1. Potty Problems Wetting and Soiling Presented by: Amanda Wagley
(Enuresis and Encopresis)
Presented by: Amanda Wagley

2. Formal Definitions Enuresis, 307.6 DSM IV
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 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 due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition ( e.g., diabetes, spina bifida, a seizure disorder)

3. Formal Definitions Cont.
DSMIV Encopresis 787.6, (w/or w/o constipation and overflow inconsistence) A. Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional. B. At least one such event a month for at least 3 months. C. Chronological age is at least 4 years (or equivalent developmental level). D. The behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.

4. Who Has it? Mostly 5-7 year olds Genetics
More common in boys (2:1)
Can affect girls and older children too
Genetics
Encopresis is not as common as enuresis
Encopresis without constipation is more rare
Can be a sign of abuse (sexual or physical)
(Shapira & Dahlen, 2010) & (Coehlo, 2011)

5. Types of Enuresis Primary Secondary Nocturnal
Occurs 2-3 times per week
Secondary
Occurs when a child starts wetting after several months or years without an “episode”
Usually brought on by additional stressors
Divorce
New Home
New Baby
Nocturnal
Occurs only at night
Most common form of Enuresis is primary nocturnal
(aacap.org, 2004)

6. Could it be something else?
Urinary tract infection
Diabetes (Enuresis)
Sickle Cell (Enuresis)
Seizures
Spina bifida
Constipation
Pain passing stool (Encopresis)
(Geroski & Rogers, 1998)

7. Causes/Characteristics
Enuresis
Encopresis
Painful or unpleasant bowel movement
Chronic constipation
Low muscle tone
Slow intestinal motility
Atypical attention span
Fear from flushing toilet
Sexual abuse
Lack of exercise and/or water
Diets high in fats and sugar
OCD
(Coehlo, 2011)
Sleep arousal difficulties
Production of large amounts of urine
Bladder dysfunction (overactive or small bladder)
Developmental delays
Low level of ADH hormone
Learning difficulties
Behavioral problems
Family problems (specifically parental separation)
(Norfolk & Wootton, 2011)

8. Common Comorbidities ADHD Depression Anxiety Disorders ODD
(Akça, Aysev, & Aycan, 2011)
Select Mutism
(Wong, 2010)
Sleep Disorder
(aacap.org)

9. What Can We Do? Enuresis DO NOT PUNISH! Bladder Stretching
Pharmacology
Desmopressin
Synthetic analog of ADH
Anti-depressants (Tofranil)
Reduce irritability of the bladder muscles
Both have about 50%-80% success rate with about 60% -90% relapse.
Behavior Modification
Cleanliness Exercises
Reward Interventions
Limit Fluid intake
Enuresis Alarm
Urine sensitive pad connected to an alarm
(Shapira & Dahlen, 2010)

10. Enuresis Alarm

11. What Can We Do? Encopresis
DO NOT PUNISH!
Pharmacology
Stool Softeners
Laxatives
Suppositories
Bowel Training
Teaches the child how to know when they need to use the restroom
Behavior Management
Punishment does not work
Maintain regular bathroom routines
Cleanliness exercises
Positive reinforcement
Nutritional Changes
Add fiber and bran
Decrease foods high in fat and sugar
Family Support
Self esteem
Depression (Coehlo, 2011)

12. If Left Untreated Most will grow out if it on their own Can lead to:
Depression
Low self-esteem
Negative Self-image
Negative affects on Peer relationships
Can lead to behavioral and emotional problems
The psychological and emotional effects can cause more damage than the disorder itself.
(Shapira & Dahlen, 2010), (Norfolk & Wootton, 2011)

13. Steps for School Counselors
Normalize the situation for the child
Let them know they are not alone.
Educate parents
Help the parents and the child cope
Provide suggestions for further reading
Suggest a medical evaluation by a pediatrician
Refer to a pediatric counselor
(Erford, 2011)

14. Helping Professionals
Counselors
Focus on “normalizing”
Overcome embarrassment
School Nurses
Pediatricians & Pediatric Nurses
Rule out underlying medical causes
Possibility of an immature bladder or
bladder dysfunction
Write prescriptions in needed
Specialist Enuresis Nurses

15. Further Reading Childhood Encopresis and Enuresis: Causes and Therapy
Overcoming Bladder & Bowel Problems in Children
Seven Steps to Nighttime Dryness: A Practical Guide for Parents of Children with Bedwetting

16. Reading for Kids Everyone Poops
Clouds and Clocks: A Story for Children Who Soil
Sammy the Elephant & Mr. Camel: A Story to Help Children Overcome Bedwetting
Zumar the Alien: An Interplanetary Tale of Bedwetting

17. Resources US Department of Health and Human Services
National Kidney & Urologic Diseases
CHKD Treatment Center
Education and Resources for Improving Childhood Continence (ERIC)
Counselors/Therapists in Hampton Roads

18. Resources Cont. The Bedwetting Store
Enuresis Treatment Center
American Academy of Pediatrics
American Urological Association Foundation
National Association for Continence

19. References
American Academy of Child and Adolescent Psychiatry. (December 2011). Facts for families: bedwetting. Retrieved from
American Academy of Child and Adolescent Psychiatry. (November 2004). Facts for families: problems with soiling and bowel control. Retrieved from
Akça, Ö., Aysev, A., & Aycan, İ. (2011). Familial features and comorbid psychiatric disorders in children with encopresis. Bulletin of Clinical Psychopharmacology, 21(4),
American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, D.C.: Author.
Coehlo, D. (2011). Encopresis: a medical and family approach. Pediatric Nursing, 7(3), Erford, B. (2011). Transforming the school counseling profession. Upper Saddle River, New Jersey: Pearson Education, Inc.
Geroski, A. & Rodgers, K. (1998). Collaborative assessment and treatment of children with enuresis and encopresis. Professional School Counseling, 2(2). 128.
Norfolk, S. & Wootton, J. (2011). Supporting children with nocturnal enuresis. British Journal of School Nursing, 6(5),
Shapira, B. & Dahlen, P. (2010). Therapeutic treatment protocol for enuresis using an enuresis alarm. Journal of Counseling &Development, 88,
Wong, P. (2010). Selective mutism: a review of etiology, comorbidities, and treatment. Psychiatry ( ), 7(3),