![]() ![]() The paucity of data on long-term outcome after PUR contributes to these drawbacks. The incidence ranges from 0.18 to 14.6%, but the importance of prompt diagnosis and appropriate management is often underappreciated. This document can be made available in alternative formats on request for a person with a disability.Postpartum urinary retention (PUR) may cause long-term urogenital tract morbidity. Please call Perth Children’s Hospital Switch on 6456 222 to discuss referral with Paediatrician on call.Įssential information to include in your referral Routine non-urgent referrals from private hospitals go to the PCH Referral Office (Fax: 6456 0097 or email Urgent referrals (less than seven days) go to the PCH Referral Office.Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service.Children with neurodevelopmental disorders should be referred to Specialist Continence and Toilet Training - Therapy Focus (previously called PEBBLES).Abnormalities on Renal US suggesting possible neurogenic bladder require urgent referral to the Department of General Paediatrics for investigation and confirmation prior to Urology Referral.Children with ongoing symptoms despite three months of recommended fluid intake and time toileting, with no history of neurodevelopmental disorder, behavioural problems or untreated constipation. ![]() Children with ongoing bladder symptoms and a history of constipation who have been compliant with constipation treatment for at least 6 months and are no longer reporting symptoms of constipation.In children with nocturnal symptoms only, please see Enuresis in Children - Health Pathways WA.Consider referral to Paediatric Continence Physiotherapist.On school days, toileting should be timed to occur during breaks Timed toileting – the child needs to toilet regularly throughout the day and when they get symptoms of bladder fullness/urge.Fluid intake should be evenly spread across the day, starting on waking. Ensure child is meeting expected daily fluid requirements.Diagnose and treat constipation – refer to Constipation guideline.Mid-stream urine – rule out Urinary tract infection. Normal rectal diameter 3 cm highly suggestive of constipation).Post void residual volumes - 1cm is abnormal and requires referral to rule out neurogenic bladder).Expected bladder capacity in mL = (age +1) x 30 (adult = 400 mL).Renal tract ultrasound – include on request form pre and post void volumes, bladder wall thickness and rectal diameters: Download the Bladder and Bowel diary sheet (PDF).Bowel – measure and document fluid intake, and stool type and frequency over 7-14 days including any soiling.Bladder – measure and document fluid intake and urinary output over 24 hours including all episodes of incontinence on 2 occasions.See Constipation pre-referral guideline.Īttempting to treat nocturnal enuresis when daytime symptoms are present will generally be unsuccessful.īehavioural difficulties (especially attention deficit hyperactivity disorder) should be addressed prior to managing bladder dysfunction. If the constipation is not addressed, any intervention to treat bladder dysfunction will be unsuccessful. Constipation however mild, must be treated first, often resulting in resolution of the child’s bladder dysfunction symptoms. Normal voiding frequency is between 4 to 7 times per day.īladder dysfunction is very commonly associated with constipation. The most common types of bladder dysfunction are overactive bladder, voiding postponement and dysfunctional voiding.Ĭhildren should be dry during the day by the age of 4 years. Clinicians should also consider the local skill level available and their local area policies before following any guideline.īladder dysfunction refers to abnormalities in either the filling and/or emptying or the bladder which may be associated with urinary incontinence. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinical common-sense should be applied at all times. These guidelines have been produced to guide clinical decision making for general practitioners (GPs). ![]()
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