Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial.

OBJECTIVES: Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS: In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS: 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 ± 2.4 years and 8.0 ± 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION: Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.

Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study.

PURPOSE: Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS: This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS: A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS: This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.

[Encopresis in children, the view of child psychiatry]. / Comment j'explore... L'encoprésie chez l'enfant, le point de vue pédopsychiatrique.

The article aims to provide a state of knowledge in the literature on encopresis in the child psychiatric population. The general definition of the symptom and its analysis are presented according to different approaches. Then, the clinic of encopresis is described according to its specificities. The main associated disorders and psychiatric/psychosocial risk factors are discussed in detail. Regarding patient care, the multidisciplinary approach, including the complementarity with the paediatrician, is essential in a number of cases. Finally, family approach and the impact of trauma would be interesting research perspectives.

L'article a pour objectif de proposer un état des connaissances dans la littérature au sujet de l'encoprésie parmi la population pédopsychiatrique. La définition générale du symptôme et son analyse sont exposées selon différentes approches. Ensuite, la clinique de l'encoprésie est abordée selon ses spécificités. Les principaux troubles associés et les facteurs de risques psychiatriques/psychosociaux sont alors abordés dans le détail. Au niveau de la prise en charge du patient, l'approche multidisciplinaire, dont la complémentarité avec le pédiatre, est primordiale dans un certain nombre de cas. Enfin, l'approche familiale et l'impact des traumatismes constitueraient des perspectives de recherche intéressantes.

[Functional Constipation and Nonretentive Fecal Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. / Funktionelle (nicht-organische) Obstipation und Stuhlinkontinenz im Kindes- und Jugendalter: Klinische Leitlinie zur Diagnostik und Therapie.

Functional Constipation and Nonretentive Fecal Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract. Objective: Constipation and fecal incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. Functional constipation and nonretentive fecal incontinence can be differentiated according to the current Rome-IV classification systems. This interdisciplinary guideline aims to summarize the current state of knowledge regarding somatic and psychiatric assessment and treatment. It formulates consensus-based, practical recommendations. Methods: The members of the Guideline Commission consisted of 11 professional associations and a parental organization. The guideline was based on current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: Functional constipation is much more common than nonretentive fecal incontinence. Constipation requires a detailed medical assessment to exclude somatic causes, especially in young children. Red flags are useful indicators of organic causes to be considered. Most cases of constipation are functional (approximately 95 %). Counseling, toilet training, disimpaction, and long-term oral laxatives, combined with cognitive-behavioral interventions, are most effective. The assessment and treatment of nonretentive fecal incontinence are similar. The rate of somatic factors is much lower (approximately 1 %). Laxatives can worsen outcomes and should be avoided. Comorbid psychological disorders are common (approximately 30 % to 50 %). They should be assessed and treated additionally according to evidence-based guidelines. Conclusions: The recommendations of this guideline were approved with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required, especially regarding nonretentive fecal incontinence.

Enuresis and encopresis: Association with child abuse and neglect.

OBJECTIVE: Several reports suggest a possible link between child abuse and enuresis or encopresis but concern small series of children and present therefore methodological biases. The objective of the present study was to clarify this issue by examining the relationships between child abuse and enuresis or encopresis in a large sample of children. METHODS: A multicenter cross-sectional study was conducted on a sample of 428 children in social residential centers in France. Four types of child abuse were considered: sexual abuse, physical abuse, psychological abuse and neglect. The accuracy and reliability of the characterization of the type of abuse as well as that of the sphincter disorder was particularly high. In fact, all the cases benefited from both a social and a psychological investigation and from an observation in a residential center. RESULTS: More than 60% of the children were victims of at least one type of abuse. Encopresis was reported in 15 children (3.5% [95% CI: 2.0%-5.7%]), mostly among boys (13 cases). Enuresis affected 54 of the 390 children aged five years or more (13.8% [95% CI: 10.6%-17.7%]). Most of the cases also appeared in boys (38 cases). Rates of encopresis were found to be seven-fold higher in both psychologically abused and neglect children compared to non-abused children (P=0.01). Concerning enuresis, a weaker but still significant association was found with sexual (OR= 3.3, P=0.025) and physical abuse (OR=2.3, P=0.035). CONCLUSION: Our findings support the hypothesis that enuresis and encopresis are associated with specific types of child abuse.

[Elimination disorders - ICD-11 classification and definitions]. / Ausscheidungsstörungen ­ Klassifikation und Definition nach ICD-11.

