ELIMINATION DISORDERS

ANNA JOSEFINA VAZQUEZ-GENUINO, MD

Child, Adolescent & Adult Psychiatrist
ENCOPRESIS

 EPIDEMIOLOGY
 95% (+) Bowel Control by 4 y/o
 99% (+) Bowel Control by 5 y/o
 Absent ≥ 16 y/o
 Incidence: M 6x > F
ENCOPRESIS
 ETIOLOGY

 Chronic Constipation 
 1) Painful Defecation  Phobia to Pain
 2) Chronic Rectal Distention  Loss
Rectal Tone & Desensitization to Pressure
 Overflow Encopresis
ENCOPRESIS
 ETIOLOGY
 Maternal Hostility
 Harsh & Punitive Parent
 (+) Sexual Abuse
 (+) Disruptive Life Event  Regressive Bvr
ENCOPRESIS
 DIAGNOSIS
 w/ or w/o Constipation & Overflow
Incontinence
 @ least 4 Y/O
 Involuntary / Intentional Defecating into
Inappropriate Places
 1x/ month x 3
 R/O Substance, Medical Condition
ENCOPRESIS

 DIFFERENTIAL DX
 Aganglionic Megacolon- Hirschsprung’s D
 Faulty Nutrition, Structural Dis of Anus,
Rectum & Colon, Medicinal Adverse
Effects, Endoc, Neuro Dis
 Sexual / Physical Abuse
ENCOPRESIS

 COURSE & PROGNOSIS

 Self Ltd, Rare beyond Mid Adol
 Depend on Physiological/ Medical Factors
 Impacted Feces, Megacolon, Anal Fissures
 Ostracized & Rejected  Low Self Esteem
ENCOPRESIS

 TREATMENT
 Medical & Psych Evaln
 Medical Tx for Constipation- Lax
 Psych Tx, Beh Mod, Regular Timed
Toilet Trng, Relax Tech
 Supportive PsychTx, Family Educ
ENURESIS: Epidemiology
Prevalence Rates
% Age ( yrs)
82 <3
49 3
26 4
7 5
3 10
1.5 14
1 Adult
ENURESIS

 ETIOLOGY

 PhysiologicalFactors  Dev Enuresis &

Bvr Patterns Maintain Maladaptive
Urination
 Genetic
 Psychosocial Stressors
ENURESIS

 ETIOLOGY

 Hinman’Syndrome – Overactive
Detrussor MM in Bladder + Habitual
Voluntary Tighten Ext Sphincter Urge to
Urinate  Urge to Urinate Dim &
Bladder doesn’t Empty  Enuresis @
Night
ENURESIS
 DIAGNOSIS
@ least 5 y/o
 Involuntary or Intentional Voiding Urine
into Clothes/ Bed
 2x/ wk x 3 consecutive mos or
 Cause Distress or Impairment in Funct
 R/O Substance, Medical Condition
 Nocturnal/ Diurnal/ Both
ENURESIS

 DIFFERENTIAL DX
ENURESIS

 DIAGNOSIS
ENURESIS

 COURSE & PROGNOSIS

ENURESIS
 TREATMENT
 Review Toilet Trng
 Educate Parents
 Classic Conditioning
 Behavior Mod- Star Chart
 Bladder Training
 Restrict Fluids
 Increase Fiber Diet
ENURESIS

 TREATMENT
 Rx if Enuresis  Impaired Social,
Family, School Funct, Bvr, Diet, Fluid
Restrict not Effective
 Imipramine, Desmopressin, Reboxetine
 Psychotx