General Description
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
There are two main elimination disorders the first is Enuresis (307.6) the second is Encopresis.
The main feature of Enuresis in urinating during the day or at night in a bed or clothes. This is usually unintentional but does not have to be. There are three subtypes of enuresis the first is nocturnal only. The nocturnal only subtype is the most common and is defined as urinating only while sleeping at night.
The second subtype is diurnal only. In this subtype an individual urinates only during the time they are awake. This subtype is more common in females and uncommon after the age of 9. This type is broken down into two groups "urge incontinence" which occurs when a child has a sudden uncontrollable urge to urinate. The second group is "voiding postponement" this is when a child has to go to urinate but puts it off because they are preoccupied with something else such as playing or school or have social anxiety about going to the bathroom.
The third subtype is nocturnal and diurnal. This subtype is a combination of both subtypes.
The main feature of Encopresis is when an individual repeatingly passes feces into clothing or other inappropriate areas.
Encopresis is divided into two subtypes. The first subtype is With Constipation and Overflow Incontinence (787.6) , this is when stool occurs less then 3 times a week, there is constipation, and leaking occurs. This is cured after the constipation is treated. The second subtype is, Without Constipation and Overflow Incontinence (307.7) this is when there is no constipation and soiling occurs. This is often associated with Oppositional Defiant Disorder and Conduct Disorder. This seems to be less common then the first subtype.
Diagnostic Criteria
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
Enuresis could be diagnosed if the following symptoms are seen.
- Repeated urinating in bed or clothes either voluntary or involuntary.
- This behavior occurs at least twice a week for three consecutive months or cause social, academic distress, or in someway affects the child's functioning.
- The child is at least five years old.
- The behavior is not do to another disorder, substance, or medical condition.
Encopresis could be diagnosed if the following symptoms are seen.
- Passing of feces in inappropriate places either intentionally or involuntarily.
- The criteria in 1 occurs at least ounce a month for 3 months.
- The child is over 4 years old or has the developmentally level of at least a 4 year old.
- The behavior can not be justified by the use of a substance, or a medical condition (excluding constipation).
Etiology
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
About 75% of children with Enuresis have a first-degree biological relative who has had the same disorder. A child who's has a parent that had enuresis as a child is five to seven more times likely to have enuresis as a child.
Prevalence
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Washington , DC.
Enuresis occurs in about 5 to 10% of 5 year olds, 3 to 5% among 10 year olds, and around 1% in individuals 15 years old or older.
EBP Treatment Approaches
Listed below are either evidence-based practices or promising practices that have been successful at treating Elimination Disorders.
None available at this time.
References
Mikklesen, E. J. (2001, Oct.) Enuresis and Encopresis: ten years of progress. Journal of the American Academy of Child & Adolescent Psychiatry. 40(10):1146-1158.
Note - Full text is available through the University at Buffalo Libraries.
Links
About Our Kids Enuresis
About Our Kids Encopresis
Disorder Information Sheet
Treatment Guidelines for Primary Nonretentive Encopresis
Treatments for Primary Enuresis
Fact Sheets
Fact Sheets from the American Academy of Child and Adolescent Psychiatry
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