Elimination Disorders Flashcards
Which comes first, control of bladder or bowel?
bowel
What age is usually to the cut off to decide when something is abnormal or not when it comes to elimination?
5 years old (because most children (77%) achieve dryness at night time and day at that time)
What is the technical term for peeing your pants?
enuresis
What are the criteria for the enuresis diagnosis?
- repeated voiding of urine where you shouldn’t - eithe rinvoluntary or intentionally
- frequency of at least 2x a week for 3 consecutive months or significant distress
- chronological age at least 5
- not attributed to a physiological issue like diabetes
What are the enuresis subtypes and which is most common
- nocturnal only (most common)
- diurnal only
- noctural-diurnal (nonmonosymptomatic)
During what stage of sleep is nocutral enuresis most common in?
REM sleep
or in the trans. from stage 1 to stage 2
What are the more common triggers for diurnal enuresis?
- disruptive behavior episode where they get scolded (in school)
- social fears, or fears of using the toilet
- preoccupation with activities or play (they just forget to go)
In what gender is enuresis more common?
males
What is the best predictor of poor progrnosis in enuresis?
the number of first degree relatives with bedwetting problems
Why is it important to ask how mnay times a night they’re wetting the bed?
kids with bladder dysfunction will wet more than once a night
What is likely the cause of the bed wetting if they totally flood the bed?
low vasopressin level
What is the number 1 cause of a sudden onset of bed wetting in a young girl who was previously normal?
UTI
What should you do with fluid intake in enuresis?
Do NOT decrease. Ironically, increasing it works better because they learn to feel when their bladder is full
What other GI elimination issue could cause bed wetting?
constipation - by putting pressure on the bladder
What is the most successful treatment for enuresis?
urine alarms and contingency management (97% success rate)
What are two meds you can try for enuresis?
imipramine
Desmopressin
Describe retention control training?
you have the child refrain from voiding for 2 minutes after initial urge
then gradually add 2 min blocks up to max of 30 min
describe sphincter control exercises?
starting and stopping the flow of urin during urination
Describe a urine alarm?
it’s a pad with a sensor that triggers an alarm when it starts to get wet, so the child wakes up and goes to the bathroom
What are some of the points of contingency management?
- practice lying in bed and getting up to the bathroom quickly
- use incentives for dry nights
- don’t give the rewards on wet nights, but do NOT shame them
At what age will the alarms and meds start to be effective?
not until after about 6-7 years old. they have to udnerstand how the alarm works
What is the technical term for poopin gyour pants?
encopresis
What are the criteria for encopresis?
- repeated passage of feces into inappropriate places (voluntary or involuntary)
- at least once per month for 3 months
- chronological age is at least 4 years
- behavior not attributable to something else like a laxative or other med problem (except thorugh a mechanism involving constipation - that’s still encopresis)
Why can you end up with encopresis with megacolon?
they hold their stool in, so it builds up and up into a megacolon and then some of the feces will squeeze through the small spaces as diarrhea (overflow incontinence)
What gender is more encopresis?
boys
What is the first step in treating encopresis?
clean out the bowel first with laxatives and suppositories
