like urethral obstruction, ectopic vesicae, etc. Secondary risk factors involved in the nocturnal incontinence are constipation, overactive bladder, hesitancy in voiding urine, incorrect posture, altered food and drinking habits, sleep-disordered breathing, obstructive sleep apnea, altered sleep pattern, etc. Another common psychological cause found in association with nighttime bedwetting is attention deficit hyperactivity disorder which occurs due to lack of concentration and attention despite having the normal intelligence quotient.
The presence of risk factor or the cause can be assessed by adequate history taking from a reliable source like parents or guardians. Most importantly parents should be asked for emotional, behavioral or personality changes in the child before and after the starting of such episodes and any precipitating psychological cause running in the family-like conflicts, history of abuse, bullying in the school, punishment from the teachers, etc. Parents should then be asked for hydration history, toilet training, sleep pattern, food and bowel habits, daytime voiding pattern, nutritional history, history of family with similar complaints, number of bed wetting episodes, estimated timing of the episode, etc.
A comprehensive physical examination should be done before opting for any investigations so as to rule out the obvious causes that can be detected on the general examination like measurement of blood pressure, assessment of skin at or around the external genitalia, suprapubic regions, abdominal examination, anal reflex testing, etc.
Is There A Blood Test For Nighttime Incontinence?
The investigations done for assessment are urine analysis, urine culture, ultrasonography, micturating cystourethrogram, voiding cystourethrography, urodynamic flow studies, uroflowmetry, magnetic resonance imaging, cystoscopy, etc. These all help to rule out genital and urinary tract abnormalities as well as infectious causes responsible for nighttime incontinence.
Blood-related investigations are usually not required because most of the cases gets diagnosed either clinically or on urine related studies but if even then the diagnosis is incomplete then a few blood tests can also be done to rule out systemic causes responsible for the condition, although, these are very rare. Blood glucose levels for type 1 diabetes mellitus, antidiuretic hormone levels for diabetes insipidus, kidney function test for renal abnormalities, adrenocorticotropic hormone levels for Cushing syndrome, aldosterone levels for Conn’s syndrome, concentration of drug in blood for drug-induced causes etc. can all be performed as blood tests for final diagnosis.
The children having a genetic predisposition, family history in earlier generations or siblings of the parents, psychological factors reducing the self-esteem of the child, history of abuse, behavioral disorders, physical abnormalities, etc. are more prone to suffer from nocturnal enuresis popularly known as nighttime incontinence.
Nighttime incontinence usually does not require any type of blood testing because it is an easy diagnosis that can be formed on the basis of history and examination by the parents or the patient. Also the most common cause is idiopathic and psychological factors play an important role in the risk involved for bed wetting which cannot be measured by blood testing or any other investigation. Only the refractory cases not responding to psychological as well as medical therapies should be investigated further for rare causes for which various blood test and urine analysis may be required.
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