Elimination Disorders

Question 1

Which comes first, control of bladder or bowel?

Answer 1

bowel

Question 2

What age is usually to the cut off to decide when something is abnormal or not when it comes to elimination?

Answer 2

5 years old (because most children (77%) achieve dryness at night time and day at that time)

Question 3

What is the technical term for peeing your pants?

Answer 3

enuresis

Question 4

What are the criteria for the enuresis diagnosis?

Answer 4

1. repeated voiding of urine where you shouldn’t - eithe rinvoluntary or intentionally
2. frequency of at least 2x a week for 3 consecutive months or significant distress
3. chronological age at least 5
4. not attributed to a physiological issue like diabetes

Question 5

What are the enuresis subtypes and which is most common

Answer 5

1. nocturnal only (most common)
2. diurnal only
3. noctural-diurnal (nonmonosymptomatic)

Question 6

During what stage of sleep is nocutral enuresis most common in?

Answer 6

REM sleep

or in the trans. from stage 1 to stage 2

Question 7

What are the more common triggers for diurnal enuresis?

Answer 7

1. disruptive behavior episode where they get scolded (in school)
2. social fears, or fears of using the toilet
3. preoccupation with activities or play (they just forget to go)

Question 8

In what gender is enuresis more common?

Answer 8

males

Question 9

What is the best predictor of poor progrnosis in enuresis?

Answer 9

the number of first degree relatives with bedwetting problems

Question 10

Why is it important to ask how mnay times a night they’re wetting the bed?

Answer 10

kids with bladder dysfunction will wet more than once a night

Question 11

What is likely the cause of the bed wetting if they totally flood the bed?

Answer 11

low vasopressin level

Question 12

What is the number 1 cause of a sudden onset of bed wetting in a young girl who was previously normal?

Answer 12

UTI

Question 13

What should you do with fluid intake in enuresis?

Answer 13

Do NOT decrease. Ironically, increasing it works better because they learn to feel when their bladder is full

Question 14

What other GI elimination issue could cause bed wetting?

Answer 14

constipation - by putting pressure on the bladder

Question 15

What is the most successful treatment for enuresis?

Answer 15

urine alarms and contingency management (97% success rate)

Question 16

What are two meds you can try for enuresis?

Answer 16

imipramine

Desmopressin

Question 17

Describe retention control training?

Answer 17

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

Question 18

describe sphincter control exercises?

Answer 18

starting and stopping the flow of urin during urination

Question 19

Describe a urine alarm?

Answer 19

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

Question 20

What are some of the points of contingency management?

Answer 20

1. practice lying in bed and getting up to the bathroom quickly
2. use incentives for dry nights
3. don’t give the rewards on wet nights, but do NOT shame them

Question 21

At what age will the alarms and meds start to be effective?

Answer 21

not until after about 6-7 years old. they have to udnerstand how the alarm works

Question 22

What is the technical term for poopin gyour pants?

Answer 22

encopresis

Question 23

What are the criteria for encopresis?

Answer 23

1. repeated passage of feces into inappropriate places (voluntary or involuntary)
2. at least once per month for 3 months
3. chronological age is at least 4 years
4. behavior not attributable to something else like a laxative or other med problem (except thorugh a mechanism involving constipation - that’s still encopresis)

Question 24

Why can you end up with encopresis with megacolon?

Answer 24

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)

Question 25

What gender is more encopresis?

Answer 25

boys

Question 26

What is the first step in treating encopresis?

Answer 26

clean out the bowel first with laxatives and suppositories