Enuresis and Encopresis

Enuresis

This is the involuntary passage of urine in absence of physical cause from 5 years. The types of it are Nocturnal (bedwetting), Diurnal, Primary, and Secondary.

In Secondary nocturnal type, the child begins wetting the bed when they’ve previously been dry for 6+ months. The causes of this are UTI, Constipation, T1DM, Abuse.

The first things to do in managing these patients are to:

• Explain the cause – Not the child’s fault. Bladder just gets so full that it can’t hold it in anymore

• Reassure the parents – Very common in those under 5 years, and usually resolves over time

• Explain the progression – They develop an increased bladder capacity, produce less urine at night, and learn to wake to the sensation of a full bladder

Management

1st line - Nocturesis Alarm (detects water in the underwear and activates an alarm, which alerts the child that they need to go to the bathroom) - generally very effective

Other options:

• Behavioural approaches – Diaries, Reward chart

• Desmopressin (ADH to reduce urine production) can be given if failed or rapid control is needed

Encopresis

This is the where there's repeated and involuntary passing of stool into clothing i.e. soiling.

The most common cause of it is Chronic constipation, which leads to faecal impaction with overflow. Other causes include Developmental delay, Normal constipation, Anxiety, and Abuse.

Management - Treat constipation, reward toileting rather than cleanliness, Safeguarding if appropriate