Enuresis and Enuresis and EncopresisEncopresis

Ann LenartAnn Lenart

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Andrea WilsonAndrea Wilson

IntroductionIntroduction

These are two separate conditions. These are two separate conditions. They are often co-existing, but not They are often co-existing, but not always. always.

Andrea will discuss EnuresisAndrea will discuss Enuresis Ann will discuss EncopresisAnn will discuss Encopresis

EnuresisEnuresis DefinitionDefinition

Bed wetting at night after age of expected continence. Does Bed wetting at night after age of expected continence. Does occur during the day time rarely. Not related to medical occur during the day time rarely. Not related to medical problems. problems.

Primary Functional Enuresis refers to children who have Primary Functional Enuresis refers to children who have never been continent.never been continent.

Rarely psychologicalRarely psychological Parents not potty training childParents not potty training child

Secondary Functional Enuresis refers to children who Secondary Functional Enuresis refers to children who have been continent for at least one year, however no have been continent for at least one year, however no longer are.longer are.

This usually is related to an event in the child’s life such as; This usually is related to an event in the child’s life such as; stress, divorce, sexual abuse, school trauma, or hospitalization. stress, divorce, sexual abuse, school trauma, or hospitalization.

EnuresisEnuresis EtiologyEtiology

For most children a specific etiology cannot be For most children a specific etiology cannot be determined.determined.

Children should always be medically assessed to rule out Children should always be medically assessed to rule out bladder problems, low ADH, & lack of arousability.bladder problems, low ADH, & lack of arousability.

Can be linked to genetic factors, parents that wet the Can be linked to genetic factors, parents that wet the bed. bed.

PrevalencePrevalence 5-10% among five year olds; 3-5% among ten year olds; 5-10% among five year olds; 3-5% among ten year olds;

1.1% among those children 15 years or older 1.1% among those children 15 years or older ManifestationsManifestations

Child wets the bed at least twice per week for at least Child wets the bed at least twice per week for at least three months and is five years old or older. three months and is five years old or older.

EnuresisEnuresis

Age of onsetAge of onset Usually around age 5 if children are wetting the Usually around age 5 if children are wetting the

bed still or have began to wet the bed again a bed still or have began to wet the bed again a problem is considered. problem is considered.

Gender differencesGender differences Between ages of 5-8 enuresis is two to three Between ages of 5-8 enuresis is two to three

times more common in boys than girlstimes more common in boys than girls Generally more common in boys than girls at all Generally more common in boys than girls at all

agesages Cultural differences/similaritiesCultural differences/similarities

Prevalence is generally the same among cultures.Prevalence is generally the same among cultures.

EnuresisEnuresis

Cultural Issues continuedCultural Issues continued New Zealand adolescentsNew Zealand adolescents

• Children who were still bed wetting after 10 Children who were still bed wetting after 10 years old were at a slightly increased risk for years old were at a slightly increased risk for having conduct problems, ADD behaviors, having conduct problems, ADD behaviors, and anxiety symptoms during adolescents. and anxiety symptoms during adolescents.

Study among Chinese adolescentsStudy among Chinese adolescents• Found that attaining bladder control after Found that attaining bladder control after

age 4 resulted in higher risk of internalizing age 4 resulted in higher risk of internalizing and externalizing problems. Which leads to and externalizing problems. Which leads to higher risk for suicide and self harm higher risk for suicide and self harm attempts and completions. attempts and completions.

Definition Definition The passing of bowel movement into The passing of bowel movement into

inappropriate places; such as underwear or inappropriate places; such as underwear or floor.floor.

Two subtypesTwo subtypes• With constipationWith constipation• Without constipationWithout constipation

ODD, or CD may be considered if child is ODD, or CD may be considered if child is intentionally defecating when not appropriate, intentionally defecating when not appropriate, or if they are playing with their feces. or if they are playing with their feces.

EncopresisEncopresis EtiologyEtiology

With constipation: feces overflows around blockage causing With constipation: feces overflows around blockage causing unintentional movements, usually not well formed and often unintentional movements, usually not well formed and often pasty.pasty.

• Causes for constipation can be medical , related to diet, Causes for constipation can be medical , related to diet, avoidance of pain from movements, or resistance to toilet trainingavoidance of pain from movements, or resistance to toilet training

Without constipation: child passes normal bowel movements Without constipation: child passes normal bowel movements into his underwear and there is no constipation noted.into his underwear and there is no constipation noted.

