1: Psych - Enuresis and Encoparesis Flashcards
What is encopresis
Voluntary defecation in unacceptable places
When is encopresis not used as a term
- Not used under 4-years
- Not used if organic cause
What needs to be excluded in cases of suspected encopresis
Constipation with overflow
Which gender is encopresis more common
Males
What can cause children not to use potties
Developmental Delay
Constipation: Hirschsprungs, Anal fissure, Fear of defecation
Impaired recognition of need to defecate
Impaired behavioural management
Emotional disturbance: abuse
When are children usually toilet trained
18 months - 4-years
What is important in investigation of encopresis
History: behaviour towards toileting, Parent’s attitude towards problem
Exam: abdominal and rectal to exclude constipation. May need plain film AXR
Outline management of encopresis
- Make potty an non-threatening environment: musical
potty, use books - Reward chart: reward the child for sitting on the potty
three times a day after meals - Control constipation: high fibre diet, fluid and laxatives
- If child is smearing poo on the wall this is a sign of abuse and needs CAMS assessment
Define enuresis
Involuntary passage of urine, with no underlying organic cause, after 5-years in girls and 6-years in boys
How can enuresis be divided
- Primary enuresis
- Secondary enuresis
What is primary enuresis
Individual has had no period of urinary continence
What is secondary enuresis
Child has been dry for at least 6-months before
When is urinary continence usually established
4-years
What % of children still wet the bed by age 5
10%
What % of children still wet the bed by age 10
5%
What is a risk factor for primary enuresis
Family history (70% of children with primary enuresis will have a first degree relative who was affected)
What is thought to cause primary enuresis
Delay maturation of micturition centres
How can causes of secondary enuresis be divided
- Organic
2. Psychological
What are 4 organic causes of secondary enuresis
Renal: UTI, Strutural anomaly
Neurology: Spina Bifida, Epilepsy
Endocrine: DM, Diabetes Insipidus
Medication: chlorpromazine
What are 3 behavioural causes of secondary enuresis
- Behavioural Problems
- Abuse
- Often due to loss: moving hours, changing schools
- Or, witnessing trauma
What investigations are ordered for enuresis
- History - assess pattern and voiding habits
- Urinalysis and Urine MC+S
- US renal tract
What are conservative management of enuresis
- Encourage regular fluid intake. Only restrict fluid intake one-hour before bed
- Drinking-Voiding chart
- Reward chart - provide rewards for agreed behaviour (eg. not drinking fluid 1h before bed) and NOT a dry night
If a child under-7 has nocturnal enuresis, what is first-line management
Enuresis alarm
If child over 7 has enuresis what is first-line
Desmopressin
When is desmopressin indicated
- Enuresis alarm failed
- Child is over-7
