Elimination

Disorders
Elimination Disorders

• Children with elimination disorders

repeatedly urinate or pass feces in their
clothes, in bed, or on the floor
• They have already reached an age at
which they are expected to control these
bodily functions
– These symptoms are not caused by physical
illness
Enuresis
• Enuresis is repeated involuntary (or in some cases
intentional) bedwetting or wetting of one’s clothes
• It typically occurs at night during sleep but may
also occur during the day
– The problem may be triggered by a stressful event
• Children must be at least 5 years of age to receive
this diagnosis
• Prevalence of the disorder decreases with age
• Those with enuresis typically have a close relative
who has had or will have the same disorder
Diagnostic Criteria
A. Repeated voiding of urine into bed or clothes, whether involuntary or
intentional.
B. The behavior is clinically significant as manifested by either a frequency of at
least twice a
week for at least 3 consecutive months or the presence of clinically significant
distress or
impairment in social, academic (occupational), or other important areas of
functioning.
C. Chronological age is at least 5 years (or equivalent developmental level).
D. The behavior is not attributable to the physiological effects of a substance
(e.g., a diuretic,
an antipsychotic medication) or another medical condition (e.g., diabetes, spina
bifida, a seizure disorder).
Specify whether:
Nocturnal only: Passage of urine only during nighttime sleep.
Diurnal only: Passage of urine during waking hours.
Nocturnal and diurnal: A combination of the two subtypes above
• Research has not favored one explanation for
the disorder over others
– Psychodynamic theorists explain it as a symptom
of broader anxiety and underlying conflicts
– Family theorists point to disturbed family
interactions
– Behaviorists often view it as the result of
improper, unrealistic, or coercive toilet training
– Biological theorists suspect a small bladder
capacity or weak bladder muscles
• Most cases of enuresis correct themselves
without treatment
– Therapy, particularly behavioral therapy, can
speed up the process
Encopresis
Diagnostic Criteria

A. Repeated passage of feces into inappropriate

places (e.g., clothing, floor), whether involuntary
or intentional.
B. At least one such event occurs each month for
at least 3 months.
C. Chronological age is at least 4 years (or
equivalent developmental level).
D. The behavior is not attributable to the
physiological effects of a substance (e.g.,
laxatives)
or another medical condition except through a
mechanism involving constipation.
Encopresis

• Encopresis – repeatedly defecating in

one’s clothing – is less common than
enuresis and less well researched
• The problem:
– Is usually involuntary
– Seldom occurs during sleep
– Starts after the age of 4
– Is more common in boys than girls
Subtypes

Feces in the with constipation and overflow

incontinence subtype are characteristically
(but not invariably) poorly formed, and
leakage can be infrequent to continuous,
occurring mostly during the day and rarely
during sleep.
Only part of the feces is passed during
toileting, and the incontinence resolves after
treatment of the constipation.
In the without constipation and overflow
incontinence subtype, feces are likely to be of
normal form and consistency, and soiling is
intermittent. Feces may be deposited in a
prominent location. This is usually associated with
the presence of oppositional defiant
disorder or conduct disorder or may be the
consequence of anal masturbation. Soiling
without constipation appears to be less common
than soiling with constipation.
• Encopresis causes intense social problems,
shame, and embarrassment
• Cases may stem from stress, constipation,
improper toilet training, or a combination of all
three
• The most common treatments are behavioral
and medical approaches, or combinations of
the two
– Family therapy has also been helpful