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

2.2 Urinary & Faecal Incontinence Flashcards

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?

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?

A

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

Treatment: timed voiding

25
Q

What is most common cause of daytime urinary incontinence?

A

Overactive bladder: 70%

26
Q

Overactive bladder is associated with what other condition?

A

Constipation

27
Q

Overactive bladder treatment?

A

Anticholinergics(oxybutynin, tolterodine, solifenacin)

TENs

28
Q

What is dysfunctional voiding?

A

Contraction fo external urinary sphincter during voiding

29
Q

What is vaginal reflux?

A

Leakage 5-10minutes after void

Anatomical predisposition

30
Q

What is treatment of choice of vaginal reflux?

A

Straddle the toilet

31
Q

What is pollakiuria?

A

> 20 small voids per day

Disappears in sleep

32
Q

Cause of pollakiuria?

A

Recent stressor usually >50%

33
Q

Treatment for pollakiuria?

A

Self limiting

Reassure

34
Q

What is giggle incontinence?

A

When laugh COMPLETELY empty bladder

Uncommon

35
Q

Stress incontinence in children common?

A

Very rare

36
Q

DDx for stress incontinence in children?

A

Overactive bladder

Voiding postponement

37
Q

When to refer for children with urinary incontinence?

A 
Recurrent UTI
Uropathology
Suspected neurological pathology
Abnormal voiding patter
No response to treatment following response
38
Q

What age do you normally get complete bowel control by?

A

Age 3

39
Q

Risk factors for constipation?

A 
Diet
Poor fluid
Lack of exercise
Stool withholding
Slow transit
Milk allergy
40
Q

Two kinds of faecal incontinence?

A

Functional

Organic

41
Q

What is functional faecal incontinence?

A
  • From constipation: involuntary

- non retentive (encopresis) ?psychosocial

42
Q

What is organic faecal incontinence?

A 
Anorectal malformation
Hirschsprungs,
CP
Mental retardation
Spinal disorders
43
Q

What is most common cause of faecal incontinence?

A

Constipation

44
Q

Stats on children with faecal incontinence?

A

1-3% of children aged 4-7%

45
Q

Causes of constipation associated faecal incontinence?

A

Voluntary withholding
Rectal dilatation
Impaired rectal sensation
Soiling during spontaneous relaxation of sphincters

46
Q

Assessment of constipation associated faecal incontinence?

A

Hx
Habits: freq, consistency, intestinal hurry, toilet posture
-fluids
-diet/fibre

47
Q

Examination in constipation associated faecal incontinence?

A 
Developmental
Nutritional
Abdo
Neuro: spine/reflexes
-Anorectal ?PR, anal tone/sensation
48
Q

Investigations for constipation associated faecal incontinence?

A 
Bowel diary
Abdo X-rays
Abdo ultrasound, ?rectal distension
-anorectal manometry 
-not really blood tests, TFTs, Ca
49
Q

Management of constipation associated faecal incontinence

A 
Education
Laxatives
Toilet ing program
Dietary changes
Treat anal fissures
Bowel diary
50
Q

What laxative treatments in constipation associated faecal incontinence?

A
  • Disimpact if significant retention

- maintenance therapy

51
Q

What is involved in toilet ing program for constipation associated faecal incontinence?

A

Foot support

Toilet sits after meals

52
Q

What kind of laxatives are there for constipation associated faecal incontinence?

A

Stool softeners: paraffin/docusate
Stimulants: senna, glycerol, microlax
Osmotic: lactulose, movicol
Bulking: fibre/psyllium

53
Q

What are potent stimulants for laxatives in hospital?

A

Sodium sulphate

Sodium phosphate

54
Q

Common osmotic laxative used in kids for constipation associated faecal incontinence?

A

ISO-osmotic: Macrogol 3350

55
Q

When to refer for faecal incontinence?

A 
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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