1. Functional Enuresis

2. What is enuresis ? Repeated involuntary voiding of urine occurring after an age at which continence is usual in the absence of any identified physical disorder Repeated involuntary voiding of urine occurring after an age at which continence is usual in the absence of any identified physical disorder ( generally 4 – 5 years ) ( generally 4 – 5 years ) Can be nocturnal or diurnal primary or secondary primary or secondary

3. Aetiology Genetic Genetic Physical causes Physical causes urinary infection urinary infection DM DM epilepsy epilepsy Rarely psychiatric disorder Rarely psychiatric disorder Psychological factors Psychological factors rigid toilet training rigid toilet training negative or indifferent negative or indifferent attitudes of parents attitudes of parents stressful events stressful events

4. Management Assessment Look for a cause Look for a cause Find out the attitudes of Find out the attitudes of the child, parents and siblings the child, parents and siblings Find out how they have Find out how they have tried to help so far tried to help so far

5. Treatment Treat physical disorder if present Treat physical disorder if present Treat psychiatric disorder if present Treat psychiatric disorder if present If functional If functional explain the condition to the parents and explain the condition to the parents and the child the child

6. Behavioural methods Explain the child is not to be blamed punishment is ineffective Do not focus attention on the problem Reward successful behaviour star charts star charts

7. Other measures restrict fluid before bedtime restrict fluid before bedtime enuresis alarms enuresis alarms Tricyclic antidepressants Tricyclic antidepressants Imipramine / amitriptyline Imipramine / amitriptyline 25 - 50 mg 25 - 50 mg Synthetic Antidiuretic hormone Synthetic Antidiuretic hormone Desmopressin Desmopressin

8. Functional Encopresis

9. What is encopresis ? Repeated voluntary or involuntary passing of faeces into inappropriate places after the age at which bowel control is usual Repeated voluntary or involuntary passing of faeces into inappropriate places after the age at which bowel control is usual ( generally 4 years ) ( generally 4 years ) in the absence of a known organic cause. in the absence of a known organic cause. Maybe primary or secondary

10. Aetiology Painful defecation - anal fissure Painful defecation - anal fissure Hirschsprung’s disease Hirschsprung’s disease Maybe associated with mental retardation Maybe associated with mental retardation Too strict or inconsistent bowel training practices Too strict or inconsistent bowel training practices Stressful events Stressful events

11. Management Look for a cause Look for a cause Find out the attitudes of the child and the parents Find out the attitudes of the child and the parents Behavioural methods Behavioural methods Reduce stressful circumstances if possible Reduce stressful circumstances if possible