Summary about Disease
Unspecified Elimination Disorder (also sometimes referred to as Functional Elimination Disorders when a medical cause is not identifiable) refers to difficulties with bowel or bladder control that are not caused by an underlying medical condition like a structural abnormality or a specific disease. It's a broad term covering situations where a child or adult has problems with urination (enuresis) or defecation (encopresis) beyond the expected age of continence, and when other more specific conditions aren't clearly present. The lack of specificity implies the exact cause and specific features are not easily categorized.
Symptoms
Symptoms can vary depending on whether the issue is with bowel or bladder control.
Encopresis (Fecal Incontinence): Soiling of clothes or underwear with stool, constipation, abdominal pain, fecal impaction, feeling of incomplete bowel emptying, infrequent bowel movements, overflow diarrhea (leaking of liquid stool around a hard stool mass).
Enuresis (Urinary Incontinence): Bedwetting during sleep, daytime wetting, frequent urination, urgency to urinate, difficulty initiating urination, weak urine stream.
Associated issues: Anxiety, embarrassment, social isolation, behavioral problems.
Causes
The cause of Unspecified Elimination Disorder is often multifactorial and can be difficult to pinpoint. Potential contributing factors include:
Genetic Predisposition: A family history of elimination disorders.
Developmental Delay: Slower development of bladder or bowel control.
Psychological Factors: Stress, anxiety, trauma, or emotional difficulties.
Learned Behavior: Poor toilet training habits or inconsistent routines.
Dietary Factors: Poor fluid intake, inadequate fiber intake (especially in encopresis).
Bladder/Bowel Dysfunction: Underactive or overactive bladder muscles, difficulties coordinating muscles for elimination.
Sensory Issues: Difficulty sensing the need to urinate or defecate.
Constipation: (Especially in encopresis), leading to impaction and overflow soiling.
Medicine Used
Medication use depends on the specific symptoms and suspected underlying issues.
Encopresis:
Laxatives: To treat constipation and disimpaction (e.g., polyethylene glycol, lactulose, mineral oil, stimulant laxatives).
Stool Softeners: To prevent constipation.
Enuresis:
Desmopressin (DDAVP): A synthetic form of vasopressin to reduce urine production.
Tricyclic Antidepressants (e.g., Imipramine): Sometimes used, but with caution due to potential side effects.
Anticholinergics (e.g., Oxybutynin): To help with overactive bladder symptoms. It is important to note that medication is generally used as part of a broader treatment plan including behavioral interventions.
Is Communicable
No, Unspecified Elimination Disorder is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Establish a Regular Toilet Routine: Encourage consistent toilet times, especially after meals.
Ensure Adequate Fluid Intake: Encourage regular water consumption throughout the day.
Increase Fiber Intake: For encopresis, increase fiber in the diet to prevent constipation.
Avoid Bladder Irritants: Limit caffeine and sugary drinks, especially for enuresis.
Address Psychological Factors: Provide a supportive and understanding environment.
Avoid Punishment: Do not punish or shame the individual for accidents.
Protect Skin: Use barrier creams to protect skin from irritation due to frequent wetting or soiling.
Maintain good hygiene: Ensure thorough cleaning after accidents to prevent skin infections.
How long does an outbreak last?
Because Unspecified Elimination Disorder isn't an 'outbreak' (it's a chronic issue), the duration varies greatly. It can last for months or even years without intervention. With proper treatment (behavioral therapy, medication if needed, and lifestyle changes), it can often be managed or resolved over several months. Relapses are possible, particularly during times of stress.
How is it diagnosed?
Diagnosis typically involves:
Medical History: Detailed questions about the individual's bowel and bladder habits, diet, and any relevant medical or psychological history.
Physical Examination: To rule out any underlying medical conditions.
Voiding Diary: Keeping a record of urination patterns (frequency, volume, accidents).
Bowel Movement Diary: Keeping a record of bowel movement patterns.
Bristol Stool Chart: May be used to evaluate stool consistency.
Functional Gastrointestinal Disorders Rome IV criteria: The Rome IV criteria for functional gastrointestinal disorders are often used to diagnose elimination disorders.
Urine Analysis: To rule out urinary tract infection or diabetes.
Imaging Studies (Rare): X-rays or ultrasounds may be used in specific cases to evaluate the bladder or bowel. The diagnosis of Unspecified Elimination Disorder is made when other, more specific conditions have been ruled out.
Timeline of Symptoms
The timeline of symptoms can vary. Symptoms may appear gradually over time or may start suddenly, especially after a stressful event. The symptoms might be persistent or intermittent, with periods of improvement followed by relapses. Tracking the symptoms using a diary can help identify patterns and triggers.
Important Considerations
Psychological Impact: The disorder can have a significant impact on self-esteem, social relationships, and emotional well-being.
Co-Occurring Conditions: Anxiety, depression, and ADHD are frequently associated with elimination disorders.
Family Involvement: Family support and involvement are crucial for successful treatment.
Multidisciplinary Approach: Treatment often requires a team approach, including physicians, therapists, and possibly dietitians.
Persistence and Patience: Treatment can take time, and setbacks are common. Patience and consistency are key.
Rule out other conditions: It is important to rule out other underlying medical conditions.
Normal Development: A certain degree of wetting and soiling can be normal in young children.