Elimination disorders (in childhood): causes, symptoms and treatment

Childhood psychological problems often cause suffering not only in the child but also in the parents or the closest family around him. This psychological distress during childhood can manifest itself in an unusual way, it is the case of elimination disorders.

These alterations related to sphincter control are generally linked to feelings of discomfort and anxiety. Throughout this article, we’ll talk about the characteristics of each of them, as well as their causes, symptoms, and possible treatments.

What are elimination disorders?

The concept of elimination disorders refers to an alteration that can appear during childhood, affecting both the psychological state and the behavior of the child as generating feelings of worry and anxiety in the rest of the family. Sometimes this alteration can become so pronounced that it ends up being a source of conflict within the family.

The nature of this disorder is related to the acquisition of control of the sphincter. Although there are individual differences in each of the children, this check-up is usually done between 18 and 36 months old.

Behaviors or behaviors that fall into this category include nocturnal and daytime fecal continence as well as nocturnal and daytime urinary incontinence.

In the event of elimination disorders, the child fails to achieve this control, which usually results in two different events: functional bedwetting or uncontrolled urination, Which tends to appear sometime after the acquisition of urinary control, it is usually not diagnosed as early as 5 years and usually occurs during sleep.

On the other hand, we find functional encopresis, which refers to the evacuation of feces at times and in inappropriate situations, both intentionally and involuntarily. In this case, the approximate age for diagnosis is 4 years.

In most cases, the two alterations appear accompanied by each other; however, this does not have to be the case. In addition, each of them is accompanied by characteristic psychological features, causes and symptoms.

Despite this, in bedwetting and encopresis, the family often feels helpless and disoriented. The reason is that there is no single cause that can cause these behaviors and also the appearance of emotional symptoms on the part of the little one makes the worry and frustration of the parents even more.

Functional enuresis

By functional enuresis we mean the inability of the child to control urination, which leads to the expulsion of urine at night or at inappropriate times and places. This behavior usually occurs both unintentionally and on purpose.

For a correct diagnosis of functional enuresis to be made, it must appear after the evolutionary guidelines have been passed; that is, at this age the child should already be able to control urination (over 3 or 4 years). In addition, it will first be necessary to rule out possible physical or organic causes,

1. Main characteristics

There are a number of defining features of functional enuresis:

  • Bedwetting occurs with a frequency of at least two weekly episodes over three consecutive months.
  • At the very least, it can generate clinically significant distress and discomfort. In addition to affecting social and academic development.
  • These behaviors cannot be explained by an organic cause such as illness or the administration of a drug or a diuretic substance.
  • When it appears at night, it tends to do them around 30 minutes to 3 hours after falling asleep.
  • In most cases, the child has failed to control the bladder, known as primary enuresis. However, in about 20% of cases, it is secondary enuresis due to a stressful or distressing event or situation.

2. Possible causes

If they can rule out physical problems related to bladder size or muscle weakness, as well as hereditary causes or sleep cycles. The health professional or the psychologist will then have to carry out a psychological evaluation which will dissonance from possible psychological factors or causes..

Sometimes functional enuresis is accompanied by emotional and behavioral symptoms. However, it has not yet been determined whether this is the cause or, conversely, the effect of the disorder itself.

Regarding the psychological origin of functional enuresis, case studies highlight the idea that periods of stress and anxiety, as well as trauma and psychosocial crises like the birth of a sibling or a sister, may be some of the causes of this problem.

3. Behavioral and physical symptoms

Functional enuresis can be associated with the following psychological and physical symptoms:

  • Feelings of confusion, aggression and anger
  • Refuse to sleep away from home
  • Feel ashamed
  • low self-esteem

  • Irritation in intimate areas

4. Treatment

Regarding the approach to the problem by parents and teachers, they must be vigilant at times when bedwetting occurs and, under no circumstances, reprimand or punish the child. to do it.

The most effective option is to consult a psychologist. Which, in addition to performing a psychological assessment and intervention, will teach the child techniques for learning sphincter control or alarm techniques and devices.

Functional encopresis

In the case of functional encopresis, the elimination disorder manifests itself by the voluntary or involuntary evacuation of feces. sometimes also inappropriate. In this case, the diagnosis dictates that the problem should remain present for at least three months, with the child over four years old.

1. Main characteristics

As in enuresis, functional encopresis has a number of characteristics that distinguish it:

  • It happens more during the day than at bedtime
  • In 50% of cases, it is due to poor learning of sphincter control (primary encopresis) while in the remaining 50%, it consists of a regression response to a distressing event or situation (from 8 years of age ).
  • The behavior cannot be explained by a medical illness or by the consumption of drugs or laxatives.

2. Possible causes

By eliminating the possible physical causes of encopresis, such as constipation and fecal impact, certain psychological factors can be found to cause this type of elimination disorder.

Poor learning and hygiene training, too early training or the onset of an emotional state such as difficult opposition disorder or conduct disorder are often the main causes of this disorder.

3. Physical and psychological symptoms

In addition to the problematic behavior itself, functional encopresis exhibits a series of symptoms, both physical and psychological:

  • Feelings of inconvenience and shame
  • Neuro-progressive symptoms such as attention problems, hyperactivity, impulsivity, low tolerance for frustration and incoordination.
  • Stomach and gastric disorders such as abdominal pain and constipation.
  • Urinary tract infections can develop in girls.

4. Treatment

As in bedwetting, neither parents nor teachers should pick up the little one when an unpleasant situation arises, but rather you have to speak to him in a language according to his age, not like he is a baby.

Regarding the medical and psychological approach, they will try to prevent constipation, as well as stimulate the development of good bowel habits.

Psychotherapy can help the child control and manage the emotional symptoms of this elimination disorder.

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