Elimination Disorders

What are Elimination Disorders?

Elimination disorders involve the inappropriate elimination of urine or feces and are first diagnosed in childhood or adolescence. Types of elimination disorder diagnoses include:

  • Enuresis
  • Encopresis
  • Other Specified Elimination Disorder
  • Unspecified Elimination Disorder
What is Enuresis, or Bed-Wetting, Disorder?

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:

  • Repeated urination into one’s bed or clothes, whether involuntary or intentional.
  • The behavior occurs at least twice a week for at least 3 consecutive months or causes significant distress or impairment in social, academic/occupational, or other important areas of functioning.
  • The individual is at least 5 years old (or at an equivalent developmental level).
  • The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Specific types of enuresis include:

  • Nocturnal only bed-wetting that occurs during nighttime sleep.
  • Diurnal only enuresis that occurs during waking hours.
  • A combination of nocturnal and diurnal enuresis.

Epidemiology

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.

What are treatments for Enuresis, or Bed-Wetting, Disorder?

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.

What is Encopresis?

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:

  • Repeated passage of stool into inappropriate places (e.g., clothing, floor), whether involuntary or intentional.
  • At least one such event occurs each month for at least 3 months.
  • Chronological age is at least 4 years (or equivalent developmental level).
  • The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through one that involves constipation.

Epidemiology

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.

What are treatments for Encopresis, or Fecal Incontinence?

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.

What is the diagnosis for Other Specified Elimination Disorder?

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).

What is the diagnosis for Unspecified Elimination Disorder?

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).

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Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Disclaimer:
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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