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Samenvatting Zindelijkheid KBK
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Samenvatting Zindelijkheid KBK Hoofdstukken: 1. Zindelijkheid 2. Blaas- & darmdysfuncies bij typisch ontwikkelende kinderen 3. Neurological bladder bowel problems in childeren
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Kinesitherapie bij kinderenKINESITHERAPIE BIJ KINDEREN...............................................................................1
ZINDELIJKHEID............................................................................................................................. 2
1. Zindelijkheid.................................................................................................................... 2
Definitie.......................................................................................................................................... 2
Voorwaarden zindelijkheid............................................................................................................... 3
1. Normale anatomie en functie van de urinewegen...................................................................3
2. Normale uitrijping van het zenuwstelsel.................................................................................. 3
3. Controle bekkenbodemspieren................................................................................................ 4
4. coördinatie tussen M. detrusor en EUS (externe urethrale sfincter).........................................4
Zindelijkheidsproces voor stoelgang............................................................................................... 4
Voorwaarden:.............................................................................................................................. 5
1. Normale colon transit tijd.................................................................................................... 5
2. Normale anorectale sensatie.............................................................................................. 5
3. voldoende kracht om te ‘persen als voor stoelgang’...........................................................5
4. goede coördinatie BBS........................................................................................................ 5
5. normale gastrocolische reflex............................................................................................. 5
2. Blaas- & darmdysfuncies bij typisch ontwikkelende kinderen..........................................6
2.1. Functiestoornissen van de lagere urinewegen “LUTS”..............................................................6
Vullingsstoornissen..................................................................................................................... 6
Toe- of afgenomen mictiefrequentie........................................................................................ 6
Incontinentie........................................................................................................................... 7
Urgentie.................................................................................................................................. 8
Nycturie.................................................................................................................................. 8
Ledigingsstoornissen................................................................................................................... 8
Hesistancy.............................................................................................................................. 8
Straining................................................................................................................................. 8
Zwakke straal......................................................................................................................... 8
intermittentie.......................................................................................................................... 8
Dysurie................................................................................................................................... 9
Andere........................................................................................................................................ 9
Ophoudmaneuvers................................................................................................................. 9
Onvolledig ledigen.................................................................................................................. 9
Urinaire retentie...................................................................................................................... 9
Nadruppelen........................................................................................................................... 9
Sproeistaal.............................................................................................................................. 9
LUT-dysfunties............................................................................................................................. 9
Bladder bowel dysfunctions (BBD)........................................................................................ 10
Overactieve bladder (OAB)................................................................................................... 10
Voiding postponement.......................................................................................................... 10
Underactive bladder............................................................................................................. 10
Dysfunctional voiding........................................................................................................... 11
Bladder outlet obstruction.................................................................................................... 11
Stress incontinentie.............................................................................................................. 11
Vaginale reflux...................................................................................................................... 11
Giggle incontinentie.............................................................................................................. 12
Bladder neck dysfunction...................................................................................................... 12
Flow curves............................................................................................................................... 12
2.2. Enuresis nocturna.................................................................................................................. 12
Verschil tussen monosympatisch / non-monosymptomatisch enuresis......................................13
pathogenese............................................................................................................................. 13
1. verminderde blaascapaciteit............................................................................................. 13
2. verhoogde nachtelijke urineproductie............................................................................... 13
3. stoornis in arousal............................................................................................................. 14
2.3. Functionele constipatie.......................................................................................................... 14
Prevalentie................................................................................................................................ 14
Subtypes................................................................................................................................... 15
Klinische presentatie................................................................................................................. 15
Definitie Functionele constipatie (FC).................................................................................... 15
Pathofysiologie.......................................................................................................................... 15
GENETISCHE FACTOREN........................................................................................................ 15
PSYCHOLOGISCHE FACTOREN............................................................................................... 16
LIFESTYLE FACTORS.............................................................................................................. 16
(Functional) Fecal incontinence................................................................................................ 17
1
, 3. Neurological bladder bowel problems in childeren.........................................................18
Innervatie blaas............................................................................................................................ 18
Denervatie Blaas........................................................................................................................... 19
CP................................................................................................................................................. 20
NLUTD: overactieve blaas......................................................................................................... 20
Neurogenic bowel dysfunction.................................................................................................. 21
Prognostische factoren.............................................................................................................. 21
SB................................................................................................................................................. 22
NLUTD: Onderactieve blaas....................................................................................................... 22
Constipatie................................................................................................................................ 22
Fecale incontinentie.................................................................................................................. 22
Behandeling BBD bij neurologische aandoeningen........................................................................ 23
Spierdystrofie duchenne (DMD)..................................................................................................... 24
Overactieve blaas..................................................................................................................... 24
Constipatie................................................................................................................................ 25
Pathophysiology of BBD?........................................................................................................... 25
SMA (spinale musculaire atrofie)................................................................................................... 25
Behandeling BBD bij neuromusculaire aandoeningen................................................................... 25
Zindelijkheid
1. Zindelijkheid
Definitie
Ondergoed dragen tijdens de dag = luier-onafhankelijk
o => onderbroekje droog houden
2
, Zelf de drang aangeven of zelfstandig naar het potje/toilet gaan
o Het aangeven van plasdrang is vaak niet verbaal maar met
lichaamstaal (het grijpen naar de genitaalstreek, schuifelen, …)
Zonder herinnering van ouders of opvoeders dat het kind moet gaan
plassen
Gecontroleerd ophouden, uitstellen & plassen op een sociaal
aanvaardbare plaats
Ongelukjes <4x/week, max 1/dag, sporadisch
= eigen verantwoordelijkheid voor zijn/haar plasdrang
Zelfstandig
Voorwaarden zindelijkheid
1. Normale anatomie en functie van de urinewegen
hoe uitleggen aan kinderen:
o in de fabriekjes (nieren) wordt de plas aangemaakt
o dat vult de ballon, en als de ballon te groot wordt openen de
deurtjes en
o kan de ballon terug kleiner worden
Hoe ouder, hoe groter
EBC = expected bladder capacity
o = verwachte blaascapaciteit ifv leeftijd
2. Normale uitrijping van het zenuwstelsel
zal ervoor zorgen dat de blaas normaal gaat vullen
3
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