Notes on Elimination Disorders: Enuresis and Encopresis

Elimination Disorders

• Involves inappropriate elimination of urine or feces;
• Typically diagnosed in childhood or adolescence.

Enuresis

• Definition: The repeated voiding of urine into bed or clothes, can be involuntary or intentional.
• Diagnostic Criteria (F98.0):
  • A: Voiding of urine occurs repeatedly.
  • B: Behavior is clinically significant, shown by:
  • Frequency of at least twice a week for at least 3 consecutive months,
  • Clinically significant distress or impairment in social, academic, or other important areas of functioning.
  • C: Chronological age is at least 5 years (or equivalent developmental level).
  • D: Behavior not due to physiological effects from substances (e.g., diuretics, antipsychotics) or another medical condition (e.g., diabetes, spina bifida).
• Types of Enuresis:
  • Nocturnal only: Urination only during night sleep.
  • Diurnal only: Urination during waking hours without nocturnal enuresis, may simply be referred to as urinary incontinence.
  • Nocturnal and diurnal: Known as nonmonosymptomatic enuresis, includes both nighttime and daytime incontinence.

Encopresis

• Definition: The repeated passage of feces into inappropriate places, such as clothing or on the floor, which can be involuntary or intentional.
• Diagnostic Criteria (F98.1):
  • A: At least one event per month for at least 3 months.
  • B: Age must be at least 4 years or equivalent developmental level.
  • C: Behavior not attributable to physiological effects from substances (like laxatives) or other medical conditions unless related to constipation.
• Types of Encopresis:
  • With constipation and overflow incontinence: Evident constipation on physical examination or by history.
  • Without constipation and overflow incontinence: No evidence of constipation on examination or by history.