Enuresis & Encopresis
Daytime or nighttime wetting (diurnal or nocturnal enuresis) occurs in approximately 5-10% of school age children, and by definition, is not considered a “disorder” until the child is at least five years old. Further, a number of studies have found that as many as 4% of adolescents wet the bed. Nighttime wetting, which is more common after age 6, occurs twice as often in boys than in girls while girls appear to outnumber boys in the frequency of daytime wetting.
There are a number of possible reasons why a child might wet. Daytime wetting, in particular, may be associated with bladder or urinary tract infections and should be checked out medically before parents consider psychological or behavioral treatment. Wetting might also be caused by a small bladder, weak muscle control, anxiety, or simply forgetting to use the bathroom in time. The most common causes of nighttime wetness are a bladder that is too small to make it through the night, and/or a very deep sleep pattern that keeps the child from waking up and using the bathroom in time. In absence of medical factors, wetting may also be caused by anxiety or depression.
Soiling (encopresis) occurs in 2-8% of children and is most often associated with constipation. Ongoing constipation can stretch the rectum, which in turn dulls the nerve endings in the rectum. Without adequate sensitivity, these nerve endings do not send the child the signal that it is time to go to the bathroom. As a result, the child doesn’t feel the pressure to use the restroom, and often ends up soiling him or herself.
Not all soiling accidents are related to constipation. A child may be so busy playing that he either holds it until the urgency to go passes or doesn’t realize that he has to go until it’s too late. Shy or cautious children may be reluctant to use a strange toilet and may try to hold it until the urgency passes. Regularly holding bowel movements, however, will also lead to constipation and further problems with soiling.
Problems with wetting and soiling can also cause anxiety, low-self esteem, and shame in children. Often children cover their confusion and embarrassment by either developing a flippant or uncaring attitude about the elimination problem (including denying that it is really problem at all) or by hiding dirty or wet underwear.
The treatment of these disorders depends in large part on what leads to the problem. A full medical evaluation is recommended as a first step in order to rule out any biological reasons for the wetting or soiling behaviors. Following that, a psychological evaluation is recommended to determine the psychological and/or social factors at work. Regardless of the treatment plan, prognosis for successful treatment is dependent on a biopsychosocial approach that includes ongoing coordination with the pediatrician or gastroenterologist. The Tarnow Center offers several services that can be helpful in treating elimination disorders:
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