Calomania in children: causes, diagnosis and treatment на flymega.ru

Fecal incontinence is a disorder that consists of the involuntary loss of fecal, solid, liquid or mucous material from the anus.

Fecal incontinence can be a source of anxiety and embarrassment. Some subjects react with shame, others try to hide the problem. Even the idea of talking to your doctor about it can be scary or embarrassing. However, in reality, an honest and open conversation with your doctor is important for diagnosis and treatment.

The main risk factors that can contribute to the occurrence of the disease are:

over 65 years old,
sedentary lifestyle,
presence of chronic illnesses, diseases or health problems,
removal of the gallbladder (cholecystectomy),
smoke .

It is more common in older people, although it affects about 2 in 100 children; In pediatrics, this is a common complication in children born with congenital spinal cord defects or severe constipation.

Treatment can help improve incontinence and reduce the impact on the patient's quality of life; The approach is closely related to the cause of the problem and may include:

wear medical clothing (diapers and other devices),
dietary changes (how to avoid foods that cause/worse diarrhea),
medicines to treat intestinal disorders (diarrhea/constipation),
exercises aimed at strengthening the muscles used to control the intestines (pelvic floor).

Surgery may be considered when previous options do not effectively control the problem.

causes

There are many causes of fecal incontinence, including disorders and chronic diseases of the digestive tract. Some risk factors, such as those associated with vaginal delivery, affect only women.

The most common type of incontinence is urge incontinence, in which the subject experiences a sudden and strong urge to defecate, which they are unable to hold in long enough to make it to the toilet. With urinary incontinence, the pelvic floor muscles may be too weak to contain fecal material as a result of muscle or nerve damage.

Another type of incontinence is passive. In this case, the subject loses excrement without realizing it; Passive incontinence may be due to the body being unable to feel the tension caused by the rectum when it is full.

Diarrhea

In stools, soft and watery diarrhea quickly fills the rectum and makes it more difficult to retain those substances. Diarrhea is the most common risk factor for the development of fecal incontinence in patients not undergoing hospitalization, nursing home or similar.

This may be due to problems in the digestive tract such as

inflammatory bowel diseases such as Crohn's disease,
irritable bowel syndrome,
proctitis,
gastroenteritis.

Constipation

Constipation can lead to the formation of large, hard stools that are difficult to pass.

These hard stools relax and eventually weaken the rectal muscles. Weakened, the muscles are no longer able to hold the watery stools that accumulate after heavy ones are passed.

Muscle injury or weakness

The muscles of the anus, pelvic floor, or rectum, if damaged or weakened, may not keep the anus closed, resulting in loss of fecal material. Damage or weakening may arise from

surgery to remove the colon or rectum,
hemorrhoid removal,
treatment of abscesses and anal fistulas,

injuries.

Nerve damage

Muscle function can be impaired by damage to the nerves that control the anus, pelvic floor, and rectum.

Damage to the nerves that warn of bowel movements in the rectum makes it difficult to understand the need to go to the toilet.

Damage may be caused

chronic effort to evacuate feces,
brain damage
spinal cord injury.

Neurological diseases

Neurological diseases affecting the nerves of the anus, pelvic floor or rectum can cause fecal incontinence.

dementia,
multiple sclerosis ,
Parkinson's disease ,
stroke ,
diabetes mellitus type 2.

Rectal stiffness

The rectum may become stiff and unable to relax enough to hold stool because it is inflamed or affected by scar tissue. Therefore, the rectum can quickly be associated with fecal loss.

Rectal surgery, radiation therapy to the pelvis, and inflammatory bowel disease can cause scarring and inflammation of the rectum.

Haemorrhoids

Hemorrhoids can prevent the muscles around the anus from completely closing and then releasing a small amount of stool or mucus.

Rectal prolapse

Also, rectal prolapse (the rectum emerges from the anus) can prevent the muscles around the anus from completely closing, leaking small amounts of feces or mucus.

Lack of physical activity

In the event of a lack of physical activity, especially if it involves many hours of complete sedentary activity, the rectum can accumulate large amounts of stool. Therefore, the most liquid component can draw around the more solid one. In older and frail adults, inactivity is often the cause of fecal incontinence due to constipation.

Vaginal birth

Childbirth sometimes causes damage to the anal sphincter, leading to fecal incontinence. Odds increase when

the fruit is large,
forceps are used,
birth occurs with the help of a vacuum,
The vaginal area is cut (episiotomy) to prevent the fetal head from tearing the vagina.

Rectocele

In a rectocele, the rectum protrudes from the vagina. This may be due to a weakening of the thin layer of muscle that separates the rectum from the vagina. Feces may remain in the rectum because the rectocele prevents pushing.

