Elimination disorders (in childhood): causes, symptoms and treatment

We talk about enuresis and encopresis, two common disorders in childhood.

Psychological problems in childhood often cause suffering not only in the child, but also in the parents or in the immediate family around the child. This psychological distress during childhood can manifest itself in unusual ways, as in the case of elimination disorders.

These alterations related to sphincter control are usually related to experiencing feelings of discomfort and distress. Throughout this article we will discuss the characteristics of each of them, as well as their causes, symptoms and possible treatments.

What are elimination disorders?

The concept of elimination disorders refers to a disorder that can appear during childhood, affecting both the psychological state and behavior of the child and generating feelings of worry and anxiety in the rest of the family. and generating feelings of worry and anxiety in the rest of the family. On occasions, this alteration can become so pronounced that it ends up being a source of conflict within the family nucleus.

The nature of this disorder is related to the acquisition of sphincter control. Although there are individual differences in each child, this control is usually achieved between 18 and 36 months of age.

Among the behaviors that fall into this category are nocturnal and daytime fecal continence and nocturnal and daytime urinary continence.

In the case of elimination disorders, the child does not achieve this control, which usually leads to two distinct events: functional enuresis or uncontrolled urination, which tends to appear some time after the acquisition of urinary control.which tends to appear some time after the acquisition of urinary control, this is not usually diagnosed as such before the age of 5 years and usually occurs during sleep.

On the other hand we find functional encopresis, which refers to the evacuation of feces at inappropriate times and situations, both voluntarily and involuntarily. In this case the approximate age for diagnosis is 4 years.

In most cases, both disorders appear together; however, this is not necessarily the case. In addition, each of them is accompanied by characteristic features, causes and psychological symptomatology.

In spite of this, both in enuresis and encopresis, the family usually feels helpless and disoriented.. The reason is that there is no single cause that can cause these behaviors and also the appearance of emotional symptoms on the part of the child makes the parents' concern and frustration even greater.

Functional enuresis

By functional enuresis we mean the inability of the child to control urination, which leads to the expulsion of urine during the night or at inopportune times and places. This behavior usually occurs both involuntarily and voluntarily.

In order for a correct diagnosis of functional enuresis to be made, it must appear after the developmental patterns have passed; that is, at this age the child should already be able to control urination (over 3 or 4 years of age). In addition, it will first be necessary to rule out possible physical or organic causes,

1. Main characteristics

There are a number of defining characteristics of functional enuresis:

• Enuresis appears with a frequency of at least two episodes per week for three months in a row.
• It can generate clinically significant distress and discomfort in the child. As well as affecting social and school development.
• These behaviors cannot be explained by an organic cause such as an illness or the administration of a medication or diuretic substance.
• When it appears during the night, it tends to occur between 30 minutes and 3 hours after falling asleep.
• In most cases the child has not achieved bladder control, which is known as primary enuresis. However, in approximately 20% of cases it is secondary enuresis due to a stressful or distressing event or situation.

2. Possible causes

If physical problems related to bladder size or Muscle weakness can be ruled out, as well as hereditary or sleep cycle causes. The medical professional or psychologist should then perform a psychological evaluation to reveal possible psychological factors or causes..

Functional enuresis is sometimes accompanied by emotional and behavioral symptoms. However, it has not yet been possible to determine whether this is the cause or, on the contrary, an effect of the disorder itself.

As for the psychological origin of functional enuresis, case studies point to the idea that experiencing periods of stress and anxiety, as well as experiencing trauma and psycho-social crises such as the birth of a sibling, may be some of the causes of this problem.

3. Behavioral and physical symptoms

Functional enuresis may be associated with the following psychological and physical symptomatology:

• Feelings of disturbance, aggression and anger.
• Refusal to sleep away from home
• Feelings of shame
• Low self-esteem
• Irritation in intimate areas

4. Treatment

Regarding the approach of parents and teachers to the problem, they should remain attentive to the moments in which the enuresis occurs and, under no circumstances, reprimand or punish the child for doing it. for doing so.

The most effective option is to go to a specialist in psychology. In addition to a psychological evaluation and intervention, he/she will teach the child toilet training techniques or alarm devices and techniques.

Functional encopresis

In the case of functional encopresis, the elimination disorder is manifested by the voluntary or involuntary evacuation of feces at inappropriate times. at inappropriate times. In this case the diagnosis dictates that the problem must remain present for at least three months, when the child is more than four years old.

1. Main characteristics

As with enuresis, functional encopresis has a number of distinguishing characteristics:

• It occurs more during the day than during sleeping hours.
• In 50% of cases it is due to poor toilet training (primary encopresis) while in the other 50% it is a regression response to a distressing event or situation (from 8 years of age).
• The behavior cannot be explained either by a medical illness or by the use of laxative drugs or substances.

2. Possible causes

Eliminating the possible physical causes of encopresis, such as constipation and fecal impaction, we can find certain psychological factors that cause this type of elimination disorder.

Deficient learning and training in hygiene, training too early or the development of an emotional condition such as oppositional defiant disorder or conduct disorder are often the main causes of this disorder.

Physical and psychological symptoms

In addition to the problematic behavior itself, functional encopresis presents a number of physical and psychological symptoms:

• Feelings of disturbance and embarrassment
• Neurodevelopmental symptoms such as attention problems, hyperactivity, impulsivity, low frustration tolerance and incoordination.
• Gastric and stomach disturbances such as stomach pain and constipation.
• In girls, urinary tract infections may appear.

4. Treatment

As in the case of enuresis, neither parents nor teachers should reprimand the child when an unpleasant situation occurs. it is necessary to talk to him in a language according to his age, not as if he were a newborn baby..

As for the medical and psychological approach, these will try to achieve the prevention of constipation, as well as to stimulate the development of correct defecation habits.

Psychotherapy can help the child to control and manage the emotional symptoms of this elimination disorder.