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Psychological issues or medical conditions in childhood can cause difficulties not only for the child in question but for the family as well. An example of how emotional problems early on can end up manifesting in unpleasant ways is the case of elimination disorders.
These disruptions, associated with voiding bodily substances, tend to be related to emotional distress such as anxiety and low self-esteem. We will have a closer look at what enuresis and encopresis entail, what their symptoms and causes might be, as well as examine potential treatments for each disorder.
The concept of elimination disorders references two conditions that can appear in childhood, affecting both the psyche and behavior of the child, as well as causing frustration and strain to the family.
The basis of these disorders is strictly connected to bladder and sphincter control which, for the most part, are attained around the ages of 18 and 36 months.
There are two types of elimination disorders: encopresis and enuresis and they may or may not be done on purpose.
In the majority of cases, enuresis and encopresis are co-morbid which means they can both manifest in the same child; however, it is not a given. Furthermore, each disorder has its separate characteristics, causes, and psychological symptoms.
With both enuresis and encopresis, the family of the affected child/ren experiences feelings of hopelessness and confusion. The reason for this is because elimination disorders don't have singular causes that trigger them and also, the emotional symptoms that come with these disorders are harrowing for the parents or caregivers.
This disorder implies the inability of the child to control their bladder which leads to nocturnal involuntary urination, either in inappropriate places or at inopportune times. But rest assured, because bed-wetting isn't a sign of toilet training gone bad but merely a regular part of a child's development.
To make an accurate diagnosis, enuresis must appear after the standard age of learning how to control the bladder (more than 3-4 years), and all other medical causes must be ruled out first.
Functional enuresis is characterized by a series of features:
Happens at least twice a week, for three weeks in a row
Can cause anxiety and distress to the child, as well as affect their social and academic performance
When nocturnal, enuresis tends to happen 30 minutes to 3 hours after going to sleep
In most cases, the child isn't in full control of their bladder - called primary enuresis. In 20% of the cases, however, we are dealing with secondary enuresis which is triggered by a stressful situation or a traumatic event
Firstly, doctors need to rule out any organic causes such as the size of the bladder, muscular weakness, as well as hereditary factors and sleep cycle disturbances. Only after this initial stage, doctors will perform a psychological evaluation to determine potential emotional factors.
In terms of the psychological origins of this disorder, case studies indicate that stressful situations, traumatic events, and psycho-social crises such as the birth of a sibling could all cause enuresis.
Functional enuresis can have the following physical and mental indicators:
Feelings of confusion, anger, aggression
Unwillingness to spend the night in a different house
Feelings of shame
Skin rashes caused by exposure to urine
Parents and teachers alike should be informed and keep an eye out for these disorders and monitor when it happens. It is vital not to reprimand or punish the child for wetting themselves.
The best solution is to seek medical advice, do a psychological evaluation, and teach the child strategies to control the bladder and also how to use an alarm clock. In many cases, setting the alarm during the night allows the child to stop themselves before wetting the bed and instead use the toilet.
Encopresis occurs when children who are old enough (over 4 years old) to eliminate waste appropriately repeatedly defecate in inappropriate places such as inside clothing or on the floor. This condition needs to be present for longer than three months before making an official diagnosis.
There are two different types of encopresis: with constipation and overflow Incontinence, and without constipation and overflow incontinence.
Encopresis also has physical and psychological indicators as follows:
Happens more during the day than at night
In 50% of the cases, encopresis occurs due to improper control of the bowel while the other half is triggered by a stressful or traumatic event.
The disorder cannot be attributed to an illness or the use of prescription pills or laxative substances
An essential step in diagnosing encopresis is first to discard any physical or medical conditions that might be causing problems. Next, doctors will look at psychological factors that could cause this elimination disorder.
Information also needs to be collected regarding the child's toilet training history (perhaps the child was potty trained too soon) and his mastery of toilet skills. Psychological factors need to be taken into account, and investigate whether or not the child is struggling with an oppositional defiant disorder (ODD) - a pattern of hostile, disobedient, and rebellious behaviors directed at adults or other authority figures
Similarly to enuresis, encopresis can also have physical and mental indicators:
Feelings of shame
Attention deficit, hyperactivity, impulsivity, low tolerance to frustration, and incoordination
Stomach pain and constipation
Urinary tract infections in girls
Just like in the case of urinary incontinence, parents, caretakers, and teachers should not punish the child for soiling themselves but instead explain the situation using age-appropriate language, and tone.
The primary treatment approach may be medical or physical in nature. Laxatives or colonic irrigations may be prescribed, together with training regarding a healthy defecating routine.
Behavioral treatment may prove useful, and it is aimed at lessening defiant behavior, encouraging bowel regularity, or helping children to develop awareness of when they need to use the toilet.
B. R. Kuhn, A. M. Bethany & L. P. Sheryl (1999) "Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal." American Family Physician, 58: 8-18.
E. J., Mikkelsen (2001) "Enuresis and Encopresis: Ten Years of Progress." Journal of the American Academy of Child and Adolescent Psychiatry, 40:1146-1159.