18. Elimination Disorders: Enuresis and Encopresis

  1. William M. Klykylo1 and
  2. Jerald Kay2
  1. Ryan C. Mast and
  2. Andrew B. Smith

Published Online: 30 MAR 2012

DOI: 10.1002/9781119962229.ch18

Clinical Child Psychiatry, Third Edition

Clinical Child Psychiatry, Third Edition

How to Cite

Mast, R. C. and Smith, A. B. (2012) Elimination Disorders: Enuresis and Encopresis, in Clinical Child Psychiatry, Third Edition (eds W. M. Klykylo and J. Kay), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781119962229.ch18

Editor Information

  1. 1

    Department of Psychiatry, Wright State University School of Medicine, 627 S. Edwin C Moses Blvd, P.O. Box 927, Dayton, OH 45401-0927, USA

  2. 2

    Department of Psychiatry, Wright State University School of Medicine, P.O. Box 927, Dayton, OH 45401-0927, USA

Author Information

  1. Department of Psychiatry, Wright State University School of Medicine, 627 S. Edwin C Moses Blvd, P.O. Box 927, Dayton, OH 45401-0927, USA

Publication History

  1. Published Online: 30 MAR 2012
  2. Published Print: 30 MAR 2012

ISBN Information

Print ISBN: 9781119993346

Online ISBN: 9781119962229

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Keywords:

  • elimination;
  • enuresis;
  • bedwetting;
  • bell and pad;
  • desmopressin;
  • imipramine;
  • encopresis;
  • retentive;
  • nonretentive;
  • incontinence

Summary

During the toddler phase, a child's attention turns toward the mastery of elimination. Typically, children achieve bowel continence before bladder continence. Failure to achieve bladder continence by age 5 is termed enuresis. If a child has never achieved bladder continence, then it is termed primary enuresis. If the child achieved bladder continence, but then regresses, it is termed secondary enuresis. A child may also have daytime incontinence (diurnal enuresis), incontinence while asleep (nocturnal enuresis), or both. Treatment modalities include: education, nonpharmacologic, and pharmacologic interventions. For nocturnal enuresis, the bell and pad is an effective behavioral (nonpharmacologic) technique. Desmopressin and imipramine are two medications with proven efficacy in the treatment of nocturnal enuresis. Failure to achieve bowel continence by age 4 is termed encopresis. Interventions include: education, nonpharmacologic, and pharmacologic modalities. Both encopresis and enuresis may cause significant stress and anxiety. Therefore, referral to a mental health professional is frequently indicated.