A Team ApproachA Team Approachto Dysfunctional to Dysfunctional

Voiding and EliminationVoiding and Elimination

Risk Factors for Urinary Tract Risk Factors for Urinary Tract Infections & Dysfunctional Infections & Dysfunctional

EliminationElimination

Poor Bladder HealthPoor Bladder Health

• HOLDINGHOLDING - NOT peeing at regular 2 hour - NOT peeing at regular 2 hour timed intervals throughout the day.timed intervals throughout the day.

• Poor Fluid IntakePoor Fluid Intake and excessive intake and excessive intake of bladder irritants such as caffeinated of bladder irritants such as caffeinated and high sugared drinks.and high sugared drinks.

• Poor peeing posturePoor peeing posture will negatively will negatively impact the bladders ability to empty impact the bladders ability to empty completely.completely.

Poor Bowel HealthPoor Bowel Health

• CONSTIPATIONCONSTIPATION – NOT establishing – NOT establishing bowel regularity.bowel regularity.

• HOLDINGHOLDING – ignoring the signal to – ignoring the signal to pooppoop

• Poor Poor wiping or soilingwiping or soiling of underpants of underpants

Poor Genital HygienePoor Genital Hygiene

•Must practice good Must practice good general body hygienegeneral body hygiene

•Always follow good Always follow good hand washing and hand washing and fingernail hygiene.fingernail hygiene.

•Uncircumcised males Uncircumcised males must provide optimal must provide optimal care to the penis.care to the penis.

•Females need optimal Females need optimal wiping habits and wiping habits and good genital hygiene.good genital hygiene.

• Not Completely understood in the Not Completely understood in the medical community – but some medical community – but some children simply have more problems children simply have more problems with UTI’s (infections) than others.with UTI’s (infections) than others.

• We can not cure children that are We can not cure children that are prone to infections, your goal is to prone to infections, your goal is to eliminate the riskeliminate the risk factors.factors.

Poor Bladder ImmunityPoor Bladder Immunity

GenderGender

•GIRLSGIRLS have more problems with UTI’s have more problems with UTI’s than BOYS.than BOYS.

•Female anatomy predisposes girls to Female anatomy predisposes girls to have more problemshave more problems

•The female urethra is shorter and the The female urethra is shorter and the anus and vagina are very close together anus and vagina are very close together increasing the risk of cross-increasing the risk of cross-contaminationcontamination

Structural defects of Structural defects of urinary Systemurinary System

•VURVUR – Vesicle – Vesicle Ureteral RefluxUreteral Reflux

•Bladder or Bladder or Kidney Kidney stones/calculistones/calculi

•Ectopic UretersEctopic Ureters

Diagnosis:Diagnosis:1.1. Must obtain a Must obtain a

detailed history and detailed history and physical including:physical including:

• Family historyFamily history• Birth HistoryBirth History• Medical and Medical and

Surgical historySurgical history• Developmental Developmental

milestonesmilestones• Bowel and Bowel and

Bladder habitsBladder habits• Current Current

medications medications • Physical ExamPhysical Exam

Problems with ConstipationProblems with Constipation

1.1. Consequences of Consequences of ConstipationConstipation

• Pain and discomfortPain and discomfort

• Chronic rectal distension Chronic rectal distension with loss of propulsionwith loss of propulsion

• Reduced perception of Reduced perception of the need to stoolthe need to stool

• A distended rectum A distended rectum imparts pressure on the imparts pressure on the bladderbladder

• Increased risk for UTIIncreased risk for UTI

• Urine flow disturbancesUrine flow disturbances

Definition of Definition of ConstipationConstipation

• No single definition No single definition existsexists−Infrequent passage of stoolInfrequent passage of stool−Difficulty passing stoolDifficulty passing stool−Straining to pass stoolStraining to pass stool−Small pebbly stoolsSmall pebbly stools−Large firm stoolsLarge firm stools−Episodes of abdominal painEpisodes of abdominal pain−Fecal soilingFecal soiling−Palpable stool on physical Palpable stool on physical

examexam

Bowel ManagementBowel Management

MedicationsMedications

1. Bowel clean out 1. Bowel clean out with with

Enemas/Enemas/suppositoriessuppositories

2. Stool softeners2. Stool softeners

3. Laxatives3. Laxatives

Bowel ManagementBowel Management

DietaryDietary

1. Increase Fluids1. Increase Fluids

2. Increase Fiber2. Increase Fiber

3. Reduce Dairy 3. Reduce Dairy IntakeIntake

Fiber Facts & TherapyFiber Facts & Therapy

Fiber is found in grains, cereals, fruits, Fiber is found in grains, cereals, fruits, veggies, nuts, seeds and legumes.veggies, nuts, seeds and legumes.

FIBER RDA’SFIBER RDA’S

1-3 yo needs 8-10g/day1-3 yo needs 8-10g/day

4-6 yo needs 12-14g/day4-6 yo needs 12-14g/day

7-10 yo needs 14-16g/day7-10 yo needs 14-16g/day

Become an expert label reader!Become an expert label reader!

Behavior ModificationBehavior Modificationfor Bowel/Bladderfor Bowel/Bladder

1.1. Dietary (remember these tips)Dietary (remember these tips)• Avoid bladder irritants such Avoid bladder irritants such

as Caffeine, Chocolate, Citrusas Caffeine, Chocolate, Citrus

• Avoid excessive dairy intakeAvoid excessive dairy intake

• Avoid heavily sugared foodsAvoid heavily sugared foods

• Increase dietary fiberIncrease dietary fiber

• Increase water intakeIncrease water intake• Decrease constipating foodsDecrease constipating foods

Behavior ModificationBehavior Modification

2. 2. Hygiene TechniquesHygiene Techniques

•Be aware of mistakesBe aware of mistakes

•Girls: wipe front to backGirls: wipe front to back

•Use sufficient amount of toilet Use sufficient amount of toilet paperpaper

•Avoid “scrubbing” or “dabbing”Avoid “scrubbing” or “dabbing”

•Change underwear when wet or Change underwear when wet or dampdamp

•Butterfly rinse for girlsButterfly rinse for girls

Behavior ModificationBehavior Modification

3. 3. Voiding TechniquesVoiding Techniques• Proper posture for girls and Proper posture for girls and

boys (see handout for boys (see handout for posture review)posture review)

• Timed voiding, timed stoolingTimed voiding, timed stooling

• Double voiding when Double voiding when necessarynecessary

• Slow down, relaxSlow down, relax

• Visualization exercise Visualization exercise

Behavior ModificationBehavior Modification

4. 4. Positive ReinforcementPositive Reinforcement• Stress overall goals and Stress overall goals and

objectivesobjectives

• Always be positiveAlways be positive

• Start with rewards for Start with rewards for attempts then advance to attempts then advance to the goalsthe goals

• Keep a calendarKeep a calendar

Make success your Make success your target:target:

CommitmentCompliancyConsistencySuccess

Follow the 3 C’s

GOAL