Enuresis and Encopresis Ann Lenart & Andrea Wilson

Introduction  These are two separate conditions. They are often co-existing, but not always.  Andrea will discuss Enuresis  Ann will discuss Encopresis

Enuresis  Definition Bed wetting at night after age of expected continence. Does occur during the day time rarely. Not related to medical problems. Bed wetting at night after age of expected continence. Does occur during the day time rarely. Not related to medical problems.  Primary Functional Enuresis refers to children who have never been continent. Rarely psychological Rarely psychological Parents not potty training child Parents not potty training child  Secondary Functional Enuresis refers to children who have been continent for at least one year, however no longer are. This usually is related to an event in the child’s life such as; stress, divorce, sexual abuse, school trauma, or hospitalization. This usually is related to an event in the child’s life such as; stress, divorce, sexual abuse, school trauma, or hospitalization.

Enuresis  Etiology For most children a specific etiology cannot be determined. For most children a specific etiology cannot be determined. Children should always be medically assessed to rule out bladder problems, low ADH, & lack of arousability. Children should always be medically assessed to rule out bladder problems, low ADH, & lack of arousability. Can be linked to genetic factors, parents that wet the bed. Can be linked to genetic factors, parents that wet the bed.  Prevalence 5-10% among five year olds; 3-5% among ten year olds; 1.1% among those children 15 years or older 5-10% among five year olds; 3-5% among ten year olds; 1.1% among those children 15 years or older  Manifestations Child wets the bed at least twice per week for at least three months and is five years old or older. Child wets the bed at least twice per week for at least three months and is five years old or older.

Enuresis  Age of onset Usually around age 5 if children are wetting the bed still or have began to wet the bed again a problem is considered. Usually around age 5 if children are wetting the bed still or have began to wet the bed again a problem is considered.  Gender differences Between ages of 5-8 enuresis is two to three times more common in boys than girls Between ages of 5-8 enuresis is two to three times more common in boys than girls Generally more common in boys than girls at all ages Generally more common in boys than girls at all ages  Cultural differences/similarities Prevalence is generally the same among cultures. Prevalence is generally the same among cultures.

Enuresis  Cultural Issues continued New Zealand adolescents New Zealand adolescents Children who were still bed wetting after 10 years old were at a slightly increased risk for having conduct problems, ADD behaviors, and anxiety symptoms during adolescents.Children who were still bed wetting after 10 years old were at a slightly increased risk for having conduct problems, ADD behaviors, and anxiety symptoms during adolescents. Study among Chinese adolescents Study among Chinese adolescents Found that attaining bladder control after age 4 resulted in higher risk of internalizing and externalizing problems. Which leads to higher risk for suicide and self harm attempts and completions.Found that attaining bladder control after age 4 resulted in higher risk of internalizing and externalizing problems. Which leads to higher risk for suicide and self harm attempts and completions.

 Definition The passing of bowel movement into inappropriate places; such as underwear or floor. The passing of bowel movement into inappropriate places; such as underwear or floor. Two subtypes Two subtypes With constipationWith constipation Without constipationWithout constipation ODD, or CD may be considered if child is intentionally defecating when not appropriate, or if they are playing with their feces. ODD, or CD may be considered if child is intentionally defecating when not appropriate, or if they are playing with their feces.

Encopresis  Etiology With constipation: feces overflows around blockage causing unintentional movements, usually not well formed and often pasty. With constipation: feces overflows around blockage causing unintentional movements, usually not well formed and often pasty. Causes for constipation can be medical, related to diet, avoidance of pain from movements, or resistance to toilet trainingCauses for constipation can be medical, related to diet, avoidance of pain from movements, or resistance to toilet training Without constipation: child passes normal bowel movements into his underwear and there is no constipation noted. Without constipation: child passes normal bowel movements into his underwear and there is no constipation noted. Causes are usually stress related if the condition comes on suddenly. If condition is long standing problem, the child is strong willed.Causes are usually stress related if the condition comes on suddenly. If condition is long standing problem, the child is strong willed.  Prevalence: 1% in all five year old children 1% in all five year old children  Manifestations Occurs once a month for at least three months, starts at age 4. Occurs once a month for at least three months, starts at age 4.

Encopresis  Age of onset 4 years old is when a problem is considered 4 years old is when a problem is considered  Gender differences Six times more common in boys than girls Six times more common in boys than girls  Cultural differences/similarities Cultural based information is scarce and generally outdated Cultural based information is scarce and generally outdated

Treatment  Enuresis Bed Wetting Alarms Bed Wetting Alarms Alarm Clock Alarm Clock Medication Medication Decreases urine production at night and helps child stay dry. DOES NOT CURE BEDWETTINGDecreases urine production at night and helps child stay dry. DOES NOT CURE BEDWETTING Expensive, temporary fix for small percentage of childrenExpensive, temporary fix for small percentage of children  Encopresis With constipation Enema’s, medication, and diet modification Behavior modification from adults involved with child Without constipation-- Behavior modification (from adults involved with child)

History  Negative reinforcement—historically parents have punished children for behaviors due to not understanding what is happening with the child  Freud would say related to unresolved sexual conflict  Historically it was believed these disorders were due to psychological disturbances, not a lot of evidence to support that now.

Demonstration  Bibliotherapy  Alarm Therapy

Sources    Support web site for parents of children with encopresis. Support web site for parents of children with encopresis.       Cuddy-Casey, M. (1997). A case study using child-centered play therapy approach to treat enuresis and encopresis. Elementary School Guidance and Counseling, 31.   El-Radhi, A. Sahib. (2005). Practical management: Children with enuresis. Update, 70,   Fritz, G., Rockney, R. (2004). Practice parameter for the assessment of children and adolescents with enuresis. Journal of American Academy of Child and adolescent Psychiatry, 43,   Geroski, A. M., Rodgers, K. A. (1998). Collaborative assessment and treatment of children with enuresis and encopresis. Professional School Counseling, 2.   Mellon, M.W. (2000). Emperically supported treatments in pediatric psychology: Nocturnal enuresis. Journal of Pediatric, 25,   Murphy, S., Carney, T. (2004). The classification of soiling and encopresis and a possible treatment protocol. Child and Mental Health, 9,   Russ, S., Landes, C., Kaufman, N., Smith, J. (2005). A team approach to enuresis and school reluctance. Journal of School Health, 75,   Soderstrom, U., Hoelcke M., Alenius, L., Soderling, A-C., Hjern, A. (2004). Urinary and faecal incontinence: A population- based study. Acta Paediatr, 93,   Xianchan, L., Zhengxiao, S. (2005). Age of attaining nocturnal bladder control and adolescent suicidal behavior. Journal of Affective Disorders, 87,   Information from Ann’ s doctor Published by McKesson Clinical Reference Systems