2.2 Urinary & Faecal Incontinence Flashcards
Enuresis is?
Urine for
>2/week
>3/month
Older than 5years
Encores is?
Faecal for:
>1/month for
>3/month
Older than 4years
In 5-12 year olds, what is % for nocturnal enuresis?
20%
What is monosymptomatic unuresis?
Treatment?
No daytime symptoms
Treat with bed alarm
Or desmopression
What is non-monosymptomatic unuresis?
Treatment?
Daytime symptoms +/- incontinence
Treat underlying problem
What is primary bed wetting?
Always wet at night
What is secondary bed wetting?
> 6months of night dryness previously
Significance of secondary bedwetting?
Likely to have an underlying pathology
What are 3 main factors for nocturnal enuresis?
Bladder size
Urine volume
Sleep-arousal
Risk factors for secondary nocturnal enuresis?
Psychological
Organic: UTIs, Diabetes, emotional stress)
Things to ask urinary incontinence details?
Day or night time or both? Continuous or intermittent? How often? How severe Urgency? Frequency? Nocturnal polyuria? Toilet posture School practices
Examination of child with nocturnal enuresis? Lumbar region?
Dimple/hair patch/skin change
?neurogenic?
Examination of child with nocturnal enuresis? Abdo?
faeces palpable?
Examination of child with nocturnal enuresis? Neurological?
Gait, reflexes, anal tone
Examination of child with nocturnal enuresis? External genitalia?
Inflammation
Labial adhesion
Meatal stenosis
What investigations for nocturnal enuresis?
MSU for UTI
Time and volume charts
Flow studies
What is normal expected max voided volume in child?
(Age +1)x 30mls (max of 390ml)
What is nocturnal polyuria formula?
EMVV x 1.3
Max: (450ml)
EMVV: (Age +1)x 30mls (max of 390ml)
What is urotherapy?
Fluid + regular voiding
Voiding posture
Constipation
Maybe anticholinergics
What anticholinergics can be used for nocturnal enuresis?
Oxybutynin
Tolterodine
Solifenacin
Treatment of choice for nocturnal enuresis?
Bed alarms
Desmopressin
How long does bed alarm take to work?
Usually 2-3 months
Why do some kids fail alarm training?
Don’t wake Don’t respond Probs with attaching to body Wearing pants Training time not long enough
What is voiding postponement?
Hold peeing
Then urgency/fluid restriction
<3voids/day
Treatment: timed voiding
What is most common cause of daytime urinary incontinence?
Overactive bladder: 70%
Overactive bladder is associated with what other condition?
Constipation
Overactive bladder treatment?
Anticholinergics(oxybutynin, tolterodine, solifenacin)
TENs
What is dysfunctional voiding?
Contraction fo external urinary sphincter during voiding
What is vaginal reflux?
Leakage 5-10minutes after void
Anatomical predisposition
What is treatment of choice of vaginal reflux?
Straddle the toilet
What is pollakiuria?
> 20 small voids per day
Disappears in sleep
Cause of pollakiuria?
Recent stressor usually >50%
Treatment for pollakiuria?
Self limiting
Reassure
What is giggle incontinence?
When laugh COMPLETELY empty bladder
Uncommon
Stress incontinence in children common?
Very rare
DDx for stress incontinence in children?
Overactive bladder
Voiding postponement
When to refer for children with urinary incontinence?
Recurrent UTI Uropathology Suspected neurological pathology Abnormal voiding patter No response to treatment following response
What age do you normally get complete bowel control by?
Age 3
Risk factors for constipation?
Diet Poor fluid Lack of exercise Stool withholding Slow transit Milk allergy
Two kinds of faecal incontinence?
Functional
Organic
What is functional faecal incontinence?
- From constipation: involuntary
- non retentive (encopresis) ?psychosocial
What is organic faecal incontinence?
Anorectal malformation Hirschsprungs, CP Mental retardation Spinal disorders
What is most common cause of faecal incontinence?
Constipation
Stats on children with faecal incontinence?
1-3% of children aged 4-7%
Causes of constipation associated faecal incontinence?
Voluntary withholding
Rectal dilatation
Impaired rectal sensation
Soiling during spontaneous relaxation of sphincters
Assessment of constipation associated faecal incontinence?
Hx
Habits: freq, consistency, intestinal hurry, toilet posture
-fluids
-diet/fibre
Examination in constipation associated faecal incontinence?
Developmental Nutritional Abdo Neuro: spine/reflexes -Anorectal ?PR, anal tone/sensation
Investigations for constipation associated faecal incontinence?
Bowel diary Abdo X-rays Abdo ultrasound, ?rectal distension -anorectal manometry -not really blood tests, TFTs, Ca
Management of constipation associated faecal incontinence
Education Laxatives Toilet ing program Dietary changes Treat anal fissures Bowel diary
What laxative treatments in constipation associated faecal incontinence?
- Disimpact if significant retention
- maintenance therapy
What is involved in toilet ing program for constipation associated faecal incontinence?
Foot support
Toilet sits after meals
What kind of laxatives are there for constipation associated faecal incontinence?
Stool softeners: paraffin/docusate
Stimulants: senna, glycerol, microlax
Osmotic: lactulose, movicol
Bulking: fibre/psyllium
What are potent stimulants for laxatives in hospital?
Sodium sulphate
Sodium phosphate
Common osmotic laxative used in kids for constipation associated faecal incontinence?
ISO-osmotic: Macrogol 3350
When to refer for faecal incontinence?
Frequent soiling -behaviour abnormalities Interferences with school/social Parental/child distress Failure to respond Deterioration after response
