Differential Diagnosis for a 7-year-old Girl with Bedwetting
- Single most likely diagnosis:
- Primary Nocturnal Enuresis: This condition is characterized by the involuntary urination during sleep in a child who is past the age of expected nocturnal bladder control, typically around 5-7 years old. The patient's history of being dry at night for the past year and then experiencing bedwetting could be a regression, possibly triggered by psychological factors such as her parents' divorce six months ago.
- Other Likely diagnoses:
- Secondary Nocturnal Enuresis: This is a condition where a child who has previously achieved nocturnal continence begins to experience bedwetting again. Psychological stressors, such as parental divorce, can contribute to this condition.
- Constipation: Although the patient denies changes in bowel movements, constipation can sometimes be asymptomatic or not readily acknowledged by children. Constipation can increase the pressure on the bladder, leading to urinary incontinence.
- Urinary Tract Infection (UTI): Despite the absence of reported symptoms like dysuria or hematuria, a UTI could still be present and contributing to the bedwetting. Children may not always exhibit typical symptoms of a UTI.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Diabetes Mellitus: Although rare in children, new-onset diabetes can cause polyuria leading to nocturnal enuresis. The absence of other symptoms like polydipsia or weight loss does not rule out this diagnosis.
- Neurological Disorders: Conditions affecting the spinal cord or brain, such as spina bifida or a tumor, can lead to urinary incontinence. These are less common but critical to diagnose early.
- Rare diagnoses:
- Sleep Disorders: Certain sleep disorders, such as sleep apnea, can increase the likelihood of nocturnal enuresis by affecting the normal sleep cycle and possibly increasing intra-abdominal pressure.
- Genetic Conditions: Some genetic conditions can predispose children to nocturnal enuresis, though these are less common and would typically be associated with other symptoms or a family history.