Dr Manju Antil (Counselling Psychologist and Psychotherapist)

Elimination disorders refer to a group of disorders that involve difficulty controlling urination or bowel movements. These disorders are typically diagnosed in childhood and can have a significant impact on a child's quality of life.

The two main types of elimination disorders are enuresis and encopresis.

1. Enuresis, also known as bedwetting, involves involuntary urination, often during sleep. It is most commonly diagnosed in children aged 5-6 years old and can continue into adolescence.
2. Encopresis, on the other hand, involves involuntary bowel movements, usually due to chronic constipation. It is more common in boys than girls and is often associated with emotional or behavioral issues.

Treatment for elimination disorders may include behavioral therapies, such as bladder training or bowel retraining, as well as medication in some cases. Parents and caregivers need to be supportive and understanding when working with children who have elimination disorders, as these conditions can be embarrassing and stressful for them.

symptoms 

As mentioned earlier, the two main types of elimination disorders are enuresis (bedwetting) and encopresis (involuntary bowel movements).

The symptoms of enuresis may include:

• Involuntary urination during sleep
• Wetting the bed at least twice a week for at least three consecutive months
• Embarrassment, shame, or anxiety related to bedwetting
• Disrupted sleep or daytime sleepiness

The symptoms of encopresis may include:

• Involuntary bowel movements, usually in the child's underwear or clothing
• Chronic constipation, which may cause painful bowel movements or the passing of hard stools
• Avoidance of bowel movements, which can make constipation worse
• Anxiety, shame, or embarrassment related to bowel movements

Both enuresis and encopresis can have a significant impact on a child's self-esteem and social functioning and may cause distress for the child and their family. It's important to seek medical attention if you or your child are experiencing any of these symptoms.

types

There are two main types of elimination disorders: enuresis and encopresis.

Enuresis:

Enuresis is a disorder that involves the involuntary discharge of urine, usually during sleep. There are two types of enuresis:

• Primary enuresis: This refers to bedwetting that has never been successfully controlled.
• Secondary enuresis: This refers to bedwetting that occurs after at least six months of dryness.

Encopresis:

Encopresis is a disorder that involves the involuntary discharge of feces. There are two types of encopresis:

With constipation and overflow incontinence: This type of encopresis is associated with chronic constipation, which leads to a buildup of fecal matter in the rectum. The rectum becomes stretched and loses its sensitivity, and the child may experience leakage of fecal matter or soiling of their underwear.

Without constipation and overflow incontinence: This type of encopresis is associated with emotional or behavioral issues, rather than physical problems. The child may withhold bowel movements or have difficulty recognizing the urge to defecate, leading to involuntary soiling.

It's important to note that elimination disorders can have a significant impact on a child's quality of life, and can be distressing for both the child and their family. Treatment options are available and can be effective in managing these conditions.

diagnosis 

The diagnosis of elimination disorders usually involves a comprehensive evaluation by a healthcare professional, such as a pediatrician, psychologist, or psychiatrist. The evaluation may include:

Medical history: The healthcare professional will ask about the child's medical history, including any previous medical conditions, surgeries, or hospitalizations.

Physical exam: The healthcare professional may perform a physical exam to look for any physical issues that could be causing the elimination disorder, such as constipation or urinary tract infections.

Diagnostic tests: Depending on the child's symptoms, the healthcare professional may order diagnostic tests, such as a urine test or X-ray, to rule out any medical conditions.

Behavioral assessment: The healthcare professional may ask the child and their parents questions about the child's behavior, emotions, and daily routines to better understand the underlying cause of the elimination disorder.

Observation: The healthcare professional may observe the child's behavior, including their toileting habits, to better understand the problem.

Once a diagnosis of an elimination disorder is made, the healthcare professional will work with the child and their family to develop an appropriate treatment plan. Treatment options may include behavioral therapies, such as bladder or bowel retraining, and medication in some cases.

treatment

The treatment for elimination disorders will depend on the specific type of disorder and its underlying causes. Here are some common treatment options for elimination disorders:

Behavioral therapies: Behavioral therapies are often the first-line treatment for elimination disorders. These therapies may include bladder training, where the child learns to hold their urine for longer periods, or bowel retraining, where the child learns to recognize the urge to have a bowel movement and sits on the toilet at regular intervals. Behavioral therapies may also involve positive reinforcement, such as reward charts or praise for successful toileting habits.

Medications: In some cases, medications may be used to treat elimination disorders. For example, desmopressin is a medication that can be used to reduce urine production and is often used to treat bedwetting. Laxatives may also be prescribed to treat constipation and encopresis.

Counseling: Counseling or therapy may be recommended for children with elimination disorders who are experiencing emotional or behavioral issues. Family therapy or individual counseling can help address any underlying emotional or psychological factors that may be contributing to the elimination disorder.

Lifestyle changes: Simple lifestyle changes can also help treat elimination disorders. Encouraging the child to drink plenty of fluids, eat a healthy diet, and exercise regularly can help improve bowel and bladder function.

It's important to work closely with a healthcare professional to develop an appropriate treatment plan for your child's elimination disorder. With the right treatment, most children can overcome elimination disorders and improve their quality of life.

prevalence 

The prevalence of elimination disorders varies depending on the specific disorder and the population being studied. Here are some estimated prevalence rates for the two main types of elimination disorders:

Enuresis:

• In children under the age of 6, the prevalence of bedwetting is estimated to be around 15% to 20%.
• By the age of 10, about 5% to 10% of children still wet the bed at least once a week.
• Bedwetting is more common in boys than in girls.
• Encopresis:
• The prevalence of encopresis is estimated to be between 1% and 3% of children.
• Encopresis is more common in boys than in girls.
• The prevalence of encopresis is higher in children with a history of constipation or other bowel disorders.

It's important to note that elimination disorders can have a significant impact on a child's quality of life, and can be distressing for both the child and their family. It's important to seek medical attention if you or your child are experiencing any symptoms of an elimination disorder.

onset

The onset of elimination disorders can vary depending on the specific disorder and the individual child. Here are some general patterns of onset for the two main types of elimination disorders:

Enuresis:

Primary enuresis, or bedwetting that has never been successfully controlled, usually begins during early childhood, around the age of 5 or 6 years old.

Secondary enuresis, or bedwetting that occurs after at least six months of dryness, can begin at any age but is more common in children over the age of 7.

Encopresis:

The onset of encopresis is usually during early childhood, around the age of 4 years old.

Children with encopresis may have a history of constipation or other bowel disorders, and the condition may develop gradually over time.

It's important to seek medical attention if you or your child are experiencing any symptoms of an elimination disorder. Early intervention can help manage these conditions and improve quality of life.

conclusion

Elimination disorders are a group of childhood conditions that can affect a child's ability to control their bladder or bowel movements. These disorders include enuresis, or bedwetting encopresis, or fecal soiling. Symptoms of these disorders can include frequent accidents, daytime or nighttime wetting, and constipation or bowel problems.

Diagnosing an elimination disorder typically involves a comprehensive evaluation by a healthcare professional, including medical history, physical exam, and behavioral assessment. Treatment options for elimination disorders may include behavioral therapies, medication, counseling, and lifestyle changes.

The prevalence of elimination disorders can vary depending on the specific disorder and population being studied, but early intervention can help manage these conditions and improve a child's quality of life. It's important to seek medical attention if you or your child are experiencing any symptoms of an elimination disorder.