Elimination disorders – Enuresis and Encopresis

Generally what are they???

  • Repeated voluntary or involuntary passage of faeces/urine into inappropriate places.

Encopresis: faeces

Enuresis: urine

  • Disorders can be functional; Often explained by causing distress.

Causes:

  • Genetic, Environmental

Signs and symptoms:

  • Repeated voluntary or involuntary passage of faeces/urine into inappropriate places.

Diagnosis:

  • Repeated voluntary or involuntary passage of urine/feces into inappropriate places.
  • >5 years old
  • Not caused by other condition or substance.

Treatment:

Medications

  • Laxatives, desmopressin to manage elimination

Psychotherapy

  • Eg. cognitive behavioral therapy

ENCOPRESIS

Pathology and causes:

  • Repeated voluntary/ involuntary passage of faeces into inappropriate places.
  • Often functional; caused by overflow due to withholding faeces (eg. fear of defecation); constipation related.
  • When faeces deposited in abnormal places, maybe neurodevelopmental/induced by fear of toilets.

Causes

  • Genetic, Environmental
  • Often associated with psychiatric comorbidities.

Sign and symptoms

  • Repeated passage, voluntary or uncontrolled, of faeces into inappropriate places.

Diagnosis

  • Occur at least once a month for three months in a row.
  • > 4 years old
  • Not caused by other condition/substance (except constipation).

Treatment

Medications:

  • Daily laxative (stool softener: 1 gm/kg polyethylene glycol per day.)

Psychotherapy:

  • Behavioral therapy (encourage toilet uses, normalize bowel movement.)

Other interventions:

  • Dietary
  • Avoid constipating foods, adequate hydration, increased fibre intake, fibre tablets.
  • Remove fake fecal impaction
  • Polyethylene glycol/Mineral oil
  • Rectal enema.

ENURESIS

Pathology and causes:

  • Repeat voluntary/involuntary passage of urine into inappropriate places.
  • Can be nocturnal,diurnal or both.
  • Can involve poor bladder control (physiological development reasons)/ exceeding bladder capacity.

Causes

  • Genetic and environmental
  • Stress related
  • Often associated with psychiatric comorbidities
  • More common in biological males

Signs and symptoms:

  • Repeated voluntary/involuntary passage of urine into inappropriate places.

Diagnosis

  • Clinically significant: occurs  >2 times per week for greater than 3 consecutive months or effects day to day life.
  • Age >5 years old
  • Not caused by any other substance.

Treatment

Medications:

Desmopressin – reduce urine production

Psychotherapy:

Behavioral therapy (eg. bedtime alarm therapy), bladder program.

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