Elimination disorders involve the inappropriate elimination of urine or feces and are first diagnosed in childhood or adolescence. Types of elimination disorder diagnoses include:
Commonly known as bed-wetting, enuresis is involuntary urination after the age when a person should be able to control his or her bladder. A diagnosis of enuresis is based on:
Specific types of enuresis include:
The prevalence of enuresis ranges from 5 to 10 percent in 5-year-olds, 1.4 to 5 percent in 9- to 10-year-olds, and about 1 percent in adolescents 15 years and older. Although most children with enuresis do not have a comorbid psychiatric disorder, children with enuresis are at higher risk for the development of another psychiatric disorder.
Nocturnal enuresis is about 50 percent more common in boys than girls, and accounts for about 80 percent of children with the bed-wetting condition.
For a large percentage of children, bed-wetting goes away on its own over time. However, in many cases, treatment is necessary. The first step is any treatment plan is to review appropriate toilet training. Other useful techniques include restricting fluids before bed and night lifting to toilet train the child. Alarm therapy, which is triggered by wet underwear, has been a mainstay of treatment for bed-wetting. Another basis intervention is to assess whether chronic constipation is contributing to urinary dysfunction, and to consider increasing dietary fiber to reduce constipation. Pharmacological treatment may include desmopressin (DDAVP) to manage nocturnal bed-wetting, especially when no fluids are ingested in the evening. In addition, psychotherapy may be useful in dealing with coexisting psychiatric problems and the emotional and family difficulties that arise with chronic enuresis.
Encopresis, sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing or other places. A diagnosis of encopresis is based on:
Encopresis has been estimated to affect 3 percent of 4-year-old and 1.6 percent of 10-year-old children. In Western cultures, bowel control is established in more than 95 percent of children by their fourth birthday and in 99 percent by the fifth birthday. Males are found to have encopresis three to six times more frequently than females.
A typical treatment plan for a child with encopresis (fecal incontinence) includes daily oral administration of laxatives (for children who have constipation) along with ongoing cognitive-behavioral training to have bowel movements in the toilet, and to reduce anxiety related to bowel movements. By the time a child is seen for treatment, considerable family discord and distress are common. Interactive parent-child family guidance can be effective for children younger than 9 years of age. Supportive psychotherapy and relaxation techniques may be useful in treating anxiety and other issues such as low self-esteem and social isolation.
The diagnosis for “other specified elimination disorder” is given when symptoms of an elimination disorder cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any specific disorder such as enuresis (bed-wetting) or encopresis (fecal incontinence).
The diagnosis for “unspecified elimination disorder” is given when symptoms of an elimination disorder cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any specific disorder such as enuresis (bed-wetting) or encopresis (fecal incontinence). This diagnosis may be given when there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).