What Are Elimination Disorders?

Elimination disorders are problems in children going to the bathroom -- both defecation and urination. It is not uncommon for young children to have occasional "accidents," but there could be a problem if this happens again and again for more than three months, especially if the child is over 5 years.

There are two forms of elimination disorders: encopresis and enuresis.

• Encopresis is the repeated passing of faeces into places other than the toilet, such as in underwear or on the floor. This behavior can be voluntary or involuntary.
• Enuresis is the habitual passing of urine in locations other than the toilet. Nocturnal, or nighttime, enuresis, also known as bed-wetting, is the most common form of elimination disorder. Like encopresis, this behavior is either done with intention or without intention.

What are the signs of Elimination Disorders?

There are common features of elimination disorders. In both instances, there are distinguishing characteristics:

Enuresis

• Recurrent bedwetting despite toilet training. This is referred to as primary enuresis.
• Bedwetting after at least six months of dryness. Otherwise termed secondary enuresis.
• Bedwetting must be frequent for at least two weeks over three consecutive months.

Encopresis

• Stool or liquid stool leakage on underwear
• Constipation
• Straining when stooling
• Dry or hard stool
• Avoiding bowel movements
• Encopretic incidents taking place for at least three months

What are the diagnosis of Elimination Disorders?

Here is how enuresis and encopresis are diagnosed.

Enuresis

• To qualify a case of enuresis, others like it should be removed: such as medical conditions brought in by a UTI, diabetes, seizures, sickle cell, or a sleep disorder.
• In the same way that the bedwetting cannot be caused by enuresis, it may sometimes have side effects from medication. Antidepressants, antipsychotic, and diuretic may cause incontinence.2
• When all these are eliminated, the pediatrician will then determine whether a child is suffering from enuresis. This may be achieved either by medical history examination, or through physical examinations.

Encopresis

• Upon making a diagnosis of encopresis, the pediatrician may inquire about the history of the child strained bowel movements. This can also demand responses to toilet training and diet.
• An appropriate diagnosis of encopresis may also involve a rectal examination. The physician may demand an x-ray of the abdomen of the child in determining a diagnosis. 
• To evaluate whether encopresis is present, conditions such as spinal cord trauma/tumors, cerebral palsy, and diseases of the pelvic muscle and anal sphincter should be evaluated. 

What causes of Elimination Disorders?

Let's have a look at some of the causes behind these two elimination disorders.

Enuresis

There is no known cause of enuresis. However, various factors are linked to bedwetting, or passing urine in inappropriate places.

For example, constipation may cause pressure on the bladder that causes an increased urge to urinate.2 Deep sleepers who cannot easily be aroused may also be at risk of developing enuresis.

Where the bladder experiences a delay in maturity, this can impact its ability to hold urine. Similarly, levels of vasopressin—a hormone that promotes water retention in the kidneys—may be lower. This can impact the likelihood of holding urine in.

Encopresis

This condition may be due to constipation. A low-fiber diet and poor hydration. Even stress over potty training can contribute to this condition.

Some risk factors that have been associated with the case of encopresis are a low socioeconomic background, fear of using unhygienic toilets, residing in a war-torn area, or child hospitalization for another condition. Bullying and behavioral problems like depression or social anxiety have also contributed. Poor performance in school is sometimes considered a factor.

What is the treatment of Elimination Disorders?

There are the ways through which these two elimination disorders are treated:

Enuresis Treatment

There are some management measures for this condition that are non-pharmacological and pharmacological in nature.

Non-Pharmaceutical Management of Enuresis

• Bell and Pad: This involves a process called the bell and pad that requires a child to take bed time with a specific apparatus. This apparatus contains sensors whose alarm sounds when it has experienced wetting. Through that, the child would then wake up. Bell and pad intends to stop the stream, instead let urine pass in the toilet.
• Dry Bed Training: This is another option which combines the bell and pad with behavior treatment for the child with parental support.
• Nighttime awakenings: Here, children are woken up at regular hours during the night. This is useful where alarms do not work to alert a child to use the toilet. However, this can lead to sleep problems in the child due to disrupted sleep.
• Restriction of fluid intake: Children who have a tendency for bedwetting can be aided by restriction of fluid intake before sleeping.
• Bladder training: In this procedure, children are made to hold the urine for longer periods of time. This is beneficial for both diurnal and nocturnal enuresis.
• Motivational therapy: The child and their care givers are given this therapy to lift up their morale before one of the above methods can be undertaken.

Medication management of Enuresis

The pediatrician can manage this condition in children by using an anti-diuretic hormone similar to desmopressin that manages urine production, though other treatment alternatives have a tricyclic antidepressant, imipramine. It also relaxes the bladder that results in enuretic episodes.

Relapse in drug therapy is more frequently higher than that with bell and pad.

Treatment of Encorpiresis

For managing the child that the pediatrician prescribes an affected laxative or administer a laxative enema with which to medicate for stool softeners.

Parents can also help with good bowel habits by planning bathroom time after meals. They can also praise the child for using the toilet. This will encourage them to use the toilet regularly and avoid excrement on clothing.

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