Elimination disorders

• Elimination disorders may be caused by a physical condition, a side 

effect of a drug, or a psychiatric disorder. It is much more common
for elimination disorders to be caused by medical conditions than
psychiatric ones.
• The American Psychiatric Association recognizes two 
elimination disorders
encopresis 
enuresis .
• Encopresis is an elimination disorder that involves repeatedly having 
bowel movements in inappropriate places after the age when bowel
control is normally expected.
• Enuresis, more commonly called bed-wetting, is an elimination
disorder that involves release of urine into bedding, clothing, or other
inappropriate places.
Both of these disorders can occur during the day or at night. They may
be voluntary or involuntary. Encopresis and enuresis may occur
together, although most often they occur separately.
Symptoms of Encopresis
• Loss of appetite
• Abdominal pain
• Loose, watery stools
• Scratching or rubbing the anal area due to irritation from watery
stools
• Decreased interest in physical activity
• Withdrawal from friends and family
Causes of Encopresis
• The most common cause of encopresis is chronic (long-term) constipation, the inability to
release stools from the bowel. This may occur for several reasons, including stress, not
drinking enough water (which makes the stools hard and difficult to pass) A diet low in fiber
• Lack of exercise
• Fear or reluctance to use unfamiliar bathrooms, such as public restrooms
• Not taking the time to use the bathroom
• Changes in bathroom routines; for example, scheduled bathroom breaks at school or camp
• The child also may develop encopresis because of fear or frustration related to toilet
training. Stressful events in the child's life, such as a family illness or the arrival of a new
sibling, may contribute to the disorder. In some cases, the child simply refuses to use the
toilet.
Prevalence of Encopresis
• Encopresis is fairly common, although many cases are not reported
due to the child's and/or the parents' embarrassment. It is estimated
that anywhere from 1.5% to 10% of children have encopresis. It is
more common in boys than in girls.
Symptoms of Enuresis
• Your child still wets the bed after age 7
• Your child starts to wet the bed after a few months or more of being
dry at night
• Bed-wetting is accompanied by painful urination, unusual thirst, pink
or red urine, hard stools, or snoring
Subtypes of Enuresis
• Nocturnal Only. This is the most common subtype and is defined as passage of
urine only during nighttime sleep. The enuretic event typically occurs during the
first one-third of the night. Occasionally the voiding takes place during the rapid
eye movement (REM) stage of sleep, and the child may recall a dream that
involved the act of urinating.
• Diurnal Only. This subtype is defined as the passage of urine during waking hours.
Diurnal Enuresis is more common in females than in males and is uncommon after
age 9 years. The enuretic event most commonly occurs in the early afternoon on
school days. Diurnal enuresis is sometimes due to a reluctance to use the toilet
because of social anxiety or a preoccupation with school or play activity.
• Nocturnal and Diurnal. This subtype is defined as a combination of the two
subtypes above.
Causes of Enuresis
• Enuresis also has both medical and psychiatric causes. Primary enuresis occurs when a
child has never established bladder control. Medical causes of primary enuresis are
often related to malformations of the urinary system, developmental delays, and
hormonal imbalances that affect the ability to concentrate urine. There appears to be a
genetic component to primary enuresis, since the condition tends to run in families.
Primary enuresis may also be caused by psychological stressors such as family instability
or erratic toilet training.
• Secondary enuresis occurs when a child has established good bladder control for a
substantial period, then begins wetting again. Involuntary secondary enuresis is thought
to be brought on by life stresses. For example, it is common for young children to begin
wetting the bed after moving to a new house or having a new sibling enter the family.
Voluntary enuresis is not common. Like voluntary encopresis, it is associated with
psychiatric conditions such as conduct disorder and oppositional defiant disorder.