Development of Fecal Scoring for the Management of Fecal Impaction With Regards to Lower Urinary Tract Dysfunction
Condition: Fecal Impaction; Lower Urinary Tract Disorder; Bladder Dysfunction; Bowel Dysfunction
MeSH terms: Intestinal Diseases; Fecal Impaction; Urologic Diseases
Study type: Observational

Summary: 
      The role of bowel bladder disorder, or BBD, has been highlighted as a major player in
      vesicoureteral reflux and urinary tract infection (UTI). However, the diagnosis of BBD are
      still conceptual and subjective, because of the diagnosis of constipation, main
      pathophysiology in BBD has not been established well.
    

Detailed description: 
      Functional constipation is a common disorder among children, accounting for 3-5% of visits to
      pediatric clinics and even 10% to 25% of consultation for pediatric gastroenterologists. It
      could cause recurrent abdominal pain, stool retention as well as fecal incontinence. In the
      urologic field, this is known to develop urinary symptoms. Constipation has been associated
      with voiding dysfunction and urinary tract infection in children. It is assumed that impacted
      stool in distal rectum mechanically affect the bladder leading to detrusor overactivity.
      Additionally, impacted stool would elevate the uretheral sphincter tone, having patients void
      with incomplete sphincter relaxation and eliciting dysfunctional voiding. Stool impaction may
      be the source of bacteria causing urinary tract infection and led to recurrent bacteriuria.
      Treatment of constipation by itself is quite effective alleviating urologic symptoms in as
      much as two-third of the patients.

      The role of constipation has been highlighted as a major player in vesicoureteral reflux and
      urinary tract infection (UTI). The presence of bowel bladder disorder (BBD) was associated
      with higher risk of breakthrough infection and a lack of spontaneous resolution. Although
      constipation is the major player in BBC, there is any objective standard regarding the
      diagnosis and treatment of constipation. Given the high prevalence and morbidity of children
      affected by UTI or VUR in relations to BBD, it is imperative that diagnostic and treatment
      methods are developed.

      Despite the known implication of constipation, the diagnosis of constipation may be
      problematic due to a lack of standard definition for this condition. This may be due to
      different views between clinicians about which aspect are most crucial for diagnosing
      constipation. Some underline the subjective nature such as infrequent or difficult
      defecation, other stress the quality of stool, still others were in search of objective
      criteria of constipation, like the amount of impacted stool or colonic transit time.
      Consequently, various criteria have been reported.

      The lack of standard criteria for constipation causes trouble sometimes in making a proper
      decision for diagnosis, intervention, follow-up, and discharge of treatment.
    

Intervention name(s): Lactitol Monohydrate
Intervention type(s): Drug
Intervention description(s): Patients with lower urinary tract dysfunction and assumed to have constipation were placed on lactitol monohydrate 10 g for 8 weeks, and had re-evaluated.
Intervention MeSH terms: Lactitol
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients who visited the department of pediatric urology for significant lower urinary
        tract dysfunction with history suggestive of constipation.