Elimination disorders - ICD-11 classification and definitions Abstract. Elimination disorders are common in children and are can be divided into three main groups: nocturnal enuresis, daytime urinary incontinence, and encopresis or fecal incontinence. There are also many subgroups that can be diagnosed exactly. This review critically presents the definitions and the classification suggestions of the ICD-11. It compares the definitions of enuresis according to ICD-11 with those of nocturnal enuresis and daytime urinary incontinence of the ICCS. It also contrasts encopresis according to ICD-11 with functional constipation and nonretentive fecal incontinence by the Rome-IV criteria. It becomes apparent that the ICD-11 does not reflect current research findings; that it does not render specific diagnoses, which are prerequisites for effective treatment; and that it is not exact enough for research. In conclusion, the ICCS and Rome-IV definitions are the preferred classification systems in clinical practice and research.

Incontinence in persons with tuberous sclerosis complex.

AIMS: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by a mutation in the TSC1 or TSC2 gene with a broad spectrum of physical and psychological manifestations. The aim of the study was to examine incontinence, psychological problems, and adaptive behavior skills in patients with TSC. METHODS: Through a worldwide TSC support group, 26 children (4-17 years) and 15 adults (18-50 years) with TSC were recruited (38.1% male, mean age 16.4 years). Parents or care-givers completed the Developmental Behavior Checklist (DBC), the Parental Questionnaire: Enuresis/urinary Incontinence, and the Vineland Adaptive Behavior Scales (3rd edition). RESULTS: A total of 60.0% of the participants had nocturnal enuresis (NE), 51.3% daytime urinary incontinence (DUI) and 52.4% fecal incontinence (FI). 65.4% of children and 50.0% of adults had a clinically relevant DBC score. Psychological symptoms were associated with at least one subtype of incontinence. The mean adaptive behavior composite (ABC) score of the patients was 57.2 (SD = 26.1), with 38.1% in the average or below-average range (IQ >70), 26.2% with a mild, 11.9% with a moderate and 23.8% with a severe/profound intellectual disability. The incontinence rate was significantly higher in the groups with a lower ABC score. CONCLUSION: A substantial proportion of patients with TSC are affected by incontinence and psychological symptoms. Incontinence was higher in persons with lower adaptive skills and those with at least one type of incontinence showed a significantly higher DBC score. As incontinence and psychological problems affect daily functioning and well-being, assessment, and treatment are recommended.

Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?

PURPOSE: Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50-70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure. METHODS: All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher's exact test, Mann-Whitney U test, or Student's t test. RESULTS: There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung's, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement. CONCLUSION: In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option. LEVEL OF EVIDENCE: Level 4 (retrospective case series or cohort).

Incontinence in autism spectrum disorder: a systematic review.

Autism spectrum disorders (ASD) are defined by persistent deficits in reciprocal social interaction, communication, and language, as well as stereotyped and repetitive behavior. Functional incontinence, as well as ASD are common disorders in childhood. The aim of this systematic review was to give an overview of the co-occurrence of nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in ASD, and vice versa, of ASD in children with incontinence. A systematic literature search of the terms "incontinence", "enuresis", and "encopresis" in combination with "autism" or "Asperger" in four databases (Scopus, PubMed, PsycInfo and Web of science) was conducted. All studies that examined incontinence frequencies in samples with ASD, and studies that measured frequencies of ASD diagnoses or symptoms in samples with incontinence were included. Risk of bias and limitations of each study were described. After eligibility assessment, 33 publications were included in the review. The published literature implies a higher prevalence of incontinence in children with ASD compared to typically developing children. Limitations and biases as inappropriate diagnostic criteria for ASD and incontinence, selected samples, or lack of control groups are reported. Associations of incontinence in ASD with psychopathological symptoms were found. Vice versa, ASD symptoms are found in incontinent children, but no study included a non-ASD control sample. Incontinence symptoms are also reported as an adverse effect of medication in ASD. Due to methodological problems and definitional discrepancies in some publications, results have to be interpreted cautiously. Research in ASD and incontinence is scarce. More systematic research including state-of-the-art assessments is needed.

Bladder Training Video versus Standard Urotherapy for Bladder and Bowel Dysfunction: A Noninferiority Randomized, Controlled Trial.

