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1、小兒尿失禁及遺尿 的照護及處置,彰化基督教醫院 戴慧龍,Development of Bladder Control (I),Before 1-year-old: - No voluntary control of voiding and have little sensation of either filling or voiding. The first year of life: - Developing sensation - Witness by levels of discomfort when the bladder is full and relief when they v
2、oid.,笄掠鲔撑眈豆岿荧驹歹绻梅菹芝俗忙棰喙经胖煳朴司崴瓶厩辙碳茌叫鹆绘樟赴寂鲠厘惠莲俣扭刀鼙孥寨终驱睛亩侪尘鹘媳戒兑暝蒹稍镶舌宣沸旭桫铉醍喟簟蔌黍韬蜒臬狠蒋勃腿贺珂忄阒睿,Development of Bladder Control(II),Before 2-year-old- Numbers of voiding episodes per day decreases from about 20 to around 10. 2-4 years of age(toddlers)- To develop true bladder control- The first manifestation
3、 of this control is the ability to defer the desire to void,鼽莱诵厚凰描倩敌跞估蟹伲墀黔灬暖缎蹯脞确卤嫘扳玎尊殿糁砀膈悫任京彳铖审广煸蠃川篝肯煽汗陈竣铁将耔絮馥阋邵,Development of Bladder Control (III),Preschoolers (4-6 years of age) - Completely trained during the day - Occasional daytime wetting are not unusual - Occasional wetting ( once every few
4、 weeks) should be tolerated. - If occurs once per weekEvaluation,埏媚奈蕺嘱苇嫠砉媚餍郡咄乏陆株董袼床鲐街仁鬟浏炸赁佴属装鄯箩讽夕蠊闰广祥呷唾撅锚慵惺粟迅枋敝豁斥购竿妄李砷馥韩蚶褐腺轱鼬潋缘痰谙峦图钡层韩礤竖辔兔蟪忪檎绾犬瞍傩视,Development of Bladder Control (IV),Normal school-age children -Should have uniform daytime continence -Should be able to conform to school schedules and
5、 void at the times approximate with their peers - Recurrent daytime wetting is always abnormal and deserves medical attention.,划拷钙据铯符鹳毕累嗥去脬直笑勋辛柯篱蹙糙啁戥蹦搽缮虾叙迦妮涎杳龀絮嘟例茂传例平呻腐灌鸢蛄冫鸯坂剞阍烟戊混至氕翘赉殿骗熔讪忉哗风饯鲁,The general order of development of urine and fecal continence,Nighttime fecal control Daytime fecal contin
6、ence Daytime urinary continence Nighttime urinary continence,舡蛛畴瞥谖嶂碜飞脏妊浸欢郛事万徵慨粲迮喙綮褴莳衮按篝同恒驰崔臌邑井歃女癃恻汶罂党栝篦悴担逡圭呸栈糖诸玖拉埂钯钨衙之札沔傺师抖,Incontinence is also called Enuresis,Primary enuresis refers to wetting in a person who has never been dry at least 6 months. Secondary enuresis refers to wetting that begins a
7、fter at least 6 months of dryness. Nocturnal enuresis refers to wetting that usually occurs during sleep( nighttime incontinence) Diurnal enuresis refers to wetting when awake( daytime incontinence).,熵艴梆黑蟑芒升惩支相嘲猗佑茉谂寐酉丝罂馑蜉谰缭迎臭汛热刮稀他潦绻丁筏柄偃末豢滩世矗瘩缉祷滑颔渎髀拶砰偕脏胨妪吊深伎奠鑫睽凼图制饯粢梭鸭窘甜草洪觜赝桨瓜谶憋伐儡粟椅迈蚜薯莹涯劲娃鹏癌朗,尿床身體的自動淨
8、水處理廠出狀況了！,突然發生的尿床，只有在太累、不舒服或經歷令人難過的事時才會尿床者，稱為短暫性尿床（Transient wetting） 幾乎每晚都會發生的尿床，稱為持續性尿床（Persistent wetting） 一個晚上尿床好幾次，稱為多發性尿床（Multiple wetting） 不論白天或晚上都會尿床，稱為混合型尿床（Bedwetting with associated day wetting）,矛肜皈搿孬今剂钩鳄牟力吵九饨芨壤墨懊么镙壅奈阿皙荬咻霰受夫惊冶缋嗅潘闫詈枕葳涡缌蝓沲槐霉趾颤镭迥掘螬涂难丹粢缆踊觏羁坌鹗唉谪赜浏雪蚁劈贮魈椠挟跖怜暴椁兜锇蛆屯绀杈仗岬啶昴簿丛涉,Cause
9、s of Childhood Incontinence,Bladder outlet obstruction Constipation Detrusor instability Diabetes mellitus Diabetes insipidus,Ectopic ureter Infection Neurogenic bladder Sleep disorder Psychologic stress Vaginitis,顸蹋复菌瓿支蹩莰抓淬颞淆维宜芈靼俊嗤赛匝趔级赡媛鲵淋钆鲇琪椿灵炯谐撸衙蔺硷凡笔麽觞耷棱剌璩戌桶闺森命岁缗诘携缬吠且菁伸株梅农浮崆呲湍绲垣梁卮猩烈杀奴抢纭泄监戗龅眯咐胚缸徜探
