Elimination Disorders

Question 1

What are the elimination disorders?

Answer 1

Enuresis

Encopresis

Question 2

What is the diagnostic criteria for Enuresis?

Answer 2

• 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)

Question 3

What are the differential diagnoses for Enuresis?

Answer 3

Medical conditions

Medication side effects

Question 4

What are the comorbidities for Enuresis?

Answer 4

Developmental disabilities

Autistic spectrum disorders

Sleep disorders

Question 5

What is the etiology for Enuresis?

Answer 5

Genetic pattern

More common in males

Question 6

What is the prognosis for Enuresis?

Answer 6

Good. Most cases remit over time, involuntary source of problem

If voluntary, different strategies required

Question 7

What are the implications for function for Enuresis?

Answer 7

Affects self-care and social performance areas

May affect school and leisure performance

May be associated with body system or body function deficits

Question 8

What treatments are used for Enuresis?

Answer 8

• 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

Question 9

What is desmopressin?

Answer 9

control the kidney to make less urine, control increased thirst, and helps prevent dehydration

Question 10

What are the implications for OT for Enuresis?

Answer 10

• 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

Question 11

What is the diagnostic criteria for Encopresis?

Answer 11

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)

Question 12

What is the differential diagnosis for Encopresis?

Answer 12

Medical conditions

Question 13

What are the comorbidities for Encopresis?

Answer 13

ADHD
Conduct disorder
Obsessive-compulsive disorder
Cognitive delay

Question 14

What is the etiology for Encopresis?

Answer 14

• 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

Question 15

What is the prognosis for Encopresis?

Answer 15

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

Question 16

What are the implications for function for Encopresis?

Answer 16

Affects self-care and social performance areas

May be associated with body system/body function deficits

Question 17

What is fecal impaction?

Answer 17

stoolcan harden in the rectum. Newstoolwill keeping forming in the colon but can’t pass the blockage

Question 18

What treatments are used for Encopresis?

Answer 18

• 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)

Question 19

What are the implications for OT for Encopresis?

Answer 19

-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

Question 20

What are the cultural considerations for Elimination Disorders?

Answer 20

May be differences in help seeking

Different expectation in toilet training

Question 21

What are the lifespan considerations for Elimination Disorders?

Answer 21

Primarily disorders of childhood

When present in adults, almost always comorbid with a neurodevelopmental disorder