Questions & answers

Abstract

Dysfunctional elimination disorder is common in children with a history of infrequent bowel movements and reports of urinating three or fewer times per day. Most children with fecal incontinence related to constipation do not have an underlying organic disorder ( 5 Guerrero R. Cavender C. Constipation: Physical and psychological sequelae. Pediatric Annals. 1999; 28: 312-316 PubMed Google Scholar ). Urinary incontinence and fecal incontinence often occur together ( 3 Floch M. Dowd J. Incontinence and constipation: Pelvic floor disorders of gastrointestinal motility and urodynamics. Journal of Clinical Gastroenterology. 1998; 27: 4-5 Crossref PubMed Scopus (2) Google Scholar ). Fecal retention or “hoarding” causes chronic rectal distension and a decrease in tone. When the child has a large amount of compacted stool, a liquid or solid overflow of stool may occur. Dysfunctional voiding disorders are characterized by inefficient urination in the absence of anatomic or neurologic disease. This disorder may be a result of failure to relax the urethral sphincter and pelvic floor muscles. At a 2-week follow-up visit, you review Tiffany's ultrasound and discover that she indeed has an enlarged bladder capacity. You have ruled out other underlying disorders that may cause some of these same symptoms: Hirschsprung's disease, neurogenic bladder and bowel disorders, and adverse effects from medications.