History

The cornerstone of good diagnostics is primarily an extensive micturition history. Frequency, urgency, when and how incontinence occurs, ways of dealing with bladder over-activity, history of febrile urinary tract infections, toileting position need to be assessed.

Defecation history focused on the Rome IV criteria for constipation is also part of the history. Due to a high rate of comorbid behavioral disorders in children with incontinence, it is recommended to consider screening for psychological symptoms as well.

ROME IV criteria

< 3 bowel movements per week
> 1 episode of fecal incontinence per week
Hard stools in the rectum seen in a digital rectal examination or palpable abdominal mass
Periodic large stools (difficult to flush)
Retentive behavior ("withholding")
Painful defecation

Be on the lookout for two or more of the criteria listed above within a period of at least 4 weeks

Bristol stool chart

Lower urinary tract disorders | 2. Diagnosing LUTD
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