1. A Team Approach to Dysfunctional Voiding and Elimination

2. Risk Factors for Urinary Tract Infections & Dysfunctional Elimination Poor Bladder Health HOLDING - NOT peeing at regular 2 hour timed intervals throughout the day. HOLDING - NOT peeing at regular 2 hour timed intervals throughout the day. Poor Fluid Intake and excessive intake of bladder irritants such as caffeinated and high sugared drinks. Poor Fluid Intake and excessive intake of bladder irritants such as caffeinated and high sugared drinks. Poor peeing posture will negatively impact the bladders ability to empty completely. Poor peeing posture will negatively impact the bladders ability to empty completely.

3. Poor Bowel Health CONSTIPATION – NOT establishing bowel regularity. CONSTIPATION – NOT establishing bowel regularity. HOLDING – ignoring the signal to poop HOLDING – ignoring the signal to poop Poor wiping or soiling of underpants Poor wiping or soiling of underpants

4. Poor Genital Hygiene Must practice good general body hygiene Must practice good general body hygiene Always follow good hand washing and fingernail hygiene. Always follow good hand washing and fingernail hygiene. Uncircumcised males must provide optimal care to the penis. Uncircumcised males must provide optimal care to the penis. Females need optimal wiping habits and good genital hygiene. Females need optimal wiping habits and good genital hygiene.

5. Not Completely understood in the medical community – but some children simply have more problems with UTI’s (infections) than others. Not Completely understood in the medical community – but some children simply have more problems with UTI’s (infections) than others. We can not cure children that are prone to infections, your goal is to eliminate the risk factors. We can not cure children that are prone to infections, your goal is to eliminate the risk factors. Poor Bladder Immunity

6. Gender GIRLS have more problems with UTI’s than BOYS. GIRLS have more problems with UTI’s than BOYS. Female anatomy predisposes girls to have more problems Female anatomy predisposes girls to have more problems The female urethra is shorter and the anus and vagina are very close together increasing the risk of cross-contamination The female urethra is shorter and the anus and vagina are very close together increasing the risk of cross-contamination

7. Structural defects of urinary System VUR – Vesicle Ureteral Reflux VUR – Vesicle Ureteral Reflux Bladder or Kidney stones/calculi Bladder or Kidney stones/calculi Ectopic Ureters Ectopic Ureters

8. Diagnosis: 1. Must obtain a detailed history and physical including: Family history Family history Birth History Birth History Medical and Surgical history Medical and Surgical history Developmental milestones Developmental milestones Bowel and Bladder habits Bowel and Bladder habits Current medications Current medications Physical Exam Physical Exam

9. Problems with Constipation 1. Consequences of Constipation Pain and discomfort Chronic rectal distension with loss of propulsion Reduced perception of the need to stool A distended rectum imparts pressure on the bladder Increased risk for UTI Urine flow disturbances

10. Definition of Constipation No single definition exists No single definition exists −Infrequent passage of stool −Difficulty passing stool −Straining to pass stool −Small pebbly stools −Large firm stools −Episodes of abdominal pain −Fecal soiling −Palpable stool on physical exam

11. Bowel Management Medications 1. Bowel clean out with Enemas/suppositories 2. Stool softeners 3. Laxatives

12. Bowel Management Dietary 1. Increase Fluids 2. Increase Fiber 3. Reduce Dairy Intake

13. Fiber Facts & Therapy Fiber is found in grains, cereals, fruits, veggies, nuts, seeds and legumes. FIBER RDA’S FIBER RDA’S 1-3 yo needs 8-10g/day 4-6 yo needs 12-14g/day 4-6 yo needs 12-14g/day 7-10 yo needs 14-16g/day 7-10 yo needs 14-16g/day Become an expert label reader! Become an expert label reader!

14. Behavior Modification for Bowel/Bladder 1. Dietary (remember these tips) Avoid bladder irritants such as Caffeine, Chocolate, Citrus Avoid bladder irritants such as Caffeine, Chocolate, Citrus Avoid excessive dairy intake Avoid excessive dairy intake Avoid heavily sugared foods Avoid heavily sugared foods Increase dietary fiber Increase dietary fiber Increase water intake Increase water intake Decrease constipating foods Decrease constipating foods

15. Behavior Modification 2. Hygiene Techniques Be aware of mistakes Be aware of mistakes Girls: wipe front to back Girls: wipe front to back Use sufficient amount of toilet paper Use sufficient amount of toilet paper Avoid “scrubbing” or “dabbing” Avoid “scrubbing” or “dabbing” Change underwear when wet or damp Change underwear when wet or damp Butterfly rinse for girls Butterfly rinse for girls

16. Behavior Modification 3. Voiding Techniques Proper posture for girls and boys (see handout for posture review) Proper posture for girls and boys (see handout for posture review) Timed voiding, timed stooling Timed voiding, timed stooling Double voiding when necessary Double voiding when necessary Slow down, relax Slow down, relax Visualization exercise Visualization exercise

17. Behavior Modification 4. Positive Reinforcement Stress overall goals and objectives Stress overall goals and objectives Always be positive Always be positive Start with rewards for attempts then advance to the goals Start with rewards for attempts then advance to the goals Keep a calendar Keep a calendar

18. Make success your target: Success Consistency Compliancy Commitment Follow the 3 C’s GOAL