• Causes are usually stress related if the condition comes on Causes are usually stress related if the condition comes on suddenly. If condition is long standing problem, the child is strong suddenly. If condition is long standing problem, the child is strong willed.willed.

Prevalence: Prevalence: 1% in all five year old children 1% in all five year old children

ManifestationsManifestations Occurs once a month for at least three months, starts at age 4. Occurs once a month for at least three months, starts at age 4.

EncopresisEncopresis

Age of onsetAge of onset 4 years old is when a problem is 4 years old is when a problem is

consideredconsidered Gender differencesGender differences

Six times more common in boys than Six times more common in boys than girlsgirls

Cultural differences/similaritiesCultural differences/similarities Cultural based information is scarce and Cultural based information is scarce and

generally outdatedgenerally outdated

TreatmentTreatment EnuresisEnuresis

Bed Wetting Bed Wetting Alarms Alarms

Alarm ClockAlarm Clock Medication Medication

• Decreases urine Decreases urine production at production at night and helps night and helps child stay dry. child stay dry. DOES NOT CURE DOES NOT CURE BEDWETTINGBEDWETTING

• Expensive, Expensive, temporary fix for temporary fix for small percentage small percentage of children of children

EncopresisEncopresis With constipationWith constipation

• Enema’s, Enema’s, medication, and medication, and diet modificationdiet modification

• Behavior Behavior modification from modification from adults involved adults involved with childwith child

Without Without constipation--constipation--Behavior Behavior modification modification (from adults (from adults involved with involved with child)child)

HistoryHistory

Negative reinforcement—historically Negative reinforcement—historically parents have punished children for parents have punished children for behaviors due to not understanding what behaviors due to not understanding what is happening with the childis happening with the child

Freud would say related to unresolved Freud would say related to unresolved sexual conflictsexual conflict

Historically it was believed these disorders Historically it was believed these disorders were due to psychological disturbances, were due to psychological disturbances, not a lot of evidence to support that now.not a lot of evidence to support that now.

DemonstrationDemonstration

BibliotherapyBibliotherapy Alarm TherapyAlarm Therapy

SourcesSources

http://www.bedwettingstore.com/http://www.bedwettingstore.com/ http://www.goodnites.com/na/bedwettinginfo/index.asphttp://www.goodnites.com/na/bedwettinginfo/index.asp http://pub48.bravenet.com/forum/4097914357http://pub48.bravenet.com/forum/4097914357

Support web site for parents of children with encopresis.Support web site for parents of children with encopresis. http://www.drgreene.com/21_96.html http://www.drgreene.com/21_1082.html Cuddy-Casey, M. (1997). A case study using child-centered play therapy approach to treat enuresis and

encopresis. Elementary School Guidance and Counseling, 31. El-Radhi, A. Sahib. (2005). Practical management: Children with enuresis. Update, 70, 60-65. Fritz, G., Rockney, R. (2004). Practice parameter for the assessment of children and adolescents with

enuresis. Journal of American Academy of Child and adolescent Psychiatry, 43, 1540-1551. Geroski, A. M., Rodgers, K. A. (1998). Collaborative assessment and treatment of children with enuresis and

encopresis. Professional School Counseling, 2.

Mellon, M.W. (2000). Emperically supported treatments in pediatric psychology: Nocturnal enuresis. Journal of Pediatric, 25, 193-214.

Murphy, S., Carney, T. (2004). The classification of soiling and encopresis and a possible treatment protocol. Child and Mental Health, 9, 125-129.

Russ, S., Landes, C., Kaufman, N., Smith, J. (2005). A team approach to enuresis and school reluctance. Journal of School Health, 75, 75-77.

Soderstrom, U., Hoelcke M., Alenius, L., Soderling, A-C., Hjern, A. (2004). Urinary and faecal incontinence: A population-based study. Acta Paediatr, 93,386-389.

Xianchan, L., Zhengxiao, S. (2005). Age of attaining nocturnal bladder control and adolescent suicidal behavior. Journal of Affective Disorders, 87, 281-289.

Information from Ann’ s doctor Published by McKesson Clinical Reference Systems