Elimination Disorders: Functional Encopresis and Functional Enuresis



Elimination Disorders: Functional Encopresis and Functional Enuresis







Clinical Description

Elimination disorders first come to the attention of pediatricians when a child is having difficulty with toilet training. Children are toilet trained at widely different times depending upon development, culture, and techniques utilized to help the child learn. Functional encopresis is fecal soiling in clothes or inappropriate places at least once monthly for at least 3 months in a child that is 4 years old or older, when full bowel control is developmentally expected. Functional enuresis is repeated voiding of urine during the day or at night at least twice weekly for at least 3 months, causing functional impairment and with an age (chronological or mental age) of at least 5 years.




Functional Encopresis

Encopresis typically occurs during the day. Many children may deny soiling, even when stool is discovered in their underwear or the odor is obvious. Primary encopresis constitutes about half of the cases and is more common with boys with developmental delay. Children with secondary encopresis experience higher levels of psychosocial adversity and may demonstrate conduct problems.

There are two types of encopresis—that with constipation and overflow incontinence (called retentive encopresis), and that without. Children with retentive encopresis often respond positively to treatment of constipation.


Epidemiology

An estimated 1% of 5-year-olds suffer from encopresis, with boys 2.5 to 6 times more commonly affected than girls. Children with lower cognitive functioning and lower socioeconomic status tend to have higher rates as well.


Etiology

Retentive encopresis often starts with a child who has toilet-related fears, inadequate or punitive toilet training, or constipation which makes defecating painful. This may set into motion a cycle of increased avoidance of using the toilet.
When constipation is more severe, colon motility decreases and, in severe cases, megacolon with decreased sensation may result. Liquid stool leaks around the impaction and the child is unaware and unable to exert control. Stress-induced diarrhea may also cause encopresis. Nonretentive encopresis is the deliberate soiling in inappropriate places. Deliberate soiling suggests that the child is experiencing extreme distress which he/she is unable to communicate directly (e.g., anger, fear of abuse, or severe psychosocial stress) or may be secondary to anal masturbation, sexual abuse, or severe conduct issues. Nonretentive encopresis is more difficult to treat.

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Jul 5, 2016 | Posted by in PSYCHIATRY | Comments Off on Elimination Disorders: Functional Encopresis and Functional Enuresis
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