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Disorders of Elimination

Updated: Jul 26, 2023

Disorders of elimination refer to a group of conditions that involve involuntary or inappropriate elimination of bodily waste. Two common disorders within this category are Nocturnal Enuresis (bedwetting) and Encopresis (involuntary soiling). These disorders can have a significant impact on the affected individuals' quality of life, emotional well-being, and social interactions. Understanding these conditions is crucial for proper diagnosis, treatment, and support. In this article, we will delve into the details of each disorder, exploring their causes, symptoms, diagnosis, and available treatment options.

1. Nocturnal Enuresis (Bedwetting)

Explanation: Nocturnal enuresis, more commonly known as bedwetting, is a condition characterized by the involuntary release of urine during sleep, primarily affecting children aged five years and older. While it is a normal part of development in toddlers, its persistence beyond a certain age can lead to distress and embarrassment for both the child and their family.

Causes: The exact cause of nocturnal enuresis is multifactorial, involving a combination of physiological, psychological, and genetic factors. Some potential causes include:

  1. Delayed Maturity: Some children's bladders may take longer to reach the necessary developmental stage for night-time control.

  2. Genetics: Bedwetting tends to run in families, indicating a genetic component.

  3. Reduced Antidiuretic Hormone (ADH) Production: ADH helps reduce urine production at night. In some children with enuresis, the production of ADH might be lower during sleep, leading to increased urine production.

  4. Small Bladder Capacity: Some children may have smaller bladder capacities, leading to more frequent trips to the bathroom or bedwetting.

  5. Urinary Tract Infections: Infections affecting the urinary system can contribute to bedwetting.

  6. Psychological Stress: Emotional stress or major life changes, such as moving to a new home or the birth of a sibling, can trigger bedwetting episodes.

Symptoms: The primary symptom of nocturnal enuresis is the repeated occurrence of bedwetting during sleep. Children with this disorder usually have no problems with daytime bladder control.

Diagnosis: To diagnose nocturnal enuresis, a healthcare professional will review the child's medical history, conduct a physical examination, and possibly recommend some tests, including a urinalysis. Additionally, keeping a detailed voiding diary can help track patterns and identify potential triggers.

Treatment: Treatment approaches for nocturnal enuresis vary depending on the severity of the condition and its underlying causes. Some common strategies include:

  1. Bedwetting Alarms: These devices sense moisture and wake the child at the onset of bedwetting, conditioning them to respond to bladder signals.

  2. Behavioral Techniques: Implementing bladder-training exercises, fluid management, and scheduled voiding can improve control.

  3. Medications: In some cases, doctors may prescribe medications like desmopressin to reduce urine production at night.

  4. Addressing Emotional Factors: If stress or anxiety plays a role, counseling or therapy may be beneficial.

  5. Encouragement and Support: Providing emotional support and understanding is essential to prevent the child from feeling shame or guilt.

It's important to remember that nocturnal enuresis often resolves naturally with time, and patience is key during the treatment process.

2. Encopresis (Involuntary Soiling)

Explanation: Encopresis is a condition characterized by the involuntary passage of feces in children beyond the age when they are expected to have control over bowel movements. Also known as fecal incontinence, this disorder can lead to significant emotional distress and social difficulties for the affected child.

Causes: Encopresis can have several causes, including:

  1. Chronic Constipation: Prolonged constipation can lead to impacted stools in the rectum, causing a loss of sensation and control over bowel movements.

  2. Withholding Stools: Children who have experienced painful bowel movements may start avoiding passing stools, exacerbating constipation.

  3. Physical or Psychological Stress: Stressful events or emotional difficulties can contribute to bowel disturbances.

  4. Toilet Training Issues: Inadequate or harsh toilet training methods can hinder a child's ability to develop proper bowel habits.

Symptoms: The primary symptom of encopresis is the involuntary passage of feces, often in inappropriate places, such as in underwear or clothing. Children with this condition might also experience chronic constipation, abdominal pain, and bloating.

Diagnosis: Diagnosing encopresis involves a thorough medical history review, physical examination, and potentially imaging tests (X-rays) to assess the extent of constipation and stool retention.

Treatment: Treatment for encopresis typically involves a combination of approaches to address the underlying causes and encourage proper bowel habits:

  1. Laxatives or Stool Softeners: These medications help relieve constipation and facilitate more regular bowel movements.

  2. Behavioral Therapy: Encouraging regular toilet visits, positive reinforcement, and addressing emotional issues through counseling can be beneficial.

  3. Dietary Changes: Increasing fiber intake and staying hydrated can improve bowel regularity.

  4. Toilet Training Support: Providing gentle and patient guidance during toilet training can be helpful.

  5. Family Education: Educating parents and caregivers about the condition and appropriate management is essential for successful treatment.


Nocturnal enuresis and encopresis are two common disorders of elimination that can significantly impact a child's physical and emotional well-being. Proper understanding, diagnosis, and treatment are crucial for helping affected children overcome these challenges and lead a more comfortable and confident life. If your child experiences persistent bedwetting or soiling issues, seeking medical advice and support from healthcare professionals can make a positive difference in their overall well-being. With time, patience, and appropriate interventions, many children can successfully manage and overcome these conditions.


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