Elimination disorder is when a child has delayed learning of sphincter control. This learning develops progressively: night-time bowel control comes first, followed by daytime bowel control, and then daytime bladder control. Normally, the last one to be achieved is night-time bladder control. In terms of their development, children acquire control of their sphincters from approximately 18 months to 3 years old, but each child develops at their own rhythm and, as in everything we learn, there can be setbacks without this necessarily meaning we are looking at a disorder. When children repeatedly urinate or defecate in inappropriate places and at an age where they should have learnt this already, this is known as enuresis and encopresis, respectively.
The elimination disorder known as enuresis is defined as repeated voluntary or involuntary urination in bed or in clothing in children aged 5 or older, and which is not due to a medical condition like diabetes or a urinary tract infection.
It can be nocturnal enuresis, or bedwetting, in which the child does not control urination during night-time sleep, daytime enuresis if it appears during waking hours, or both nocturnal and daytime enuresis in cases where the child loses bladder control during the day and night alike.
If enuresis is not resolved, as children get older they can develop behaviours to avoid social activities such as going to summer camps or sleeping at a friend’s house. They may also have problems with their peers, or their own image may be affected by the sense of embarrassment that they cannot control their urination. This can lead to emotional impairment, expressed in the form of feelings of sadness, fears or insecurities.
The elimination disorder called encopresis is defined as repeated voluntary or involuntary defecation in inappropriate places such as in clothing or on the floor in children aged 4 or older, and which is not due to a medical condition. In some cases, encopresis may be accompanied by constipation and there may be overflow incontinence. Boys and girls who have experienced constipation may associate defecation with pain and discomfort, so they subsequently hold back their excretion reflex, reinforcing retention and encopresis.
Both enuresis and encopresis can be primary or secondary. In the first case, the child has never achieved bladder or bowel control, while in the second case, they had already learnt sphincter control, but environmental, emotional or conditioning issues cause the re-emergence of problems with incontinence.
Cognitive behavioural therapy brings together two types of therapeutic treatments, because although behavioural therapies are successful in the treatment of some pathologies, other aspects involved in the way in which people respond to different situations have to be taken into account.