PURPOSE: We evaluated whether an animated bladder training video was as effective as standard individual urotherapy in improving bladder/bowel symptoms. MATERIALS AND METHODS: Patients 5 to 10 years old who scored greater than 11 on the bladder/bowel Vancouver questionnaire were included in a noninferiority randomized, controlled trial. Children with vesicoureteral reflux, neuropathic bladder, learning disabilities, recent urotherapy or primary nocturnal enuresis were excluded from analysis. Patients were randomly assigned to receive standard urotherapy or watch a bladder training video in clinic using centralized blocked randomization schemes. Bladder/bowel symptoms were evaluated at baseline and 3-month followup by intent to treat analysis. A sample size of 150 patients ensured a 3.5 difference in mean symptomology scores between the groups, which was accepted as the noninferiority margin. RESULTS: Of 539 screened patients 173 (37%) were eligible for study and 150 enrolled. A total of 143 patients (95%) completed the trial, 5 (4%) were lost to followup and 2 (1%) withdrew. Baseline characteristics were similar between the groups. Baseline mean ± SD symptomology scores were 19.9 ± 5.5 for the bladder training video and 19.7 ± 6.0 for standard urotherapy. At 3 months the mean symptomology scores for the bladder training video and standard urotherapy were reduced to 14.4 ± 6.5 and 13.8 ± 6.0, respectively (p = 0.54). The mean difference was 0.6 (95% CI -1.4-2.6). The upper 95% CI limit of 2.6 did not exceed the preset 3.5 noninferiority margin. CONCLUSIONS: The bladder training video was not inferior to standard urotherapy in reducing bladder/bowel symptoms in children 5 to 10 years old. The video allows families to have free access to independently review bladder training concepts as often as necessary.

Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia.

OBJECTIVES: To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). STUDY DESIGN: Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. RESULTS: Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. CONCLUSIONS: Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.

[Home training as a treatment of faecal incontinence and sphincter dyssynergia]. / Entrenamiento anorrectal domiciliario como tratamiento de la encopresis y disinergia esfinteriana.

OBJECTIVE: The defecation disorders represents the 3% of consultations in pediatrics patients. Our goal was to demonstrate the effectiveness and efficiency of the reeducation of the defecation maneuver through home training in patients with encopresis and sphincter dyssynergia. MATERIAL AND METHODS: Study of patients with fecal incontinence treated with home training at our center between 2014-2015. Anorectal manometry was performed and was valued defecation maneuver by expulsion of rectal probe with or without the ball. Daily sessions were performed using a Foley catheter (18-20Fr.) with progressive filling of the balloon, maximum 20cc. The response to the treatment was assessed in terms of episodes of soiling. RESULTS: Seven patients (6 males and 1 female) with a mean age of 9.7 years (range, 5-15) were included; two patients with anorectal malformation history, 1 Hirschsprung disease, 1 sacrococcygeal teratoma and 3 functional encopresis. Three patients had soiling episodes daily and 4 patients frequently. The mean basal pressure of anal channel was 32.34mmHg (range, 11.74-50.75) with negative defecation maneuver in 2 cases, deficient in 3 and dyssynergic in 2 patients. The mean time of biofeedback therapy to be asymptomatic was 5.14 months (range, 2-11), with a mean of 16.14 months (range, 3-24), with the 7 patients currently maintained clean. CONCLUSIONS: The present study suggests that re-education of defecation maneuver through home training, seems to be an effective and efficient therapy, achieving excellent results in medium term.

OBJETIVO: Los trastornos de la defecación representan el 3% de las consultas en pediatría. Nuestro objetivo fue demostrar la eficacia y eficiencia de la reeducación en la maniobra defecatoria mediante el entrenamiento domiciliario en los pacientes con encopresis y disinergia esfinteriana. MATERIAL Y METODOS: Estudio de los pacientes con encopresis tratados mediante entrenamiento domiciliario en nuestro centro entre 2014-2015. Se realizó manometría anorrectal y fue valorada la maniobra defecatoria mediante la expulsión o no de la sonda rectal con o sin balón. Se realizaron sesiones diarias de forma domiciliaria empleando una sonda de Foley (18-20 Fr.) con llenado progresivo del balón, máximo 20 cc. Se evaluó la respuesta al tratamiento en función de la presencia de manchado. RESULTADOS: Se incluyeron 7 pacientes (6 varones y 1 mujer) con edad media de 9.7 años (rango, 5-15); dos con antecedente de malformación anorrectal, una enfermedad de Hirschsprung, 1 teratoma sacrococcígeo y 3 encopresis funcionales. Tres pacientes presentaban manchado diario y 4 de forma frecuente. La media de presión basal del canal fue de 32,34 mmHg (rango, 11,74-50,75) con maniobra defecatoria negativa en 2 casos, deficiente en 3 y disinérgica en 2. La media de tiempo realizando el entrenamiento intestinal hasta lograr estar asintomáticos fue 5.14 meses (rango, 2-11), con un seguimiento medio de 16,14 meses (rango, 3-24), manteniéndose limpios actualmente los 7 pacientes. CONCLUSIONES: El presente estudio sugiere que la reeducación de la maniobra defecatoria mediante entrenamiento domiciliario parece ser una terapia eficaz y eficiente, logrando excelentes resultados a medio plazo.

