Monday, January 30, 2023

Constipation And Urinary Incontinence In Childhood

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Can Constipation Cause Incontinence

Voiding Dysfunction Urinary Incontinence in Children | Dr. Amrish Vaidya

If you suffer from bladder leaks, you may notice that they get worse when you are constipated. Thats because when you are constipated, your colon becomes enlarged and places more pressure on your bladder. This in turn can make you feel like you have to go more urgently and more often, and may lead to more bladder leaks.

Constipation And The Bowel

Severe constipation is the most common cause of faecal incontinence , especially in older people. This is because hard bowel motions are difficult to pass and may cause a partial blockage high up the bowel, resulting in watery bowel motions flowing around the constipated stool without warning. This is sometimes mistaken for diarrhoea.

You can use the Bristol Stool Chart to check what your bowel motions should look like.

Management Strategies Reinforced By The Information In Loeningbaucke’s Paper

The data that this paper provides should encourage those who influence health policy in giving continence problems in childhood the level of priority they deserve. Too often life spoiling conditions like these are neglected in the competition for scarce health resources. We have evidence that incontinence is common in young people in young offenders’ institutions and we could speculate that the low selfesteem resulting from poor continence could be one reason for adolescent antisocial behaviour and substance abuse. Early simple treatment is likely to benefit the majority of children when young and so avoid the complex psychological and physiological vicious cycles that go on to blight later childhood. The key to this is locally based provision of basic advice on adequate fluid intake, sensible and developmental age appropriate pot training and rapid access to effective medical treatment for urinary tract infection, overactive bladder and constipation when these are found. This means setting up more community based continence clinics for children and training for health professionals in this less than glamorous area.

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What Are Behaviors Associated With Daytime Wetting

  • Urinary urgency: An immediate need to go to the bathroom
  • Urinary frequency: Urinates more than 8 times a day.
  • Urinary infrequency: Urinates fewer than 3 times a day.
  • Incomplete bladder emptying: Does not completely empty the bladder when urinating.
  • Holding behaviors: Squatting or squirming, to avoid accidents.

How Is Urinary Incontinence Diagnosed

How Pelvic Floor PT Helps Children with Constipation &  Incontinence

The first stage in diagnosis is where the doctor records a clinic history of when the leakage started and how often it happens. They will usually carry out a physical examination to see if the bladder feels hard because it is full of urine or if there are any signs of constipation. They may also carry out an ultrasound scan of the bladder and kidneys.

Parents may find it helpful to keep a bladder diary for a few days there are lots of examples online but the basic information you should record is the volume of fluids drunk, the volume of wee passed as well as details of any accidents and what the child was doing at the time.

Bladder function assessment may also be helpful this is a combination of tests that are used to examine the childs urinary system and how it is working in close detail. These tests are usually carried out over a period of up to five hours, involving using a special uroflow toilet, which takes lots of measurements as the child is weeing. Next, they will do an ultrasound scan of the childs bladder to see if it is empty or not. These two tests uroflow and bladder ultrasound are repeated two to three times to get a full picture of the childs weeing.

Some children may benefit from having a micturating cystourethrogram , which is a scan that shows how well the childs bladder works. It is used to diagnose why the child may have urinary tract infections. It is also used to show up any abnormalities with the childs urinary system.

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What Are The Symptoms Of Constipation

One of the most obvious signs of constipation is having too few bowel movements. This may be different for everyone – some people empty their bowels several times a day and some may only go a few times each week. What you should look for is any abnormalities in your own schedule. Typically, going longer than 3 days without having a bowel movement is too long, as your stool gets harder and more difficult to pass in that time.

Illustrative Case: Primary Monosymptomatic Nocturnal Enuresis

One year ago, primary enuresis was diagnosed in a six-year-old girl. At the time, she was not concerned with her bed-wetting. After discussion with her parents, treatment was deferred until she expressed interest in staying dry at night. Now, her parents report that she has been reluctant to attend sleepovers because of her bed-wetting, and she has been increasingly interested in resolving her bed-wetting. What initial treatments are appropriate for this patient? When should referral be considered?

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How Does Constipation Affect Children

Children have a smaller abdomen and pelvis area than adults. As the rectum and colon fill with stool, it can press on or block the bladder from emptying completely during urination. It also can limit the amount of urine the bladder can hold. The stool may push on the bladder, causing it to squeeze and leak, which children will not be able to control or stop.

Constipation often is multifactorial, and can be difficult for parents and caregivers to identify.

How Does The Urinary System Work

Dr. Marc A. Levitt, MD Discusses Constipation and Fecal Incontinence in Children

The urinary system consists of the kidneys, ureters, the bladder and urethra. The kidneys filter the blood to remove waste products and produce urine. The urine flows from the kidneys down through the ureters to the bladder. A ring of muscle squeezes shut to keep urine in the bladder and relaxes when we need to wee. The urine passes through another tube called the urethra to the outside when urinating .

