Elimination Disorders


They consist of an inability to voluntarily control the emission of urine or feces, in the time it is considered normal. In most cases there is a cause. Enuresis and encopresis can occur in isolation or associated with each other or with other diseases. If the child complains that he or punished because his dirty clothes or bed, you may have feelings of guilt or anxiety.Enuresis is defined as the involuntary discharge of urine. Nocturnal enuresis is involuntary urination while asleep after the age is considered normal for bowel and bladder control. The diurnal enuresis refers to involuntary loss of urine while awake, and is more likely to be an anatomical problem or biological background. The term is used when primary enuresis has not been achieved continence for extended periods, and secondary when bedwetting episodes occur after a period of at least six months of a control completes  considered a normal age to control urination during sleep, 5 years.


The fundamental characteristic of fecal incontinence is the involuntary expulsion of feces formed  or liquid, repeatedly, in inappropriate places such as on the floor or clothing. The child must have a maturity that matches at least 4-5 years of chronological age. Usually the child realizes that you are leaking stool, but can also be voluntary. To speak of encopresis, these incidents have to occur at least once a month for a minimum of three months.

Children affected

in 70% of cases diagnosed enuresis is usually bed-wetting is the disorder most common disposal and therefore most studied. This disorder occurs equally in both boys and girls, however, fecal incontinence is more common in children. Nocturnal enuresis affects 15% of five year olds, 70% of cases is diagnosed in some cases parents did not attend the consultation ashamed that their children continue to have a weak bladder. At four years beyond the feces were 3% of children once a week, and seven years, has a prevalence of fecal incontinence of 2.3% in boys and 0.7% in girls, according data from a document on “Elimination Disorders: Enuresis and encopresis.We also know that one third of children with encopresis suffers nocturnal enuresis, diurnal enuresis by 20% and 10% of girls suffer urinary  recurrences infections.

Organic and psychological causes:

Enuretic disorder may have organic causes for urological disorders, sores or any infectious process such as cystitis, but may also be due to the functional capacity of the bladder is reduced, implying that enuretic children need most often go to bathroom. Other times it may be caused by neuromuscular disorders affecting the genitourinary system, the spinal cord or brain centers.

When a child over four years urine during the night and out of the bathroom, it is important to see a pediatrician to rule out any organic causes above. Once discarded, if it is determined that bedwetting is a psychological origin, it is necessary to see a psychologist, According to experts, the psychological causes of bedwetting may also be multiple: lack of learning of the child because he has not been taught properly ; desensitization of skin to moisture, favored or caused by use diapers until later, depriving the child of the emergency mechanism that leads him to wake up when it feels wet.

There may also be a child’s interest to get a reaction from their parents, because you get something, which usually is your attention. Or emotional problems such as change of school, home, separation from parents or the birth of a younger brother, in short, anything that alters the child’s environment.Similarly, behind the causes of fecal incontinence can be constipation: both children retain feces in the colon pressure overcomes the sphincter and involuntary evacuations occur.

Treatment of affective area:

  •  The objectives in this area are the resolution of anxieties / fears about bedwetting parent or the child’s own on this problem.
  • For parents can be indicated cognitive-behavioral therapy
  •  Management of underlying concerns and means of coping with the problem
  •  For the child may be given different treatment modalities of their fears: behavioral therapy desensitization of fears, play therapy for the expression and conflict management, etc..

Treatment of interpersonal area:

The goals of treatment in this area focus on the resolution or reduction of stressors affecting the family and relationship conflicts. Family therapy (with all available members who wish to engage in therapy.)

Behavioral treatment area:

The aim is to deal directly enuresis and the immediate factors that maintain it. Often is “all” therapy, but in more complicated cases should explore the other areas mentioned.

The most used and effective methods are:

The expansion method of Kimmel and Kimmel bladder (1970: More useful in daytime wetting. Use positive reinforcement intervals and amounts of urine retained increasing measures in a bucket.

The alarm urine (pee-stop) of Mowrer (1978): It has the highest success rate of all existing treatments (75-80%). It basically consists of a circuit that rings a bell when the child begins to urinate. Recommended for use with the “overlearning” by consuming the Baby 1/4 liter of water before bed many nights and connecting the alarm intermittently (days and days if not).

Dry bed training Azrin (1974): Use the test as a game, going to bed-up-go to the bathroom. Use positive reinforcement contingent. Waking up to a certain time step, making the child use the bathroom, strengthening control and cleanliness of the bed if it gets wet.

Often combining various behavioral procedures with each other, the child’s record (by age) of dry days and wet (p,. And suns and clouds) and the use of reinforcements (eg immediate or delayed by the accumulation of “points or stars” ), this latter to increase the motivation of the child and not as a technique by itself (by itself ineffective in primary nocturnal enuresis). However, it is noteworthy that the motivation / participation of children in treatment

Effects of disorder suffer from enuresis:

  •  The child (a) that has the disorder manifests emotional effects as enuresis:
  •  Shame
  •  Interpersonal problems (with friends or siblings)
  •  Low self-esteem
  •  Irritability
  •  Persistent concern


  •  Get medical opinion from a doctor or urologist.
  •  Psychotherapeutic treatment
  •  Reduce fluid intake before going to bed.
  •  Accustom the child to sit on the toilet daily time intervals.
  •  Using a strategy of reward and reinforcement when does the right thing.
  •  Having lots of patience, impatience caused him stress the whole family.
  •  Many times, you can lie, but they should not stop trying.
  •  It must be the child who remove clothing, bring it to the washer, look for clean clothes and change.

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