Enuresis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Spine [inspection of lumbosacral region (lumbar spine-cruciate region): presacral lipoma?, occult dysraphic signs (e.g., spina bifida occulta)?]
      • Genitals (Note: respect children’s sense of shame) [stenosing phimosis (foreskin constriction)?, labial synechiae (“labia adhesions)?]
      • Lower extremities
    • Auscultation (listening) of the heart
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • Neurological examination
    • Examination of:
      • Sensitivity in the breeches area
      • Bulbocavernosal reflex (S3-L5): extraneous reflex; triggering of the bulbocavernosal reflex by pinching the glans penis or clitoris. This leads to contraction of the pelvic muscles.
      • Anal sphincter tone and the anal reflex (S3-L5): extraneous reflex; triggering the anal reflex by brushing the perianal region with a spatula. This results in contraction of the sphincter (sphincter muscle).
      • Reflex and sensitivity differences in the area of the lower extremities.
    • Movement sequence, coordination
    • Toe and heel gait,
    • Balance test (one-leg stand and one-leg hop).
  • Psychiatric examination [due topossible secondary diseases:
    • Fears
    • Attention-deficit/hyperactivity disorder (ADHD).
    • Depressive disorders
    • Developmental disorders
    • Mental disorders, unspecified
    • Sleep disorders such as sleepwalking
    • Language development disorders
    • Social behavior disorders]
  • Urological examination [due topossible causes:
    • Chronic renal insufficiency (kidney weakness).
    • Double kidney with ectopic ureteral orifice
    • Malformations of the urethra
    • Tubulopathies (renal dysfunction due to tubular apparatus restriction)]

    [due toPossible sequelae: common urinary tract infections (UTIs), unspecified]

  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.