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What Causes Daytime Wetting

Daytime wetting can be caused by any of the following:

  • The child ignores the urge to urinate. As a result, the bladder becomes too full, causing urine leakage.
  • The child has an overactive bladder and cannot get to the toilet in time.
  • The child has an underactive bladder and does not have the urge to use the bathroom.
  • The child may be suffering from dysfunctional elimination syndrome, in which the bladder muscles and nerves are not working together. The muscles may tighten, stopping the flow of urine when there is still urine in the bladder.
  • Some neurologic and developmental conditions can cause poor bladder control.
  • The child is suffering from constipation and the full bowel is pressing on the bladder.
  • The child is suffering from a urinary tract infection.

Children are often mistakenly blamed for being lazy or seeking attention when they have daytime wetting episodes. However, this is not usually the case and other causes should be explored.

What Is The Prognosis For Fecal Incontinence

For children born with anorectal defects or Hirschsprung disease, doctors are able to predict the potential for bowel control fairly accurately. Once a childs reconstructive surgery has healed, physicians will evaluate several factors and give caregivers an idea of what to expect. This is particularly important to help parents set expectations around potty training, and to determine if they need to adopt a long-term bowel management program.

Factors that indicate good prognosis for future bowel control:

  • Normal sacrum
  • Good sphincter muscles
  • Good bowel movement pattern, of 1-2 well formed bowel movements per day
  • Evidence of sensation when passing stool

Factors that indicate a poor prognosis for future bowel control:

  • Abnormal sacrum

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What Are The Symptoms Of Urinary Incontinence

The main symptom of urinary incontinence is the leakage of urine. There may also be increased urgency to wee, leading to increased frequency of weeing. Urinary tract infections may also develop more often and be hard to shift. Children may be reluctant to drink fluids in case they have an accident this can lead to dehydration and often makes any constipation worse as well.

Constipation & Urinary Incontinence

Pediatric Constipation: What is Your Child

Constipation can affect urinary incontinence. You may be having trouble with bladder leakage or having to be always near a toilet . When the bowel is very full it can press on the bladder . When the bladder gets squashed by a full bowel, it can reduce the bladders capacity to hold urine, or making it more active making you feel like you need to rush to the toilet or wee more often.

Pelvic Physiotherapy with our team of experts can help you and your child treat this issue. We will ask you lots of questions and find out what is causing the problem. A toileting program will be started, and laxatives prescribed if necessary.

Your physiotherapist will correctly diagnose the reason for soiling and accidents. Physiotherapy assessment and treatment involves abdominal palpation, real time ultrasound assessment of the bladder and rectum, teaching the parent about constipation management with diet, massage and using a sitting routine. We also work with the child, teaching the child how to relax their pelvic floor whilst sitting in the correct position on the toilet. A toileting program works best if carried out for at least 6-12 months.

Remember a child should not be punished for accidents, it is not their fault, however positive reinforcement is a great way of rewarding favourable behaviour!

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How Is Enuresis Diagnosed

Your childs health care provider will ask about your childs medical history. Make sure to tell the health care provider:

  • If other members of the family have had enuresis

  • How often your child urinates during the day

  • How much your child drinks in the evening

  • If your child has symptoms such as pain or burning when urinating

  • If the urine is dark or cloudy or has blood in it

  • If your child is constipated

  • If your child has had recent stress in his or her life

The health care provider may give your child a physical exam. Your child may also need tests, such as urine tests or blood tests. These are done to look for a medical problem, such as an infection or diabetes.

What Is Faecal Incontinence

Faecal incontinence is when children who are past the age of toilet training cant control when and where they do a poo. This means that they regularly do poos in places other than the toilet, most often in their underwear.

Faecal incontinence is also called soiling or encopresis.

Faecal incontinence is accidental your child doesnt do it on purpose. But it can be difficult to live with, and its natural to find it challenging or upsetting. If this sounds like your situation, talk to your GP about getting support.

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Treatment For Urinary Incontinence In Children

There are many different treatment options for urinary incontinence. The right treatment for your child will depend on whats causing the incontinence.

Behaviour modification The most common treatment for urinary incontinence is behaviour modification, which is also called urotherapy.

This involves giving children information about how their bodies store and get rid of wee, and also about:

  • going to the toilet regularly
  • not holding on when they need to wee
  • recognising the signs of needing to do a wee.

Your child might need to keep a diary of how often they go to the toilet, how long they go between wees, and how often they wet themselves.

Your child might also need to keep track of how much they drink and how much wee they do when they go to the toilet. As part of the treatment, your child will probably be asked to wee at particular times throughout the day.

Medication In some cases, the doctor might prescribe medication to treat daytime wetting. The type of medication depends on the cause. Your doctor can explain why medication is needed and whether it has any side effects.

Other treatment options Depending on the cause of your childs urinary incontinence, there are other treatment options. These treatment options are for more complex cases of incontinence, and your GP will usually refer you to a specialist for advice about these options.

