Bladder & Bowel Dysfunction (BBD) & Constipation
The functioning of the lower urinary tract and anorectum are inter-related. The association between detrusor overactivity and constipation has been clearly described. [61,62] The combination has been termed bladder and bowel dysfunction, [20] and may be explained by rectal distension interfering with bladder function or shared innervation pathways. The association between constipation and enuresi
The functioning of the lower urinary tract and anorectum are inter-related. The association between detrusor overactivity and constipation has been clearly described.[61,62] The combination has been termed bladder and bowel dysfunction,[20] and may be explained by rectal distension interfering with bladder function or shared innervation pathways. The association between constipation and enuresis is more controversial, and appears to be limited to children with NMSE.[63] Treatment of constipation without treating enuresis has also been shown to have a poor effect on MSE.[64,65]
The diagnosis of functional constipation is often elusive, and the history and examination of a child with enuresis should include looking for features as described by the Rome IV criteria.[66] The combination of constipation and enuresis should also prompt a careful neurological and spinal examination. The treatment of constipation is challenging and consists of education and pharmaceutical treatment. Education and de-mystification are essential; caregivers and children must understand the central role of withholding behaviour in the pathogenesis of functional constipation.[67] Osmotic laxatives such as polyethylene glycol or lactulose are the first-line medications to induce and maintain soft stools while toilet training/ retraining is ongoing. Second-line options include stimulant and lubricant laxatives or rectal enemas.[67] If disimpaction is required, a combination of laxatives in relatively high doses is often required before starting maintenance therapy.
The South African Medical Journal_The South African guidelines on enuresis: 2024 update_November 2024; Vol. 114, No. 11