Elimination problems

DSM-IV defines enuresis as involuntary or intentional wetting:

• in a child who has reached a chronologically or developmentally equivalent age of 5 years

• that is of clinical significance (i.e. occurs twice a week for at least 3 consecutive months or is associated with distress/impairment in the child's psychosocial or educational functioning)

• that is functional in aetiology (i.e. must not be attributable solely to physiological effects or a general medical problem).

Wetting may be diurnal, nocturnal, or both. It can be primary (existed from birth) or secondary (follows a period of continence that has lasted for at least 1 year). Children with diurnal enuresis often have a higher incidence of urinary tract infections and abnormal urodynamics, often requiring combined medical evaluation, than children who have nocturnal enuresis (bedwetting).

Encopresis is persistent faecal incontinence, which is involuntary or intentional, without an anatomical abnormality in a child of at least 4 years of age. Faeces are repeatedly passed in inappropriate places for at least once a month for a minimum of 3 months. It may be a result of constipation with overflow. When faecal incontinence is not accounted for by organic factors and is primarily psychogenic in origin it is termed encopresis. Three subtypes of encopresis have been identified: (i) soiling for secondary benefit; (ii) stress-induced diarrhoea and loose bowels; (iii) retentive encopresis, which occurs in 80 to 90 per cent of cases. (25>

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