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HISTORY

• Onset—primary versus secondary


• Nocturnal versus diurnal


• Has there ever been dry period even if only for weeks


• Frequency


• Pattern of urination
o Constantly wetting pants (dribbling)
o
o Frequent small urine
o
o Dysuria
o
o Frequency
o
o Hesitancy
o
o Dry when sleeping out

• Past medical history
o Obstipation, constipation, stool incontinence
o
o Behavioral, developmental history
o
o
o Toilet training history
o
o Medications
o
o
o Neurologic symptoms
o
o
o
o Other medical problems


• Family history
o One parent or two
o
o Is child aware?

• Social history • • • For whom is this a problem—parent or child? • • • Effect on child o Can he or she sleep out without embarrassment? o o Teasing at school o o Emotional effect • • Social changes o Divorce o o New significant other for parent o o o New sibling o o Household move o o Change in school o o Death or illness in family o o Other change in home environment • • Intervention o What has been attempted—treatment or punishment? o o o How effective? Physical Examination • Vital signs • • • • • • Growth parameters and pattern .

balanitis. vulvo-vaginitis. sensory. cremasteric reflex . peri-anal sensation. motor.• • Neurologic examination with fundoscopy—rule out intracranial pressure • • • • Abdominal examination—rule out masses especially renal mass • • • • • Genitalia—rule out adhesions. cutaneous signs of underlying defects • • • • • Neurologic examination—gait. DTR's. stenosis. anal wink • • • • Spine—bony defects. tone. foreign bodies • • • • Urinary stream • • • • Rectal examination—tone.