Dealing with constipation and other comorbidities

Management of constipation and reduction of fecal impaction can reduce pressure on the bladder neck and urethra causing LUTD.

Bristol Stool Form Scale and Rome IV criteria of constipation

The Bristol Stool Form Scale (BSFS) consists of seven pictorials and stool form descriptors [73]. It allows children to express their bowel movement consistency. Aside from its descriptive function, the accuracy of defecation history can be improved with its use in a 7-day bowel diary [15]. In children with recurrent UTI and constipation, maintaining a bowel diary with a BSFS and a frequency volume chart allows physicians and/or parents to monitor elimination habits and adjust treatment strategies.

In addition, the educational components of constipation resemble those for urotherapy. In toilet training for constipation, the child is advised to go to the bathroom for five minutes after meals to try to defecate. The results are recorded in a defecation diary, distinguishing between spontaneous defecation and planned defecation while on the toilet. This will help the child to re-learn the sense of urgency. Besides toilet training, the importance of physical exercise for good motility of the intestines, eating healthy food, and drinking sufficiently should be discussed [62]. Please note that a minority of children may have such a dilated rectum that their sense of feeling is compromised. For cases like this, the use of wash-out enemas is recommended.

Lewis, S.J.; Heaton, K.W. (1997). Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology. s. 920-4. doi:10.3109/00365529709011203. 9299672

Bedwetting | 3. Treating nocturnal enuresis
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