الفهرس 
Defecation and Continence
Laboratory TestingOnly 14 pages are availabe for public view
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Abstract
Functional defecation disorders are common challenging pediatric problems with bad impact on quality of life affecting both the child and family, they are considered complex disorders with multifactorial etiology and pathophysiology.
Functional constipation (FC) is characterized by withholding behavior with subsequent rectal dilatation and increased rectal compliance and continue vicious circle. The majority of children with functional constipation are associated with fecal incontinence (ORSI), only 10-30% of children with fecal incontinence show no signs of fecal retention (FNRFI).
The diagnosis of functional defecation disorders primarily based on history and physical examination and many symptoms based systems have been instructed for clarified definitions such as ROME and PACCT criteria. Management protocol of these children based mainly on educational instructions and medical regimens, role of surgical intervention is very limited and related to special intractable cases.
The association between defecation disorders and lower urinary tract dysfunction has been well recognized and the term bowel bladder dysfunction (BBD) is adapted to describe this association. Urge syndrome, voiding dysfunction, impaired frequency, urinary tract infection (UTI) and vesicoureteric reflux (VUR) are commonly included.Several theories have been suggested to explain this association, the overlapping neurological pathways leads to crosstalk between rectum and bladder, also the loaded rectum compress the bladder with direct mechanical effect and stimulate stretch receptors leading to bladder instability.
Proper management of defecation problems has a significant effect on the resolution of urological disorders, and assessment of bowel habits is crucial in evaluation of lower urinary tracts complaints, other measures as urotherapy, education, physiotherapy and medications can be used.
The current study included 100 children (4-14 years) with functional defecation disorders associated with urological manifestations, functional constipation and overflow retentive stool incontinence (ORSI) were diagnosed in (87%), and functional non retentive fecal incontinence (FNRFI) in (13%), the most common urinary manifestations were withholding maneuver (75%), urinary incontinence (73%) and urgency (71%).
We found nocturnal enuresis as the most common type of urinary incontinence, positive urine culture was present in (11%), VUR was diagnosed in (17%) mainly in the left side. PVR was elevated in (52.8%), detrusor overactivity was recorded in (43.6%).
They all were managed with the protocol of management of functional defecation disorders of CRSDPC, improvement was achieved in (81%). Children with FC and ORSI, disimpaction with saline enema was sufficient and maintenance therapy was based on SBL, we found SBL effective and safe in children.
We found that the response to improvement of defecation disorders was significantly noticed in dysuria (83.3%), sense of incomplete emptying (78.9%), withholding maneuver (68.2%) and urgency (67.7%).
According to our results, children with daytime incontinence and nocturnal enuresis improved in (57.14%) and (75%), respectively.
Although the frequency of UTI diagnosis was low among our children, significant percentage (77.7%) were cured with no recurrence after defecation disorder management.
Vesicoureteric reflux diagnosed by VCUG dropped from (17.2%) to (6%) after defecation problem treatment.
Urodynamic studies were performed before and after management of defecation disorders, when comparing the results, we found significant improvement in normalization of urinary flowmerty pattern, the elevated volume of PVR, bladder capacity and detrusor overactivity.
Conclusively, this study has confirmed the previous findings of the functional connection between defecation disorders and lower urinary tract dysfunction and we found both symptoms of voiding dysfunction and symptoms of detrusor overactivity had been included.
We focused on the role of management of the defecation disorders in the improvement of lower urinary tract symptoms, we found significant effect and confirmed the importance of management of these disorders.