Elimination disorders Notes

NOTES NOTES ELIMINATION DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES DIAGNOSIS ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places ▫ Encopresis: feces ▫ Enuresis: urine ▪ Disorders can be functional; often explained by/causing distress ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places ▪ > five years old ▪ Not caused by other condition/substance CAUSES MEDICATIONS ▪ Genetic, environmental TREATMENT ▪ Laxatives, desmopressin, to manage elimination SIGNS & SYMPTOMS ▪ Repeated voluntary/involuntary passage of feces/urine into inappropriate places PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy ENCOPRESIS osms.it/encopresis PATHOLOGY & CAUSES ▪ Repeated voluntary/involuntary passage of feces into inappropriate places ▪ Often functional, caused by overflow due to withholding feces (e.g. fear of defecation); constipation-related ▪ When feces deposited in abnormal places, may be neurodevelopmental/induced by fear of toilets CAUSES ▪ Genetic, environmental ▪ Often associated with psychiatric comorbidities SIGNS & SYMPTOMS ▪ Repeated passage, voluntary or uncontrolled, of feces into inappropriate places DIAGNOSIS ▪ Repeated passage, voluntary or uncontrolled, of feces into inappropriate places ▪ Occurs at least once a month for three months in a row OSMOSIS.ORG 705

▪ Age: > four years old ▪ Not caused by other condition/substance (except constipation) TREATMENT MEDICATIONS ▪ Daily laxatives (stool softeners: 1g/kg polyethylene glycol per day) OTHER INTERVENTIONS Dietary ▪ Avoid constipating foods ▪ Adequate hydration ▪ Increase fiber intake; fiber tablets Remove fecal impaction ▪ Polyethylene glycol/mineral oil ▪ Rectal enema PSYCHOTHERAPY ▪ Behavioral therapy ▫ Encourage toilet usage, normalize bowel movements ENURESIS osms.it/enuresis PATHOLOGY & CAUSES DIAGNOSIS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ Can be nocturnal, diurnal, both ▪ Can involve poor bladder control (physiological developmental reasons)/ exceeding bladder capacity ▪ Repeated voluntary/involuntary passage of urine into inappropriate places ▪ “Clinically significant”: occurs > two times per week for > three consecutive months or affects day-to-day life ▪ Age: > five years old ▪ Not caused by other substance CAUSES ▪ Genetic, environmental; stress-related ▫ Often associated with psychiatric comorbidities ▫ More common in biological males SIGNS & SYMPTOMS ▪ Repeated voluntary/involuntary passage of urine into inappropriate places 706 OSMOSIS.ORG TREATMENT MEDICATIONS ▪ Desmopressin (reduce urine production) PSYCHOTHERAPY ▪ Behavioral therapy (e.g. bedtime alarm therapy), bladder program