What Can I Do To Get Relief From Constipation

Bowel Problems in Children with Urinary Incontinence part 1

If youre currently suffering from constipation, try these remedies:

  • Drink more water . Warm liquids can help too, since they stimulate the bowel by widening blood vessels in your digestive system and increasing the blood flow and GI activity.

  • Adjust your diet. Certain foods are known to help aid in constipation. Prunes are a tried and true remedy for constipation. You can also try adding probiotics, such as keifer and yogurt, or sauerkraut to your diet. Other foods, such as broccoli, clear soups, beans, wheat bran, grapes, and apples or pears may also help.

  • Add some exercise to your day. Moving your body helps to get your bowels moving too.

  • If you have to go, dont ignore it. Holding it in can cause damage to the nerves in your rectum, making your problem worse over time.

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Etiology Of Urinary Incontinence In Children

Urinary incontinence in children has different causes and treatments than urinary incontinence in adults Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many… read more . Although some abnormalities cause both nocturnal and diurnal incontinence, etiology typically varies depending on whether incontinence is nocturnal or diurnal, as well as primary or secondary. Most primary incontinence is nocturnal and not due to an organic disorder. Enuresis can be divided into monosymptomatic and complex .

When Can I Expect My Children To Stop Having Bowel Or Bladder Leaks

Every child is different. Depending on the bowel or bladder issue affecting your children and the length of time your children have had leaks, it may take several weeks to months to see improvements. Most children complete the program in six to eight months.

Working on the physical therapy techniques at home, as well as at physical therapy sessions, can improve results. Discuss bathroom habits and tips with teachers and day care providers to reinforce proper use during time away from home.

Don’t wait until your child “grows out of it” to address bowel and bladder issues. Education, lifestyle and diet modification, and proven treatment techniques can resolve, or significantly decrease, occurrence of bowel and bladder issues affecting children.

JonPaul Dragseth is a physical therapist specializing in treating children with bowel and bladder dysfunction in Eau Claire, Wisconsin.

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

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How Can I Help My Children Prepare For Bowel And Bladder Therapy

First, if your children are motivated to have the leaks stop, it may improve the results of the therapy. Support from parents at therapy sessions and at home is important to reinforce education and skills learned in therapy. Encourage your children to ask questions and become educated about the medical condition.

Remind your children that the therapy care plan is individualized for their specific needs. Just like homework from school, practice the new skills or healthy bowel and bladder habits introduced during therapy at home.

Reflection On The Article

IUHP Advanced Praxis Case Management Unremitting Functional ...

As LoeningBaucke stresses in the article, the problem with literature review has been the lack of an agreed set of definitions for constipation. The Paris consensus has improved on the Rome II definitions and she has shown how valuable it is to apply these even in a retrospective notes survey.1 Her study also avoids the problem of extrapolating data from a referral centre to the whole community. As with any epidemiological study there may be characteristics of the community being studied that limit its generalisability. LoeningBaucke’s population is based on a university and so may not have an average socioeconomic profile. A population based study in the UK showed a prevalence in 7.5year old children of infrequent daytime faecal incontinence of 6.8% and of severe incontinence of 0.8%.2

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Tips For Managing Enuresis

  • Remember, your child cant control the problem without help. Make sure not to scold or blame. Make sure your child is not teased by family or friends.

  • Keep in mind that many children outgrow enuresis.

  • Protect your childs mattress bed with a fitted plastic sheet.

  • Have a change of clothes on hand while out and about.

Should I Be Concerned

Rarely, daytime wetting, bedwetting, and constipation can be the result of an underlying medical problem.

At UNC Pediatric Urology, we are dedicated to properly evaluating your child with wetting and soiling issues, offering the appropriate treatment and working with you and your child to help your child make great strides towards becoming dry and soil free!

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How Is Urinary Incontinence Treated

There are number of options for treating urinary incontinence, some of which may be used in combination. If constipation is thought to be causing the urinary incontinence, the doctors may suggest reviewing what foods the child is eating and their toileting habits. They may also suggest managing the childs fluid intake for a while to see if this improves the incontinence. Medicines can be prescribed to reduce the sensitivity of the bladder or reduce the amount of urine produced by the body. Some medicines are best only given in short bursts to cover a special occasion as they can have side effects.

There are a number of behavioural interventions to help with urinary incontinence. These include bladder retraining, pelvic floor exercises and biofeedback training.

A fairly new form of treatment for urinary incontinence is tibial nerve stimulation, which involves passing a low electrical charge through a nerve in the ankle, which then relaxes the nerves controlling the muscles around the bladder.

In rare circumstances, surgery might be suggested to improve urinary incontinence. This could include injections into the sphincter to strengthen or relax it. Major surgery, for instance, if a childs bladder capacity is too small, an operation called a bladder augmentation might be suggested.

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