PERSONAL PRACTICE The management of urinary incontinence

Wetting presents in two forms, enuresis and incontinence. Enuresis is defined as wetting when no underlying anatomical or functional abnormality of the urinary tract can be detected. A diagnosis of incontinence implies the presence of an underlying anomaly that requires investigation and treatment. However, the diagnosis of incontinence in children is not simple. When an adult presents with wetting the diagnosis of incontinence is automatic, but most wetting children will be enuretic and in the majority spontaneous improvement is to be expected. Many children are labelled as enuretic and incontinence is missed. The art of paediatrics is to recognise the incontinent patient. This can be done in the majority of patients with a proper history, examination, and knowledge of the conditions that cause incontinence (table 1). Urinary and faecal dysfunction commonly coexist and both systems should be assessed and treated simultaneously. Before discussing the management of incontinence it is important to identify the clinical features that should alert us to the diagnosis.