Table 2.

Important physical examination and urinary test findings in children with enuresis

Strategy	Observation/test	To check for
1 (minimal)	Body weight and height	Growth retardation and/or failure to thrive suggestive of an underlying disorder
1 (minimal)	Genital examination—including examination of underwear	Physical abnormalities: hypospadias, phimosis, labial agglutination. Signs of fecal incontinence
1 (minimal)	Inspection of lumbosacral spine	Occult spinal dysraphism: dimple, lipoma, hypertrichosis, or sacral agenesis
1 (minimal)	Urine dipstick test	Glycosuria, infection (leucocyturia, nitrite test), hematuria, and proteinuria
2 (extended evaluation)	Rectal palpation if acceptable for child, parent/care giver	Fecal masses; left bowel palpation may be more acceptable to family
2 (extended evaluation)	Neurological examination (size, tight heel cords, hammer, or claw toes)	Signs and symptoms suggestive of lower spinal cord dysfunction
	The neurologic exam should include assessment of posturing with a stress gait or mirror movements	CNS abnormalities suggestive of a central cause

CNS central nervous system