Enuresis And Encopresis

Question 1

What is functional enuresis?

Answer 1

Repeated

Involuntary

Voiding of urine

After usual age of continence (3-4 years)

In the absence of a physical cause (idiopathic- due to developmental delay of bladder control)

Can be nocturnal, diurnal or both

NOT diagnosed if preceding continence is established

Mostly in boys, as nocturnal (10%)

Rarely in girls, as diurnal

Question 2

What are the causes of secondary enuresis?

Answer 2

UTI
DM
Anatomical disorder
Diuretics
ADHD
Learning disorders
Behavioral 
Psychological

Question 3

How is functional enuresis managed?

Answer 3

Look for secondary causes

Family history

Stress sources at home or school

Watchful waiting

Educate

Practical advice

Rewarding behavioral therapy

Reduce stressors

Bell and pad (30% relapse)

Desmopressin, TCAD imipramine

Bladder training

Question 4

What is functional encopresis?

Answer 4

Uncommon disorder

Passing feces

In inappropriate places

After age of bowel control (3-4 years)

For at least once a month for 3 months

Boys&raquo_space;» girls (6:1)

Common in learning disability 
Chronic constipation
Overflow incontinence 
Hirschprung disease
Anal fissures
Stressors
Rebellion
Anxiety or mood disorders 
Child abuse

Question 5

How do you manage functional encopresis?

Answer 5

Look for secondary cause

Educate and reassure

High fiber diet and good hydration

Laxatives

Encourage normal bowel habits

Reward positive behavior therapy

Remove stressors