Differential Diagnosis for Functional Constipation with Retentive Behaviour, Delayed Dental Shedding of Primary Teeth, and Nocturnal Bed Wetting

Single Most Likely Diagnosis

• Encopresis/Constipation with associated nocturnal enuresis: This diagnosis is the most likely due to the combination of functional constipation with retentive behavior and nocturnal bed wetting. The delayed dental shedding of primary teeth could be related to the overall developmental and physiological issues associated with chronic constipation.

Other Likely Diagnoses

• Functional constipation with overflow incontinence: This could explain the constipation and the nocturnal enuresis if the overflow incontinence is contributing to the bed wetting.
• Neurodevelopmental disorders (e.g., ADHD, Autism Spectrum Disorder): Children with neurodevelopmental disorders may exhibit a range of symptoms including constipation, delayed dental development, and nocturnal enuresis due to difficulties with bladder control and bowel habits.
• Anxiety or stress-related disorders: Stress and anxiety can exacerbate constipation and contribute to nocturnal enuresis, and may also be associated with delayed dental shedding due to overall health impacts.

Do Not Miss Diagnoses

• Diabetes Mellitus: Although less likely, diabetes mellitus can cause polyuria leading to nocturnal enuresis and could potentially contribute to constipation due to autonomic neuropathy. It's crucial to rule out diabetes due to its significant health implications.
• Spinal Cord Lesions or Neurological Disorders (e.g., Spina Bifida): These conditions can cause both constipation and urinary incontinence due to nerve damage affecting bladder and bowel control.
• Hypothyroidism: Can cause constipation and may be associated with developmental delays, including dental issues.

Rare Diagnoses

• Cystic Fibrosis: Although rare, cystic fibrosis can cause constipation due to the thick, sticky nature of intestinal secretions and may be associated with developmental delays.
• Chronic Intestinal Pseudo-obstruction: A rare condition characterized by impaired intestinal motility leading to severe constipation, which could potentially contribute to the other symptoms.
• William’s Syndrome: A genetic disorder that can cause developmental delays, constipation, and urinary issues, among other symptoms.