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Sydney Child Health Program > 2.2 Urinary & Faecal Incontinence > Flashcards

2.2 Urinary & Faecal Incontinence Flashcards

(55 cards)

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1
Q

Enuresis is?

A

Urine for
>2/week
>3/month
Older than 5years

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2
Q

Encores is?

A

Faecal for:
>1/month for
>3/month
Older than 4years

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3
Q

In 5-12 year olds, what is % for nocturnal enuresis?

A

20%

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4
Q

What is monosymptomatic unuresis?

Treatment?

A

No daytime symptoms
Treat with bed alarm
Or desmopression

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5
Q

What is non-monosymptomatic unuresis?

Treatment?

A

Daytime symptoms +/- incontinence

Treat underlying problem

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6
Q

What is primary bed wetting?

A

Always wet at night

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7
Q

What is secondary bed wetting?

A

> 6months of night dryness previously

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8
Q

Significance of secondary bedwetting?

A

Likely to have an underlying pathology

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9
Q

What are 3 main factors for nocturnal enuresis?

A

Bladder size
Urine volume
Sleep-arousal

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10
Q

Risk factors for secondary nocturnal enuresis?

A

Psychological

Organic: UTIs, Diabetes, emotional stress)

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11
Q

Things to ask urinary incontinence details?

A 
Day or night time or both?
Continuous or intermittent?
How often?
How severe
Urgency?
Frequency?
Nocturnal polyuria?
Toilet posture
School practices
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12
Q

Examination of child with nocturnal enuresis? Lumbar region?

A

Dimple/hair patch/skin change

?neurogenic?

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13
Q

Examination of child with nocturnal enuresis? Abdo?

A

faeces palpable?

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14
Q

Examination of child with nocturnal enuresis? Neurological?

A

Gait, reflexes, anal tone

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15
Q

Examination of child with nocturnal enuresis? External genitalia?

A

Inflammation
Labial adhesion
Meatal stenosis

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16
Q

What investigations for nocturnal enuresis?

A

MSU for UTI
Time and volume charts

Flow studies

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17
Q

What is normal expected max voided volume in child?

A

(Age +1)x 30mls (max of 390ml)

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18
Q

What is nocturnal polyuria formula?

A

EMVV x 1.3
Max: (450ml)

EMVV: (Age +1)x 30mls (max of 390ml)

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19
Q

What is urotherapy?

A

Fluid + regular voiding
Voiding posture
Constipation
Maybe anticholinergics

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20
Q

What anticholinergics can be used for nocturnal enuresis?

A

Oxybutynin
Tolterodine
Solifenacin

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21
Q

Treatment of choice for nocturnal enuresis?

A

Bed alarms

Desmopressin

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22
Q

How long does bed alarm take to work?

A

Usually 2-3 months

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23
Q

Why do some kids fail alarm training?

Study These Flashcards
A 
Don’t wake
Don’t respond
Probs with attaching to body
Wearing pants
Training time not long enough
24
Q

What is voiding postponement?

Study These Flashcards
A

Hold peeing
Then urgency/fluid restriction
<3voids/day

Treatment: timed voiding

25
What is most common cause of daytime urinary incontinence?
Overactive bladder: 70%
26
Overactive bladder is associated with what other condition?
Constipation
27
Overactive bladder treatment?
Anticholinergics(oxybutynin, tolterodine, solifenacin) | TENs
28
What is dysfunctional voiding?
Contraction fo external urinary sphincter during voiding
29
What is vaginal reflux?
Leakage 5-10minutes after void | Anatomical predisposition
30
What is treatment of choice of vaginal reflux?
Straddle the toilet
31
What is pollakiuria?
>20 small voids per day | Disappears in sleep
32
Cause of pollakiuria?
Recent stressor usually >50%
33
Treatment for pollakiuria?
Self limiting | Reassure
34
What is giggle incontinence?
When laugh COMPLETELY empty bladder | Uncommon
35
Stress incontinence in children common?
Very rare
36
DDx for stress incontinence in children?
Overactive bladder | Voiding postponement
37
When to refer for children with urinary incontinence?
``` Recurrent UTI Uropathology Suspected neurological pathology Abnormal voiding patter No response to treatment following response ```
38
What age do you normally get complete bowel control by?
Age 3
39
Risk factors for constipation?
``` Diet Poor fluid Lack of exercise Stool withholding Slow transit Milk allergy ```
40
Two kinds of faecal incontinence?
Functional | Organic
41
What is functional faecal incontinence?
- From constipation: involuntary | - non retentive (encopresis) ?psychosocial
42
What is organic faecal incontinence?
``` Anorectal malformation Hirschsprungs, CP Mental retardation Spinal disorders ```
43
What is most common cause of faecal incontinence?
Constipation
44
Stats on children with faecal incontinence?
1-3% of children aged 4-7%
45
Causes of constipation associated faecal incontinence?
Voluntary withholding Rectal dilatation Impaired rectal sensation Soiling during spontaneous relaxation of sphincters
46
Assessment of constipation associated faecal incontinence?
Hx Habits: freq, consistency, intestinal hurry, toilet posture -fluids -diet/fibre
47
Examination in constipation associated faecal incontinence?
``` Developmental Nutritional Abdo Neuro: spine/reflexes -Anorectal ?PR, anal tone/sensation ```
48
Investigations for constipation associated faecal incontinence?
``` Bowel diary Abdo X-rays Abdo ultrasound, ?rectal distension -anorectal manometry -not really blood tests, TFTs, Ca ```
49
Management of constipation associated faecal incontinence
``` Education Laxatives Toilet ing program Dietary changes Treat anal fissures Bowel diary ```
50
What laxative treatments in constipation associated faecal incontinence?
- Disimpact if significant retention | - maintenance therapy
51
What is involved in toilet ing program for constipation associated faecal incontinence?
Foot support | Toilet sits after meals
52
What kind of laxatives are there for constipation associated faecal incontinence?
Stool softeners: paraffin/docusate Stimulants: senna, glycerol, microlax Osmotic: lactulose, movicol Bulking: fibre/psyllium
53
What are potent stimulants for laxatives in hospital?
Sodium sulphate | Sodium phosphate
54
Common osmotic laxative used in kids for constipation associated faecal incontinence?
ISO-osmotic: Macrogol 3350
55
When to refer for faecal incontinence?
``` Frequent soiling -behaviour abnormalities Interferences with school/social Parental/child distress Failure to respond Deterioration after response ```

Sydney Child Health Program (113 decks)

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