Causes of fecal incontinence in children

In children over 4 years of age, the most common cause of incontinence is constipation, followed by the accumulation of large amounts of feces in the rectum.

When this happens, the baby may not perceive the arrival of new fecal material. You may not be aware of the need to defecate. Rectal accumulations of large quantities of feces can cause chronic relaxation of the internal and external anal sphincter with loss of the most liquid fecal component.

Birth defects of the anus, rectum, or colon, such as Hirschsprung's disease, can in turn cause fecal incontinence in the child. These defects can weaken the pelvic muscles or damage the nerves of the anus or rectum.

Damage to the nerves of the anus and rectum can also cause fecal incontinence, as well as spinal cord injuries and birth defects.

Varieties

Encopresis varies in severity.

There are 3 degrees of defecation disorder:

difficulty retaining gases;
incontinence of loose feces and gases;
inability to control bowel movements of any consistency.

When the first difficulties appear, you should immediately seek medical help.

When to see a doctor

It is recommended to consult a doctor if:

You are experiencing fecal leaks that cannot be checked,
panties get dirty without feeling the need to defecate,
traces of feces are lost during flatulence,
the disorder affects the patient's life from a social/psychological perspective.

Please note that an occasional episode, perhaps during intestinal distress due to diarrhea, is not a cause for concern and can happen to anyone; Although some subjects may cope with mild or sporadic incontinence problems, it is helpful to consult a physician if urinary incontinence is altering quality of life or causing emotional or social distress.

Fecal incontinence in the elderly: which diapers are best to use?

Fecal incontinence is almost always accompanied by urinary incontinence. Seni V pads with an absorbent effect are ideal for this. They are used together with other diapers, since classic diapers simply cannot cope with feces and urine at the same time.

What are the best diapers and nappies to use?

It is possible to use pads together with a ureteral catheter; they are placed and fixed in panties, and in such conditions the diaper can no longer be used.
The peculiarity of these pads is that they perfectly absorb all unpleasant odors, thanks to the super absorbent layer.
The antibacterial layer prevents the growth of bacteria.

Such products adapt to the shape of the body, thereby providing comfort and not allowing moisture to pass through, but most importantly, these pads are made from a “breathable” component and easily allow air to pass through.

complications

Fecal incontinence may lead to further problems as a result of symptoms

irritation of the skin around the anus,
emotional and social stress such as fear,
embarrassment,
social isolation,
loss of self-esteem,
fear
or depression,

affects quality of life, such as

inability to engage in physical activity,

to work,

go to school,

participate in social events.

The principle of the act of defecation

People are able to suppress the urge to defecate from about 2 years of age. Bowel emptying is controlled by the central nervous system.

Reaching the anus, feces usually already have the required density and volume (on average 200 ml). The sphincter muscles hold the stones, allowing bowel movements to occur exactly at the right time.

The muscles of the abdominal cavity and pelvic floor are also involved in the process of defecation.

diagnostics

The diagnosis is made based on

story,
physical examination
and instrumental exams.

It may be helpful to keep a bowel diary to aid diagnosis. It is a matter of recording the details of fecal evacuation on a daily basis. The physician may provide a form to fill out, or the subject may create their own form on which to write down the details.

The doctor's questions may cause embarrassment and reluctance. However, the doctor will not be upset or surprised. The more the subject can provide details and examples related to his problem, the more easily the clinician can help. Talking honestly and openly about the problem with your doctor makes diagnosis much easier.

General information about the violation

The disease is widespread

in pediatrics: 1-5% of children experienced this disorder.

It is most often detected in children aged 5 to 8 years and may be a symptom of nervous system disorders or a sign of other pathologies, including mental disorders.

In boys

Fecal incontinence occurs several times more often than in girls.

30-35% of children with fecal incontinence also have bedwetting.

Many parents, having seen that their child has problems with fecal retention, may not consult a doctor for a long time, hoping that the problem will sooner or later go away on its own

Statements such as “this is the age”, “it’s all from nerves” are used as justification, but it is important to understand that encopresis in some cases is a sign of serious diseases that need to be treated urgently, and in addition creates psychological discomfort for the matured child.

Children with this disease find it more difficult to adapt to school and may become outcasts.

, who will be mocked for years, even after the violation disappears.

Young children with incontinence also often suffer humiliation and insults from relatives, including parents, many of whom, upon seeing feces in their underwear, become indignant and shame the child, which only worsens the problem.

It is important for parents to learn: it is impossible to humiliate and shame a child for fecal incontinence.

