Enuresis and encopresis

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Incontinence, which is common in childhood, is a physiological and / or psychological condition that distresses the child and his parents in case of Enuresis (incontinence) after 5 years of age and Encopresis (fecal incontinence) after 4 years of age. It is normal for children to experience bedwetting at night until the age of 2-3 years on average until bladder control is achieved. Since the need to go to the toilet requires sufficient muscle control, the acquisition of going to the toilet continues until the age of 4 in children. Bowel and bladder control of the child first starts with night stool control; then it ends with daytime stool control, daytime urine control and finally nighttime urine control.

DSM-V divides the bedwetting disorder into 3 types:

Involuntary incontinence occurs only at night, during sleep enuresis nocturnalis called.

Involuntary kidnapping occurs only in daytime wakefulness. enuresis diurnalis called.

Although involuntary kidnapping occurs both during nighttime sleep and during daytime wakefulness. enuresis nocturnal and diurnalis called.

enuresis It is divided into two groups as primary enuresis and secondary enuresis.

1.) Primary enuresis: It is the condition in which the child has never gained control of his bladder since infancy. Generally, 80% of children with enuresis are in this group. It is more common at night and is mostly nocturnal incontinence. Primary enuresis is mostly caused by genetic predispositions, biological and developmental factors, and inadequate and irregular toilet training by parents.

2. Secondary enuresis: Secondary enuresis is when the child starts to leak urine again after he has had a dry period between at least 6 months and 1 year. An important distinction here is that the child has gained toilet training and the problem of bedwetting begins after he achieves toilet control. This condition accounts for 20% of children with Enuresis. It is often seen between the ages of 5-8 years. Conditions that cause secondary enuresis are usually physiological and/or psychological.

Causes of Enuresis

Biological Causes:

• Presence of genetic background: Parents or close relatives having enuresis problems during childhood may cause the child to have enuresis problems. Studies have shown that parents of children with bedwetting problems also experienced this problem in their childhood.

• Hormonal Factors: While the excretion of urine from the body is higher during the day, this rate decreases 2-3 times at night. The fact that this excretion does not decrease at night in children with enuresis problems may cause children to experience bedwetting problems.
• Bladder, kidney related problems
• Developmental disorders

• Side effects of the drugs used
• The problem of not being able to wake up from deep sleep can also cause enuresis in some children.
Psycho-social Causes:

• Mother’s pregnancy or sibling jealousy

• Giving toilet training when the child is not ready or wrong toilet training attitudes. For example: Punishing the child, getting angry, shouting and being stubborn.

• Incorrect and inadequate parental attitudes: A passive response to an overly harsh, oppressive parent or an infantile attitude towards an overprotective, possessive parent.

• Negative life events experienced by the child: Intense anxiety that arises as a result of family quarrels, arguments, parental separations, beatings, violence, sibling jealousy, having a new sibling, moving, immigration, illness, death, problems at school cause enuresis. it could be.

Encopresis (fecal incontinence) is the situation in which the child makes his/her poop under or in inappropriate places even though he/she has achieved bowel control and has reached the age and maturity to hold and release his/her poop. It is the situation where the child over the age of 4 performs the act of pooping repetitively and this behavior occurs once a month for at least 3 months and is not due to a medical condition.

Encopresis It is divided into two groups as primary encopresis and secondary encopresis.

1.) Primary encopresis: It is seen when the child does not develop any control about holding his poop from infancy to 4 years old.

2.) Secondary encopresis: It is seen when the child starts to miss his poop after he has been able to control the kidnapping behavior for at least 1 year.

It is also an important point whether incontinence is related to constipation or not. If it is related to constipation, it is necessary to prevent constipation by applying a suitable nutrition program to the child with medical support. Psychological evaluation is very important if the problem is not related to constipation.

Causes of Encopresis

Biological Causes:

Intestinal disorders


• Developmental disorders
Psychosocial Causes:

• Negative life events experienced by the child: Intense anxiety that arises as a result of family quarrels, arguments, parental separations, beatings, violence, sibling jealousy, having a new sibling, moving, immigration, illness, death, problems at school cause enuresis. it could be.

The mother is very meticulous

• Toilet training is given at an age when the child is not ready, insufficient education is given, or the child is exposed to pressure during education, there are coercions.

• Wrong and inadequate parental attitudes. A passive response to an overbearing, overbearing parent or an infantile attitude to an overprotective, possessive parent.

Not being able to develop toileting skills due to attention deficit and hyperactivity disorder in the child

The child’s stubbornness as a personality form and resistance to toilet training

Ways to Prevent Enuresis and Encopresis

Providing psychological support to the child has an important place in the treatment of primary enuresis and encopresis.

First of all, you should start toilet training when your child is ready. Children between the ages of 1.5 and 2 are ready to take toilet training. The first thing that should not be done is to diaper the child, this situation causes reinforcement of the situation rather than a precaution. Inform the child about using the potty by explaining how you go to the toilet while toilet training and showing the child how to do it.

Do not punish, raise your voice, or yell for toilet accidents. Punishments are not instructive. “Do you need to go to the toilet?”, “Do you have a toilet?” Instead of saying “Check your underwear, let’s see if it’s dry” at certain intervals is more of a reminder. In this way, your child will both develop a sense of responsibility and feel the feeling that he has more control over the troubled issue. As a result, the child helps him feel grown because he feels that he can take responsibility for himself and take care of himself. If you get the answer “dry”, say a rewarding, supportive sentence to reinforce your child’s behavior such as “How nice it is to have dry underwear”. The more often you reiterate the importance of staying dry, the faster your child will realize the benefits of not wetting the bed. You can also take advantage of small rewards such as “It’s nice that the gold isn’t wet, now we can play any game you want together”, “We can read a fairy tale you like” or “We can watch a cartoon you like” when he doesn’t wet the bed.

When you ask, if the bottom is wet, you can speed up your child’s achievement of going to the toilet by repeating the toilet exercises frequently during the day with calm and soft responses. Your child does not need to pee or poop during the toilet exercises that you do during the day, the important thing is to ensure the correct toilet movements.

Pay attention to the fluid intake that your child should take during the day so that your child’s body does not become dehydrated. Try to stop fluid intake 2 hours before going to bed and take it to the toilet before going to bed. Apart from this, ask him to hold the toilet for 1 minute when he comes to the toilet during the day and give a small reward when he does. Gradually increase the time to 2 minutes, 3 minutes. This helps to increase the capacity of the urinary bladder. Ensure your child’s active participation in changing the bed linen or changing clothes in case he wets the bed.

If incontinence continues at the age of 4 years, it is defined as encopresis, if incontinence continues after the age of 5 years, it is defined as enuresis. It is very important to take a detailed history of the child before proceeding to treatment for enuresis and/or encopresis. A specialist should be consulted to investigate whether there is a physiological problem and to conduct medical examinations. In addition, psychological support from a specialist is required for a detailed examination of the underlying psychological causes of kidnapping.

Page content only for informational purposes , for diagnosis and treatment be sure to consult your doctor

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