The Ins and Outs of Voiding and Defaecation – CFA Queensland Branch Conference 2015

Here’s the abstract for the talk I’ll be doing at the Continence Foundation of Australia Queensland Branch Conference on 13th March 2015.
Click here for more information on the Conference: http://bit.ly/1DKXiAA
Toilet training, like much of parenting, can be a mystery to many mothers and fathers and yet the implications for the child in their future years can be enormous. Bladder/bowel dysfunction (BBD) in paediatrics can include a number of conditions related to urinary voiding and defaecation such as dysfunctional voiding, dysfunctional elimination syndrome and lead to dysfunctional lower urinary tract symptoms including urinary incontinence, recurrent UTI’s, dysuria, voiding postponement and potentially vesicoureteral reflux .⁽¹⁾
Young girls can be prone to recurrent urinary tract infections because of poor voiding patterns where there is a dyssynergic pattern of voiding. There can be a failure of relaxation of the external urethral sphincter and /or the pelvic floor muscles leading to high voiding pressures and incomplete emptying of the bladder. This can also lead to girls developing urinary leakage due to their voiding position and technique. There is evidence that suffering with LUTS in childhood increases the risk of subsequent problems as an adult.⁽²⁾
Developing a habit of straining at stool can cause constipation, rectal prolapse and anal fissures, which can lead to pain and subsequent withholding of the stool. Bloating, faecal impaction followed by faecal incontinence (encopresis), feeling unwell and causing subsequent behavioural issues in young children⁽³⁾, are just some of the consequences of poor defaecation training.
This session will cover the anatomy and physiology of bladder and bowel emptying especially understanding the muscles involved; will look at the recent research into voiding dysfunction, constipation and obstructed defaecation; and cover the implications of bladder voiding dysfunction on the different life-stages of women and men starting at toilet training including some latest research into low grade urinary tract infections and the overactive bladder.
A practical revision of the correct positions and dynamics of bladder and bowel emptying will be covered for those in the audience who are new to continence and pelvic floor dysfunction.
References

1. American Urological Society (2010) Management of children with vesicouretal reflux and bladder/bowel dysfunction.
2. Salvatore S et al (2012) Is overactive bladder in children and adults the same condition? ICI-RS 2011. Neurourol Urodyn 31(3):349-51. doi: 10.1002/nau.22223. Epub 2012 Mar 15
3. Van Dijk M et al (2010) Prevalence and Associated Clinical Characteristics of Behaviour Problems in Constipated Children. Pediatrics 125 No. 2 February 1, 2010 pp. e309 -e317 (doi: 10.1542/peds.2008-3055) first published online January 18, 2010