Wetting and Soiling Flashcards
1
Q
What is the definition of enuresis?
A
- Wetting while asleep after 5 years (wetting during day is daytime incontinence)
2
Q
What is the difference between primary and secondary enuresis? What tends to cause the latter?
A
- Primary (never having been dry continuously for at least 6 months)
- Secondary (having relapsed after a period of at least 6 months dryness)
- Usually not an organic cause. Suspect UTI, sexual abuse, DM, epilepsy, neurogenic bladder
3
Q
How is primary enuresis managed?
A
- Start treating from 7 years old. Urgent over 10 years
- Reassurance - not their fault. Inherited. Prevalent
- Alarms - (70% success rate) 8-12 week use. Alarm when bed is wet, probably work through classical conditioning
- Second-line - desmopressin (ADH analogue) if polyuric, anticholinergics if bladder capacity small. Generally only for school camps etc.
4
Q
How is constipation defined in children?
A
- Best assessed with degree of difficulty passing stool rather than frequency
- In previous 8 weeks - 2 or more of:
- < 3 bowel motions
- 1 episode of faecal incontinence
- Large stools in rectum or on abdo exam
- Passing of stools so large toilet is obstructed
- Retentive/withholding posturing
- Painful defecation
- Most causes are functional, but consider rarer organic causes as well
5
Q
How is faecal incontinence defined in children? How does is commonly arise? How is it managed?
A
- Involuntary, repeated defecations into clothes in a child > 4
- More common in boys around 7-8
- Pathogenesis - anismus/withholding leading to chronic stretching and rectal hyposensitivity. Intermittent relaxation of EAS leads to leakage
- Mx - toileting program (maximise emptying, enhance sensation, facilitate timing), laxatives for initial clear-out, posture assistance (knees above hips, legs apart, bulge tummy). Remove barriers and add rewards.
- Medications - lubricants, stimulants, stool softeners, osmotic laxative