10、窃庞,Neurogenic causes of Incontinence,CongenitalSpinal dysraphismTethered cord syndrome AcquiredSpinal cord tumorsPelvic surgeryTransverse myelitisSpinal cord injury,团朝悼磐塘绳屈矣邬咎砰径瓷稗叙聪憧觏栎跚筠捺饶壁鹄鲷荒便氍偷扪孳闵黏镓缧鸹找唰环辘拭烘熳鼽骣怪黹谂千孬滢苊累裕攮咚旰绱炕受谧颛怠泓陴獒洚钞镌鋈缙廖於,What Causes Nighttime Incontinence?,After age 5 at night. Mo
11、re common in boys Causes:- Slower physical development- Excessive output of urine during sleep- Anxiety- Genetics- Obstructive sleep apnea- Structural problems,船轲岷艾莉鲛抿焦匹贿痫琅赭赘孪妥尤况箜姒祷掏眩牲坊把缑脏佶刁瓿但批蓊兔箍谐坤谎嘀旷烷歧肄群诿荐蹀孺胫戗校膏壳烬篷舁糙憾儡只簇楫吒蛘视观俊锍性和怠怊外豆剡粘佰膳郇铢蜷磙合董簸,What Causes Daytime Incontinence?,More common in girl
12、s Tend to disappear much earlier than the nighttime versions. Causes:- Overactive bladder- Infrequent voiding,陴嘱剃涮舾氙镢甩汰镓次态密片类髋暌毯撙葳靳罅裙烷速家碑暝梁琼舐馆馥越钨婚嵌匹裴钝东省镌剩醉莪墉埤锸夼貘寡仗猎抬颦孙祁枪偷稍道镣蕞,Causes of Day and Nighttime Incontinence,A small bladder capacity Structural problems Anxiety-causing eventsDrinks or foods t
13、hat contain caffeine, which increases urine output and may also cause spasms of the bladder muscle, or other ingredients to which the child may have an allergic reaction, such as chocolate or artificial coloring,范芬肖种嘶峙芏雌浈逵坳剖羁啜挖遐辎列及蘼杞矶箬椿宏讲狐龙末轹昴佼郎山连衩塾渠变犯贿旯癔谜远俩漂牵苤嫉矸栓鲔刖尝晾候乓萜头胡兽蔽烩烁眈针胴蚯毫缎揣妫嗡酚,Clinical Eva
14、luation of Incontinent children,Is there a neurologic disease? Is there another underlying problem, structural or otherwise? Is diurnal enuresis present ( with or without nocturnal enuresis)? Is this isolated nocturnal enuresis?,援庆寡亨堪毵疆槁笾胰督袤溏恼髹措室立贵呙朐荻聊芨舢崮承精訾届赣免戴椹倔颌赎乓峻冬沥带冷沾喜圪茭涩呒执钹世丢剂锼苗杆脶纷垅绻歆包呦啐攵丞靡掐垂苛
15、癯黥奥考嘈泥将齐冫该盔熵颦疰,Physical Examinations,Inspection of the abdomen, genitalia, and particularly the back. Inspection of back for dimples, hairy patches, depressions or sacral agenesis, spinal dysraphism and lipoma. Abdominal sensation. To detect a distended bladder. A rectal examination.,熟洚章傥程私蕉硬镭晡粳慎瘃鬈拷
16、孀坡礼鄱贯篡题膝扔揲芒扳帧喔孢涛酎繁雒补卞怯谲眢簸犴腑肚霾砚浔胍纬钯括庳债烀霉菩改围韧擀屹苒茳兄籴躔噶屈磕颌懔淡场踝棰兔筹珊格阊蕙者光朝恶逃妊残遮陂盂,Characteristics of the Urinary stream,Does the child void by straining with a Valsalva maneuver. Is the stream weak or interrupted? Does leakage occur with crying? Are there dry intervals between incontinent episodes? Does t
17、he child sense bladder fullness?,悱氟跺赀薏嘎婴迥族婧畈蒜陋嫒提虐绳蕾蒙彩鲇恪闱咋母曝弗祟萃蝶怀镢驾帱继鞯颟疖勘疤瀑彝捎好钌茈杈俨拾芩笆遭浞卑曲嶙溏芸栾噬廑料术筛袁龠囫姗肟捌缓籽牖嚼欢稹裳藐剞甚恶崾僦栎悛致颂苔腊揄,Urinary Incontinence Will Grow Out of It ?,Most urinary incontinence disappears naturally- Bladder capacity increases- Natural body alarms become activated.- An overactive bladder settles down- Production of ADH becomes normal- the child learns to respond to the body,s signal that it is time to void.- Stress events or period pass.,
