During the past two years i`ve been working with children (3-12 years old). Two of the most common disorders i´ve come across are enuresis and encopresis disorders. Among all the cases i had, none of them were the result of bad training habits (primary enuresis/encopresis). All of them had a psychological correlation (secondary enuresis/encopresis).
These disorders account for 1.5% of the western world. Its incidence vary according to gender (boys are more prone), social stratus (statistically lower classes are more prone) and environment.
The population i worked with had no social security coverage, where mainly from lower social statuses and living in precarious conditions. But all of this is not a precondition for these disorders.
So, what if your child is suffering from either of these disorders?
First you have to take into account some points:
- Have they suffered a recent breakup between their parents?
- Is one of them absent from home during long periods?
- Does he/she witness domestic violence scenes?
- Is he stressed?
- Does he/she have problems adjusting to school/kindergarden?
If the answer is yes to any of these situations, then it´s probable that the cause could reside there.
Then, what to do?
First of all consult a physician to discard any neurological or physical problem. If there are not, then go pay a visit to your friendly neighbor Spiderman… sorry, the shrink. Nowadays there are several ways to quickly cope with this problem. My second advise would be for the kid to start a short therapy (not only focused on the encopresis/enuresis disorder) because whereas the symptom can be removed quickly, the underlying reason (its cause of existence, the ‘meaning’ of it) lies somewhere else in the person´s life history. The goal here is to remove the root where the symptom is anchored, to create a causeway for it to express in a less pathological way. Ergo, through words. Sometimes what cannot be said with the voice is spoken by the body in its own terms.
Tags: encopresis, enuresis, treatment, causes
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{ 9 comments… read them below or add one }
Your blog is interesting!
Keep up the good work!
Your blog is interesting!
Keep up the good work!
What I gathered from your statement is that enuresis and encopresis are the result of either 1) bad training habits (primary) or 2) some sort of psychological cause (secondary). This does not fit with either the literature or my clinical experience (25+) years.
Primary enuresis (in which the child has never obtained bladder control during the night) is by far most often a symptom related to a sleep condition in which the child falls into such a deep state of sleep that their sphincters relax and they void their bladder. The two primary medical treatments over the last several decades have been either a low dosage of tofranil, a tri-cyclic antidepressant which appears to interrupt the sleep cycle or DDAVP, an antidiuretic hormone which causes the child to retain fluid during the night. The behavioral treatment which has shown the most effectiveness is a “bell and pad” which uses classical conditioning to train the child to awaken before voiding.
Secondary enuresis, a conditon in which the child has attained bladder control for a period of time and is no longer exercising it. If bladder control is being maintained during the day but not at night, I would consider it to be a psychological symptom of stress and would look for the causes of that stress and address those. If it is an acute onset of daytime enuresis, I would consider it to be a symptom of difficulty resisting distraction, a characteristic of ADHD. In other words, the child is too busy and too distracted to notice his physical cues and waits too long to make it to a toilet in time.
Primary and secondary encopresis are successfully treated the same way. With all medical conditions having been ruled out, the treatment is incredibly simple. At approximately the same time every day, usually dinner, the child is fed a warm meal. The warm food stimulates the bowel. 15 minutes after eating the child is to sit on the toilet for 15 minutes. If they have not had a bowel movement in that time they are given a suppository to produce a bowel movement. They are praised for the bowel movement which ever way it occurs. The next day the same thing happens. Within a week the child will be having regular bowel movements at the same time every day. If they have a regular bowel movement, there will be no leakage or accidental bowel movements. The only difficulty in maintaining the regular bowel movements is for the family to develop enough routine in their lives that the child can have the opportunity to have a bowel movement at the same time every day. As with the diurnal enuretic kids, these encopretic kids most often are highly distractible and do not recognize the cues than they need to attend to their bodily functions and wait until it is too late to manage them appropriately. Some of these kids also have significant psychological issues, many do not. But my experience is that the enuresis and encopresis can be addressed successfully without manufacturing some deep psychological conflict. I have had a higher level of success in treating secondary encopresis than any other problem, 100% success to date. Thanks is due to Logan Wright and Eugene Walker and their 1977 publication “Treatment of the Child with Psychogenic Encopresis”. Clinical Pediatrics, Vol. 16, No. 11.
What I gathered from your statement is that enuresis and encopresis are the result of either 1) bad training habits (primary) or 2) some sort of psychological cause (secondary). This does not fit with either the literature or my clinical experience (25+) years.
Primary enuresis (in which the child has never obtained bladder control during the night) is by far most often a symptom related to a sleep condition in which the child falls into such a deep state of sleep that their sphincters relax and they void their bladder. The two primary medical treatments over the last several decades have been either a low dosage of tofranil, a tri-cyclic antidepressant which appears to interrupt the sleep cycle or DDAVP, an antidiuretic hormone which causes the child to retain fluid during the night. The behavioral treatment which has shown the most effectiveness is a “bell and pad” which uses classical conditioning to train the child to awaken before voiding.