. He really cannot control the process of defecation, and psychological abuse has never been good for anyone.

Care and protection

The first stage of treatment is directed to the doctor to consider the causes and possible treatments for fecal incontinence.

Simple procedures such as

change your diet
drugs,
bowel training (trying to use the bowels to evacuate at certain times of the day, such as after eating or upon waking),
use of sanitary napkins,
and exercises to strengthen the pelvic muscles (Kegel exercises),

These treatments can stop urinary incontinence in 1 in 5 patients.

Your doctor can tell you how to treat and treat fecal incontinence. It may also explain how to reduce anal discomfort and cope with incontinence.

The patient can and should play an active role in treatment by communicating openly and honestly about symptoms and possible consequences of treatment.

When these approaches are insufficient, more invasive interventions can be evaluated:

Biofeedback therapy uses devices to help understand the effectiveness of exercises in strengthening the pelvic floor muscles.
The sacral nerves control the anal sphincters, colon, and rectum. In cases where these nerves are not working properly, sacral nerve stimulation (a type of electrical stimulation) is used.
Prescription drugs.
Vaginal balloon, a device that inflates a balloon inside the vagina. Pressure on the wall of the rectum makes it difficult for stool to pass.
Non-absorbent mass agents are substances that are injected into the wall of the anus to swell the tissue around the anus to limit its opening so that the sphincters are more effective.
Surgery.

Remedies for anal discomfort

Fecal incontinence can cause anal discomfort, that is, irritation, pain, or itching. You can help ease the discomfort:

washing the anal area after defecation,
change bed linen as soon as possible,
keeping the anal area dry,
applying a moisturizing protective cream to the area around the anus,
using non-medicinal powders,
using disposable pads or bed linen,
Wear clothes and underwear that allow air to pass through.

Adopting some habits can help you better solve the problem:

evacuate before leaving home,
leaving the house, taking with you equipment for cleaning and changing clothes,
find public toilets before you need them,
wear absorbent
bring disposable bed linen,
Take over-the-counter medications to prevent episodes of diarrhea before going to restaurants or social events.

Finally, remember that fecal incontinence

it's not a fault to be ashamed, but just a medical problem,
it can often be treated; There are several possible effective treatments,
should not be considered normal age-related involution,
it does not disappear on its own; in many cases treatment is necessary.

Diet and fecal incontinence

It is necessary to follow a healthy and balanced diet. A doctor or nutritionist can recommend an adequate nutrition program.

In cases where incontinence is caused by constipation or hemorrhoids, increasing your fiber and fluid intake may be helpful.

In cases involving diarrhea, it is necessary to avoid foods that make it worse, such as

alcoholic drinks,
drinks and products containing caffeine,
dairy products such as milk, cheese and ice cream,
fatty and fatty foods,
drinks and foods containing fructose,
fruits such as apples, peaches and pears,
spicy food,
products (including sweets and chewing gum) containing sweeteners ending in “ol” such as sorbitol, mannitol, xylitol and maltolol.

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Encopresis in childhood

In this category of patients, the root cause of the pathology is usually a psychological factor. Boys are diagnosed with this condition more often than girls. The problem can also exist from infancy. Psychologists say that if parents are too persistent in trying to potty train their child by refusing to use diapers, the baby may begin to hold back the process of bowel movements out of fear and misunderstanding. This will manifest the protective reaction of his body in a stressful environment.

At school age, starting from 8–10 years old, the psychological load increases. If, in addition, an unfavorable environment at home remains, then encopresis can be the result of the manifestation of psychosomatics without any organic abnormalities (encopresis of an inorganic nature has an ICD-10 code F98.1). This way the child is relieved of tension. If cases of fecal incontinence occur only at night, then parents should form the child's habit of defecation in the evening, shortly before bedtime. The psychological mood of the little patient and the timing of treatment depend to a large extent on the attitude of the parents to the problem that has arisen.

Treatment

How to treat? The following methods are used in the treatment of incontinence:

Traditional methods of treatment, especially herbal medicine, can improve the child’s condition. It is useful to brew soothing herbs (mint, lemon balm, motherwort, valerian, chamomile); you can also add decoctions to bathing water.

After eating, the child can be seated on the toilet so that he tenses the sphincter for a while: this stimulates intestinal motility, and the child learns to control bowel movements and feel the urge.
Compliance with the regime is very important: if the child gets used to pushing at a certain time, most of the intestinal problems will disappear.
If a child does not want to sit on the toilet, there is no need to force him: this will adversely affect his psyche. Also, the child should be told in a calm atmosphere about the work of the intestines and why it is important to follow the regime.