Elimination disorders

Elimination disorders

1. Muhammad Musawar Ali MPHIL, ICAP [email protected] Elimination Disorders

2. Elimination disorders Elimination disorders all involve the inappropriate elimination of urine or feces. Their onset occur usually in childhood or adolescence. This group of disorders includes enuresis, the repeated voiding of urine into inappropriate places . And encopresis , the repeated passage of feces into inappropriate places .

3. Elimination disorder Both disorders may be voluntary or involuntary. Although these disorders typically occur separately, co-occurrence may also be observed.

4. Enuresis disorder Diagnostic features Repeated voiding of urine during the day or at night into bed or clothes. Voiding is involuntary, though some times it may be intentional. The voiding of urine must occur at least twice a week for at least 3 consecutive months or must cause clinically significant distress or impairment in social, academic ,occupational, or other important areas of functioning The urinary incontinence is not attributable to any medication.

5. Etiology Environmental factors: including delayed or relax toilet training and psychosocial stress. Developmental and biological factors A signaling mechanism matures during early childhood, This signal may initiate dreams about water or going to the toilet, which usually wakes them up. Some children with primary enuresis, however, lack normal development of this signal processing in the brain Genetic factors: Studies were conducted on twins and segregation analysis depicts that it is heritable. Hormonal factors Deficiency of antidiuretic hormone leads to enuresis.

6. Encopresis Diagnostic features Repeated passage of feces into inappropriate places (e.g., clothing, floor), It may be involuntary or intentional . At least one such event occurs each month for at least 3 months. Chronological age is at least 4 years (or equivalent developmental level ). The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation. The constipation may develop for psychological reasons (e.g., anxiety about defecating in a particular place, a more general pattern of anxious or oppositional behavior) Dehydration is also responsible for constipation.

7. Etiology Genetic and physiological. Painful defecation that is, they contract rather than relax the external sphincter when they attempt to defecate (Campbell et al., 2009), can lead to constipation and a cycle of withholding behaviors that make encopresis more likely. Use of some medications (e.g., anticonvulsants, cough suppressants) may increase constipation and make encopresis more likely.

8. Treatment Behavioral intervention in Classical conditioning principal an alarm is used that sounds at the first detection of urine Traditionally ‘bell and pad’ (a battery operated device that produced a loud sound as soon as a drop of urine closed the electrical circuit) was invented.

9. Treatment Modern alarms have a simple moisture sensor that snaps into a child’s pajamas, with a small speaker attached to the shoulder to awaken the child. The alarm will begin to wake the child directly within 4 to 6 weeks, and by 12 weeks.

10. Treatment Operant conditioning principles , It involves variations of dry-bed training. Monitoring and intermittent reinforcement is also used. Dry-bed training methods combined with an alarm (referred to today as full-spectrum home training ). A simple incentive such as earning stars or similar tokens for dry nights .

11. Treatment To get the process moving, (Encopresis) fiber, enemas, laxatives, or lubricants may be given to disimpact the fecal mass ( Kuhl et al., 2010).

12. Thank you so much for your attention  Questions??