29. Wetting and soiling

Question 1

What is most faecal incontinence in children associated with?

Answer 1

constipation

Question 2

What is the model of constipation-associated faecal incontinence?

Answer 2

withholding > increased vol and pressure in rectal ampulla> chronic stretching of rectal ampulla> rectal hyposensitivity

Question 3

Organic causes of constipation (7)

Answer 3

anorectal malf
spinal cord lesions
cow milk allergy
coeliac disease
CF
intestinal neuropathy
metabolic - hypothyroid, hyper calcemia

Question 4

examination in coninence problems

Answer 4

motor and sensory exam
abdo for distension, fecaloma
anal exam- rectal tear

Question 5

When is disimpaction required?

Answer 5

if large mass that is unlikely to pass. requires sedation

Question 6

ongoing management of toileting?

Answer 6

• facilitate timing
• laxatives
• posture- feet supported, knees above hips, legs apart
• remove barriers to going
• add rewards

Question 7

Laxative treatment options?

Answer 7

• paraffin- lubricant
• stimulants - senna, bicasodyl
• softener- coloxyl, paraffin
• osmotic laxative - movical/osmolax

Question 8

Is urinary incontinence normal?

Answer 8

not after 4 y.o - needs to be assessed and managed

Question 9

3 causes of bladder dysfx

Answer 9

• urethrovaginal reflux
• overactive blladder
• voiding dysfx

Question 10

signs of overactive bladder

Answer 10

urgency, usually with frequency and wetting

Question 11

treatment of overactive bladder

Answer 11

• regular voiding

- oxybutinin (antichol - 2.5-5 mg bd to tds)

Question 12

Management of day wetting

Answer 12

• regular toileting and fluids
• 7 wees a day
• antichol if indicated