Secondary enuresis, a conditon in which the child has attained bladder control for a period of time and is no longer exercising it. If bladder control is being maintained during the day but not at night, I would consider it to be a psychological symptom of stress and would look for the causes of that stress and address those. If it is an acute onset of daytime enuresis, I would consider it to be a symptom of difficulty resisting distraction, a characteristic of ADHD. In other words, the child is too busy and too distracted to notice his physical cues and waits too long to make it to a toilet in time.
Primary and secondary encopresis are successfully treated the same way. With all medical conditions having been ruled out, the treatment is incredibly simple. At approximately the same time every day, usually dinner, the child is fed a warm meal. The warm food stimulates the bowel. 15 minutes after eating the child is to sit on the toilet for 15 minutes. If they have not had a bowel movement in that time they are given a suppository to produce a bowel movement. They are praised for the bowel movement which ever way it occurs. The next day the same thing happens. Within a week the child will be having regular bowel movements at the same time every day. If they have a regular bowel movement, there will be no leakage or accidental bowel movements. The only difficulty in maintaining the regular bowel movements is for the family to develop enough routine in their lives that the child can have the opportunity to have a bowel movement at the same time every day. As with the diurnal enuretic kids, these encopretic kids most often are highly distractible and do not recognize the cues than they need to attend to their bodily functions and wait until it is too late to manage them appropriately. Some of these kids also have significant psychological issues, many do not. But my experience is that the enuresis and encopresis can be addressed successfully without manufacturing some deep psychological conflict. I have had a higher level of success in treating secondary encopresis than any other problem, 100% success to date. Thanks is due to Logan Wright and Eugene Walker and their 1977 publication “Treatment of the Child with Psychogenic Encopresis”. Clinical Pediatrics, Vol. 16, No. 11.
Twitter: ftarnogol
September 30, 2009 at 5:10 pm
Hi Richard, thank you for your extensive feedback.
The post did not address the primary type, thus your elaboration on it is mostly appreciated
With regards to the secondary type, as I wrote and in line with your remarks, it can be treated within a short period of time with high effectiveness.
My point is that secondary enuresis is one of many symptoms in a more complex constellation of psychological issues. Granted that enuresis/encopresis can be easily treated, but the underlying reasons for it will still prevail if not addressed.
Symptoms have the characteristic of sliding into other manifestations if a “patch solution” is implemented. We’ll solve the enuresis but something else will show up.
I do not disagree with focused therapies (which I think are great “instant” relievers of psychological suffering) and I also believe that they should be complemented with a more holistic approach.
If the kid lives in a dysfunctional environment (which also complicates commitment with the treatment from the parents/guardians) the causes that triggered that symptomatology will still operate and will continue triggering more problems. That’s why I encourage treating those factors also, instead of just the enuresis/encopresis.
In some cases, digging deep into the family issues or the issues the child is having is something uncomfortable (sometimes inconvenient to talk about) either for families or the children themselves, but that shouldn’t stop us from providing a solution that englobes not just the reason why that kid arrived to your office but the individual and its environment as a whole.
Thanks again for discussing the post
Fernando
Twitter: ftarnogol
September 30, 2009 at 5:10 pm
Hi Richard, thank you for your extensive feedback.
The post did not address the primary type, thus your elaboration on it is mostly appreciated
With regards to the secondary type, as I wrote and in line with your remarks, it can be treated within a short period of time with high effectiveness.
My point is that secondary enuresis is one of many symptoms in a more complex constellation of psychological issues. Granted that enuresis/encopresis can be easily treated, but the underlying reasons for it will still prevail if not addressed.
Symptoms have the characteristic of sliding into other manifestations if a “patch solution” is implemented. We’ll solve the enuresis but something else will show up.
I do not disagree with focused therapies (which I think are great “instant” relievers of psychological suffering) and I also believe that they should be complemented with a more holistic approach.
If the kid lives in a dysfunctional environment (which also complicates commitment with the treatment from the parents/guardians) the causes that triggered that symptomatology will still operate and will continue triggering more problems. That’s why I encourage treating those factors also, instead of just the enuresis/encopresis.
In some cases, digging deep into the family issues or the issues the child is having is something uncomfortable (sometimes inconvenient to talk about) either for families or the children themselves, but that shouldn’t stop us from providing a solution that englobes not just the reason why that kid arrived to your office but the individual and its environment as a whole.
Thanks again for discussing the post
Fernando
Have you ever thought about writing an ebook or guest authoring on other sites? I have a blog centered on the same subjects you discuss and would love to have you share some stories/information. I know my visitors would enjoy your work. If you’re even remotely interested, feel free to shoot me an e mail.
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Hi just wanted to give you a quick heads up and let you know a few of the pictures aren’t loading properly. I’m not sure why but I think its a linking issue. I’ve tried it in two different internet browsers and both show the same outcome.
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January 2, 2012 at 11:28 am
Hey Sueann,
Thank you for the heads up. Yeah, when we got hacked last week we had to restore the blog from the ground up and many files were lost, including pics. We are still working to get everything back to normal but I’m afraid it’s gonna take time
Happy New Year!
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