Psychiatric disorders and symptoms severity in preschool children with atopic eczema.

BACKGROUND: To compare with a control group the frequency of psychiatric disorders and severity of psychiatric symptoms in preschool children with atopic eczema. METHODS: The study included children between the ages of 3-5 who were diagnosed to have atopic eczema. The parents of the children with atopic eczema were interviewed in person and were asked to fill in "The Early Childhood Inventory-4" form. This form assesses the psychiatric disorders and symptoms severity in children between the ages of 3-5. RESULTS: The atopic eczema group included 80 patients (38 male, 42 female) with a mean age of 48.4 ± 15.7 months and the control group included 74 patients (41 male, 33 female) with a mean age of 49.9 ± 15.19 months. It was established that 68.8% of the group with atopic eczema received at least one psychiatric diagnosis. Between the psychiatric disorders, ADHD (Odds ratio: 2.57, 95% CI: 1.049-6.298, p=0.035), enuresis and encopresis (Odds ratio: 2.39, 95% CI: 1.121-5.097, p=0.022) and attachment disorder (Odds ratio: 2.03, 95% CI: 1.046-3.953, p=0.035) were found to be significantly higher when compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores calculated by using ECI-4, ADHD severity (p=0.043), conduct disorder severity (p=0.001), anxiety disorders severity (p<0.001), eating disorders severity (p=0.011) and tic disorder severity (p=0.01) were found to be higher in the atopic eczema group. CONCLUSION: Psychiatric illnesses are frequent in preschool children with atopic eczema.

Measuring Health-Related Quality of Life With the Parental Opinions of Pediatric Constipation Questionnaire.

OBJECTIVES: The purpose of this study was to develop a caregiver-completed constipation condition-specific health-related quality of life (HRQL) instrument. METHODS: 410 caregivers of children aged 2-18 years completed the Parental Opinions of Pediatric Constipation (POOPC), the PedsQL Generic Core Scales, PedQL Family Impact Module, Pediatric Symptom Checklist, the Functional Disability Inventory, the Pediatric Inventory for Parents, and a demographic questionnaire. Exploratory and confirmatory factor analyses were conducted to assess the psychometric properties of the POOPC. RESULTS: Analyses yielded four factors called Parental Burden/Distress, Family Conflict, Difficulties with the Medical Team, and Worry about Social Impact that reflect problems in HRQL secondary to constipation and soiling, which were generally more strongly correlated with similar measures relative to a general measure of youth's psychosocial functioning. CONCLUSION: The POOPC is a psychometrically sound measure, which may be useful to clinicians and researchers identifying domains of treatment needs for children and their families.

Familial psychological factors are associated with encopresis.

BACKGROUND: The aim of this study was to assess maternal psychiatric symptoms, family functioning and parenting styles in children with encopresis. METHODS: Forty-one children with encopresis were compared to 29 children without any psychiatric disorder. RESULTS: Higher maternal psychiatric symptoms were found in children with encopresis. The general family functioning and strictness/supervision in parenting were significant predictors of encopresis. CONCLUSIONS: Family functioning may be screened in children with encopresis, especially when standard interventions have had limited success. Identification and treatment of familial factors may enhance the treatment efficacy in encopresis.

Systematic review and meta-analysis of behavioral interventions for fecal incontinence with constipation.

