Elimination Disorders Flashcards
What are the elimination disorders?
Enuresis
Encopresis
What is the diagnostic criteria for Enuresis?
- Repeated voiding of urine in bed or clothing, involuntary or intentional
- Significant either because of frequency or associated distress or dysfunction
- The individual is at least five years old (or equivalent developmental level)
What are the differential diagnoses for Enuresis?
Medical conditions
Medication side effects
What are the comorbidities for Enuresis?
Developmental disabilities
Autistic spectrum disorders
Sleep disorders
What is the etiology for Enuresis?
Genetic pattern
More common in males
What is the prognosis for Enuresis?
Good. Most cases remit over time, involuntary source of problem
If voluntary, different strategies required
What are the implications for function for Enuresis?
Affects self-care and social performance areas
May affect school and leisure performance
May be associated with body system or body function deficits
What treatments are used for Enuresis?
- Health education for the child and parent: how urinary system works and how bladder control develops
- Bedwetting: Behavioral changes and routine education (limiting fluid in the evening, wetness sensor alarm)
- Bladder therapy- medication and bladder control
- Psychological intervention
- Medical interventions include desmopressin and antidepressants
What is desmopressin?
control the kidney to make less urine, control increased thirst, and helps prevent dehydration
What are the implications for OT for Enuresis?
- Interview parent and child for routine, find out cause and pattern if behavioral (public, school, bedwetting, previous trauma?)
- Advising parents about behavioral and environmental modification
- Strategies for bladder training
- Strategies for building the child’s self-esteem; stress and anxiety management
What is the diagnostic criteria for Encopresis?
Repeated defecation in inappropriate places, either involuntary or intentional (soiling)
At least one event each month for at least three months
Chronological age of at least 4 (or equivalent developmental level)
What is the differential diagnosis for Encopresis?
Medical conditions
What are the comorbidities for Encopresis?
ADHD
Conduct disorder
Obsessive-compulsive disorder
Cognitive delay
What is the etiology for Encopresis?
- Anxiety about bowel function
- Chronic constipation during infancy
- Low muscle tone and coordination
- Slow intestinal motility
- A poor diet, with low dietary fiber and high intake of sugary fluids
- Stress
- Low physical activity level
- Unpredictable daily routine
- Unpleasant experience with toilet training- parental disapproval
What is the prognosis for Encopresis?
Can lead to chronic bowel difficulties that persist into adulthood for as many as 30% of those with the childhood condition
But the remaining 70% typically improve to normal function
What are the implications for function for Encopresis?
Affects self-care and social performance areas
May be associated with body system/body function deficits
What is fecal impaction?
stoolcan harden in the rectum. Newstoolwill keeping forming in the colon but can’t pass the blockage
What treatments are used for Encopresis?
- Treatment of bowel impaction as needed (hospital)
- Dietary changes
- Bowel training: daily routine, bathroom time
- Behavior management (ie holding it in because I am busy playing)
- Family support & education: Teach parents the association of negative experience in bowel training
- Medications (but avoid strong laxatives)
What are the implications for OT for Encopresis?
-Identify readiness signs and developmental skills needed for toilet training
-Identify if sensory or stress/ anxiety related
-Educational programming for families:
Assist family and child to develop realistic routine; Desensitization if fear related
What are the cultural considerations for Elimination Disorders?
May be differences in help seeking
Different expectation in toilet training
What are the lifespan considerations for Elimination Disorders?
Primarily disorders of childhood
When present in adults, almost always comorbid with a neurodevelopmental disorder
