G. ELIMINATION DISORDERS

Question 1

Classify Elimination disorders.

Answer 1

1. Enuresis
   
   • nocturnal only

Question 2

Classify Elimination disorders.

Answer 2

1. Enuresis
- nocturnal only
- diurnal only
- nocturnal and diurnal
2. Encopresis
- with constipation and overflow incontinence
- without constipation and overflow incontinence

Question 3

Enuresis(Bed-wetting)
Dx Criteria.

Answer 3

A. Repeated voiding of urine into bed or clothes
B. Occur at least 2 times per week for 3 consecutive months
C. Child must be at least 5 years of age
D. Impairment seen to limit child’s social activities or affect the child’s self-esteem

Question 4

Classification of enuresis.

Answer 4

Primary enuresis - continence was never achieved
Secondary enuresis - continence was achieved and then lost.

Question 5

What are the specifiers of Enuresis?

Answer 5

• Nocturnal only (while sleeping)
• Diurnal only (while awake)
• Nocturnal and Diurnal

Question 6

What re the differential diagnoses for enuresis?

Answer 6

• UTI
• DM
• Diabetes insipidus
• Urethritis
• Seizure disorder
• Sickle cell disorder
• Spina bifida
• Genitourinary malformation
• Neurological bladder
• Obstructive sleep apnea
  -Neurodevelopmental disorder

Question 7

Epidemiology of enuresis.

Question 8

Etiological factors of enuresis.

Question 9

How do you manage Enuresis?

Answer 9

1. Anxiety reduction - positive feedback and reinforcement from parents, No punishment
2. Strengthen bladder outlet valve - Kegal exercises
3. Conditioning waking up with full bladder - Urine alarm therapy and dry bed training

Medications - Imipramine -(TCA) which relaxes the detrusor muscle - decreases enuretic episodes

               - Vasopressin

Question 10

What is the disadvantage of using Imipramine or other medications to treat enuresis?

Answer 10

Enuresis may return after stopping the medications.

Question 11

Encopresis
What id the diagnosis criteria of Encopresis?

Answer 11

A. Repeated passage of feces into inappropriate places such as clothing or the floor, whether involuntary or intentional

B. At least one such event each month for 3 consecutive months

C. Individual must be at least 4 years of age

D. The behavior is not attributable to the physiological effects of a substance or another medical condition except through the mechanism of constipation.

Question 12

Epidemiology of Encopresis.

Question 13

Etiological factors of Encopresis.

Question 14

What are the specifiers of encopresis?

Answer 14

1. Encopresis with constipation and overflow incontinence.
2. Encopresis without constipation and overflow incontinence.

Question 15

How do you manage encopresis?

Answer 15

1. Empty bladder - laxatives
2. Acquire normal bowel habit - high fibre diet
   - plenty of oral fluids
   - pre and pro-biotics
3. Biofeedback - keep bowel diary
   - toilet training 3-4 times every day, following meals or after arriving from school.
4. Improvement of parent-child relationship - positive feedback and reinforcement from parents
   - No punishment (reduces anxiety)

Question 16

Healthy Toilet training.