BACKGROUND: Multiple treatments exist for fecal incontinence. However, the relative and additive influence of commonly used behavioral approaches remains unclear. OBJECTIVE: We conducted a systematic review of randomized controlled trials to synthesize the effects of behavioral treatment of fecal incontinence with constipation in children aged 4-18 years. Mixed treatment comparisons (MTCs) and random effects models were used to analyze outcomes. Risk of bias and quality of evidence were rated. RESULTS: Although 10 studies were identified for MTCs, results did not yield reliable or valid estimates. Four studies were retained for random effects pooled outcome analysis. Results indicated that behavioral intervention was more effective than control conditions for author-defined success and soiling frequency. CONCLUSION: Although evidence supports behavioral treatments for fecal incontinence with constipation in children, available evidence is limited. More and higher-quality trials are needed to better understand the relative effects of different treatments, including behavioral strategies.

Milk and molasses enemas: clearing things up.

INTRODUCTION: We aimed to describe current nursing practice and clarify the safest and most effective dose of milk and molasses enemas used to relieve constipation in pediatric patients presenting to a suburban pediatric emergency department. METHODS: We surveyed emergency nurses about current practice in administration of milk and molasses enemas. In addition, we identified consecutive patients aged 2 to 17 years with a discharge diagnosis of constipation or abdominal pain between 2009 and 2012. Stable patients were included from the emergency department, in the absence of chronic medical conditions. For each patient, we recorded demographic characteristics, chief complaint, nursing administration technique, stool output, patient tolerance, side effects, amount of enema given, and patient disposition. RESULTS: We identified 500 patients with abdominal pain or constipation, 87 of whom were later excluded. Milk and molasses enemas were found to be effective at relieving constipation in our population, with a success rate averaging 88% in patients given 5 to 6 mL/kg with an institutional guideline maximum of 135 mL. The success rate was found to vary with age, along with the amount of enema given. DISCUSSION: Our nursing survey showed that varying practice exists regarding technique and dosing of milk and molasses enemas. Historical chart review showed that milk and molasses enemas in our emergency department were safe and effective with minimal side effects.

[Classification of enuresis/encopresis according to DSM-5]. / Klassifikation der Enuresis/ Enkopresis im DSM-5.

Elimination disorders are common in childhood and adolescence. Enuresis is traditionally defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards - after all organic causes have been excluded. In the past decades, many subtypes of elimination disorders have been identified with different symptoms, etiologies, and specific treatment options. Unfortunately, the DSM-5 criteria did not integrate these new approaches. In contrast, classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence as well as the ROME-III criteria for fecal incontinence offer new and relevant suggestions for both clinical and research purposes.

Elimination disorders and associated factors among children and adolescents age 5-14 year-old attending paediatric outpatient clinic at Wolaita Sodo University comprehensive specialized hospital, South Ethiopia.

BACKGROUND: Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5-14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. METHOD: A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value < 0.05 were used to determine the predictors of the outcome variable. RESULT: The overall magnitude of elimination disorder among children and Adolescents age 5-14 in this study was (n 70, 16.8%); in boys (n 47, 17.3%) and girls (n 23, 15.75%). The prevalence of enuresis was (n 64, 15.3%), encopresis (n 15, 3.6%), both enuresis and encopresis, or combined elimination disorder (n 9, 2.2%). Age 9-11 years (AOR = 3.2, 95%CI:1.09, 9.43), family size four and above (AOR = 3.4, 95%CI:1.78, 6.56), family history of elimination disorder (AOR = 3.9, 95%CI:2.12, 7.45), emotional problem (AOR = 2.2, 95%CI:1.18, 4.05), hyperactive problem (AOR = 3.8, 95%CI:1.83, 7.83), low toilet training skills (AOR = 5.9, 95%CI:2.61, 13.33), bad parenting practices, were poor supervision (AOR = 4.4, 95%CI 1.29, 14.69) were significantly associated with elimination disorder. CONCLUSION AND RECOMMENDATION: In this study, approximately one in five children and adolescents had an elimination disorder. Younger age, family size four and above, positive family history of elimination disorder, presence of emotional and hyperactive problems, bad parenting practices, and low toilet training skills were factors associated with elimination disorders. Therefore, preventative, etiological, and therapeutic measure, early toilet training, supportive parenting practices, screening for children's and adolescents' behavioral problems, and elimination disorders need attention to reduce the effect of the problem.

Dysfunctional elimination syndromes--how closely linked are constipation and encopresis with specific lower urinary tract conditions?

PURPOSE: It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract conditions. MATERIALS AND METHODS: We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined. RESULTS: Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p <0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys. CONCLUSIONS: Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.