小儿尿失禁及遗尿精品课件

小兒尿失禁及遺尿 的照護及處置,彰化基督教醫院 戴慧龍,Development of Bladder Control (I),Before 1-year-old: - No voluntary control of voiding and have little sensation of either filling or voiding. The first year of life: - Developing sensation - Witness by levels of discomfort when the bladder is full and relief when they void.,Development of Bladder Control(II),Before 2-year-old - Numbers of voiding episodes per day decreases from about 20 to around 10. 2-4 years of age(toddlers) - To develop true bladder control - The first manifestation of this control is the ability to defer the desire to void,Development of Bladder Control (III),Preschoolers (4-6 years of age) - Completely trained during the day - Occasional daytime wetting are not unusual - Occasional wetting ( once every few weeks) should be tolerated. - If occurs once per weekEvaluation,Development of Bladder Control (IV),Normal school-age children -Should have uniform daytime continence -Should be able to conform to school schedules and void at the times approximate with their peers - Recurrent daytime wetting is always abnormal and deserves medical attention.,The general order of development of urine and fecal continence,Nighttime fecal control Daytime fecal continence Daytime urinary continence Nighttime urinary continence,Incontinence is also called Enuresis,Primary enuresis refers to wetting in a person who has never been dry at least 6 months. Secondary enuresis refers to wetting that begins after at least 6 months of dryness. Nocturnal enuresis refers to wetting that usually occurs during sleep( nighttime incontinence) Diurnal enuresis refers to wetting when awake( daytime incontinence).,尿床身體的自動淨水處理廠出狀況了！,突然發生的尿床，只有在太累、不舒服或經歷令人難過的事時才會尿床者，稱為短暫性尿床（Transient wetting） 幾乎每晚都會發生的尿床，稱為持續性尿床（Persistent wetting） 一個晚上尿床好幾次，稱為多發性尿床（Multiple wetting） 不論白天或晚上都會尿床，稱為混合型尿床（Bedwetting with associated day wetting）,Causes of Childhood Incontinence,Bladder outlet obstruction Constipation Detrusor instability Diabetes mellitus Diabetes insipidus,Ectopic ureter Infection Neurogenic bladder Sleep disorder Psychologic stress Vaginitis,Neurogenic causes of Incontinence,Congenital Spinal dysraphism Tethered cord syndrome Acquired Spinal cord tumors Pelvic surgery Transverse myelitis Spinal cord injury,What Causes Nighttime Incontinence?,After age 5 at night. More common in boys Causes: - Slower physical development - Excessive output of urine during sleep - Anxiety - Genetics - Obstructive sleep apnea - Structural problems,What Causes Daytime Incontinence?,More common in girls Tend to disappear much earlier than the nighttime versions. Causes: - Overactive bladder - Infrequent voiding,Causes of Day and Nighttime Incontinence,A small bladder capacity Structural problems Anxiety-causing events Drinks or foods that contain caffeine, which increases urine output and may also