Dysfunctional Elimination Syndromes-How Closely Linked are Constipation and Encopresis with Specific Lower Urinary Tract Conditions?
Dysfunctional Elimination Syndromes-How Closely Linked are Constipation and Encopresis with Specific Lower Urinary Tract Conditions?
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DOI：
10.1016/j.juro.2013.03.111
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发表时间：
2013-09-01
影响因子：
6.6
通讯作者：
Glassberg, Kenneth I.
中科院分区：
文献类型：
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作者：
Combs, Andrew J.;Van Batavia, Jason P.;Glassberg, Kenneth I.
目的：人们已经认识到，膀胱和肠道功能障碍之间有很强的相关性。材料与方法：将下尿路功能障碍患儿分为3类(便秘、尿失禁和便秘合并尿失禁)和4种下尿路疾病(排尿功能障碍、特发性逼尿肌过度活动障碍、逼尿肌利用不足和原发性膀胱颈功能障碍)。结果：在163名男性和205名女性中，便秘是最常见的肠功能障碍(27%)，平均年龄8.5岁。虽然大便失禁通常被认为反映了潜在的便秘，但在这个系列中，只有一半的大小便失禁儿童有便秘。排尿功能障碍与肠功能障碍的发生率最高有关。除1名患者外，所有患者都有相关的紧迫感和逼尿肌过度活动，75%的患者在开始抗胆碱能治疗后尿失禁消失。便秘在女孩中的发生率(27%)显著高于男孩(11%，p<；0.01)，而大便失禁在男孩中(9%)比女孩(3%，p=0.02)更常见，这可能反映了女孩排尿功能障碍和男孩特发性逼尿肌过度活动障碍的发生率更高。结论：在尿路状况较低的儿童中，有一半出现活动性肠功能障碍。便秘在排尿功能障碍患者中更为常见，而在特发性逼尿肌过度活动障碍患者和排尿功能障碍、严重紧迫症和逼尿肌过度活动患者中，大便失禁显著增加。尽管抗胆碱药有便秘作用，但用于治疗逼尿肌过度活动的药物在大多数患有这种肠道功能障碍的儿童中解决了尿失禁。
Purpose: It is recognized that there is a strong association between bladder and bowel dysfunction. We determined the association of constipation and/or encopresis with specific lower urinary tract conditions.Materials and Methods: We reviewed our database of children with lower urinary tract dysfunction and divided cases into 3 categories of bowel dysfunction (constipation, encopresis and constipation plus encopresis) and 4 lower urinary tract conditions (dysfunctional voiding, idiopathic detrusor overactivity disorder, detrusor underutilization disorder and primary bladder neck dysfunction). Associations between bowel dysfunction types and each lower urinary tract condition were determined.Results: Of 163 males and 205 females with a mean age of 8.5 years constipation was the most common bowel dysfunction (27%). Although encopresis is generally thought to reflect underlying constipation, only half of children with encopresis in this series had constipation. Dysfunctional voiding was associated with the highest incidence of bowel dysfunction. All but 1 patient with encopresis had associated urgency and detrusor overactivity, and the encopresis resolved in 75% of patients after initiation of anticholinergic therapy. Constipation was significantly more common in girls (27%) than in boys (11%, p < 0.01), while encopresis was more common in boys (9%) than in girls (3%, p = 0.02), likely reflecting the higher incidence of dysfunctional voiding in girls and idiopathic detrusor overactivity disorder in boys.Conclusions: Active bowel dysfunction was seen in half of the children with a lower urinary tract condition. Constipation was more common in patients with dysfunctional voiding, while encopresis was significantly increased in those with idiopathic detrusor overactivity disorder and in those with dysfunctional voiding, severe urgency and detrusor overactivity. Anticholinergics, despite their constipating effect, given for treatment of detrusor overactivity resolved encopresis in most children with this bowel dysfunction.