Association between dysfunctional elimination syndrome and sensory processing disorder.

OBJECTIVE. We explored whether sensory processing disorder (SPD) is related to dysfunctional elimination syndrome (DES). METHOD. We used the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire and the Short Sensory Profile with participants who sought treatment of DES (n = 19) and healthy control participants (n = 55). RESULTS. Significantly more children with DES (53%) had SPD than was reported for the general population (p < .001; Ahn, Miller, Milberger, & McIntosh, 2004). Control participants did not have a greater rate of SPD (p = .333). We found a significant association between the occurrence of DES and SPD, χ²(1) = 20.869, p < .001, and a significant correlation between test scores (Spearman's ρ = -.493, Rs² = .243, p < .001). CONCLUSION. Many children with DES may also have SPD, suggesting that a child's sensory processing pattern would be an important aspect that could influence the plan of care.

Síndrome de mala eliminación / Dysfunctional elimination syndrome

El Síndrome de Mala Eliminación (SME) comprende la alteración en la evacuación a nivel intestinal y urinario, en distintos grados y formas de presentación clínica. Diversos estudios muestran el origen de esta patología en una alteración a nivel de la musculatura del piso pelviano. El objetivo de esta revisión es entregarle al pediatra una visión general de este concepto, usa cada vez más utilizado en la literatura internacional, destacando la importancia de la sospecha clínica, diagnóstico y manejo precoz. Los resultados de estudios internacionales avalan la necesidad del tratamiento conjunto de la afección urinaria y gastrointestinal, para lograr mayor porcentaje de mejoría. El enfoque conjunto de la incontinencia y la constipación, más la amplia gama de situaciones clínicas que cada uno de ellos conlleva, es el objetivo que persigue introducir este nuevo síndrome.

Functional urinary and fecal incontinence in neurologically normal children: symptoms of one 'functional elimination disorder'?

OBJECTIVE: To clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. PATIENTS AND METHODS: In the European Bladder Dysfunction Study, a prospective multicentre study comparing treatment plans for children with NNBSD, 202 children completed questionnaires on voiding and on defecation, at entry and after treatment for UI. Four symptoms of disordered defecation were evaluated; low defecation frequency, painful defecation, fecal soiling, and encopresis. RESULTS: At entry, 17 of the 179 children with complete data sets had low defecation frequency and/or painful defecation (9%), classified as functional constipation (FC). Of the 179 children, 57 had either isolated fecal soiling or soiling with encopresis (32%), classified as functional fecal incontinence (FFI). After treatment for UI, FFI decreased to 38/179 (21%) (statistically significant, P = 0.035); for FC there were too few children for analysis. After treatment for UI, 19 of the 179 children (11%) reported de novo FFI. Symptoms of disordered defecation did not influence the cure rate of treatment for UI. CONCLUSIONS: FFI improved significantly after treatment for UI only, but not in relation to the outcome of such treatment. FFI did not influence the cure rate for UI. There was little to support a causal relation between disordered defecation and NNBDS ('functional elimination syndrome').

Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life?

OBJECTIVE: It has been suggested that urinary tract infections (UTIs) early in life predispose to dysfunctional elimination syndrome (DES). This study evaluated the relationship between early UTI, vesicoureteral reflux (VUR), and DES by comparing two cohorts of school-aged children. METHODS: The UTI cohort (n = 123) included children previously enrolled in a prospective treatment trial conducted between 1992 and 1997. All were diagnosed with a febrile UTI before 2 years of age. The comparison cohort (n = 125) included children who were evaluated for fever in the emergency department between 1992 and 1997, whose urine culture was negative. Dysfunctional elimination symptoms were compared in the two cohorts by having families complete a revised version of the Dysfunctional Voiding Scoring System. RESULTS: Completed questionnaires were received from 248 children. There were no significant differences in selected demographic or clinical characteristics between the two cohorts. DES was present in 22% and 21% of children with and without a history of early UTI, respectively. Among children with UTIs, 18% of those with VUR and 25% of those without VUR had DES. CONCLUSIONS: Dysfunctional elimination is common in a general pediatric population. Neither UTI nor VUR diagnosed before 2 years of age was associated with DES in school-aged children.

Animus: um desafio diagnóstico e terapêutico / Animus: a diagnosis and therapeutic challenger

O animus tem sido implicado como o principal componente da evacuação obstruída. Além da constipação intestinal, a proctalgia crônica é outra manifestação freqüente deste distúrbio. O diagnóstico envolve medições laboratoriais do esforço evacuatório, sendo a proctografia dinâmica o exame padrão-ouro. O tratamento consiste, na maioria dos casos, de retreinamento com biofeedback (BF), associado a medidas dietoterápicas e uso de laxantes suaves.