Elimination Disorders

It is not uncommon for children to urinate in their clothes. However, some continue to urinate or defecate at inappropriate places in their clothes even when they have undergone toilet training. In many cases, even children in their pre-teens or adolescence wet their pants. It becomes an awkward situation for them when this happens. Often children who pass urine or stools in their clothes are bullied at school. This leads to a lot of embarrassment and stress in children. However, unstoppable happening of such thing leads to elimination disorders.

What are Elimination Disorders?

Elimination disorders are found in children past the age where soiling the pants or urinating in them are a common occurrence. The American Psychological Association subdivides elimination disorders into Enuresis and Encopresis.

Enuresis, often known as bedwetting, is an elimination problem that causes urine to escape into objects such as clothes, bedding, or other improper locations. In encopresis, a person has bowel movements at inappropriate places. This occurs when the person is past the age of not being able to control their bowel movements.

Enuresis: Most elimination disorders occur in children. In the case of enuresis, children are unable to hold their urine. This results in bedwetting. Due to the inability to control the urine, the children let it pass through at inappropriate places. This condition may occur in two forms:

  • Nocturnal: Bedwetting or release of urine occurs at nighttime when the child is asleep

  • Diurnal: Urine is released in the daytime when the child is awake.

  • Combined nocturnal and diurnal: A combination of the above subtypes.

Encopresis: This occurs in children. It refers to a condition when a child passes stools in their clothes. It happens at improper places in the clothes themselves. Encopresis typically occurs throughout the day. Both children who have received toilet training and those who have not, may exhibit this issue. This condition can be further divided into types.

  • Constipation-related encopresis: Here, constipation makes it difficult and uncomfortable to pass stool. In addition to making it harder to release the feces, this pain can keep a child from using the restroom. Colon nerves may become fragile due to the strain from being unable to pass the stools.

  • Overflow incontinence: Overflow happens when a child soils their clothes or other unsuitable items without exhibiting constipation symptoms. This child will have the urge to pass stools in inappropriate locations or at inappropriate times.

Diagnostic Criteria

It includes:

  • Repeated wetting of bed or clothes. This behavior can be intentional or involuntary.

  • Occurs at least two times a week for three consecutive months. Occurs in inappropriate situations where the release of urine can be socially awkward. This includes schools, playgrounds, or family gatherings.

  • The age of the child is five years or above.

  • The behavior is not caused by the use of substances or other conditions such as diabetes.

Symptoms of elimination disorders

The following are some most prevalent symptoms found in children suffering from elimination disorder:

Enuresis Encopresis
Bedwetting, letting go of urine in clothes despite repeated toilet training. Release of stools or the liquid matter in the clothes.
Continued bedwetting for two weeks in a consecutive fashion. This pattern continues for three consecutive months. Straining while excreting, constipation, dry hard stools.
In secondary enuresis, there is a period of dryness for about six months before a fresh episode of bedwetting. Avoid the use of the toilet, and hold the bowel movements for longer periods.

Causes of elimination disorders

Primary enuresis is caused by physical factors such as when the child has not developed bladder control or other underlying conditions such as deformation problems in the urinary system or a developmental delay. Hormonal imbalance can also lead to problems in urinary bladder control. Since primary enuresis frequently runs in families, it appears to have a hereditary component. Primary enuresis can also result from psychological factors like unstable families or inconsistent toilet training.

The child has established good bladder control in secondary enuresis and starts wetting the clothes again. Involuntary enuresis is caused by psychological factors such as the inability to adjust to a transition, repressed fear, or having a new sibling in the house. Voluntary enuresis, although uncommon, is caused by conditions such as a conduct disorder. Chronic constipation is often the cause of medical encopresis. The big intestine's lining becomes stretched out when hard feces accumulate there. Because of this, the liquid matter of the stool starts leaking out and stains the clothes.

Psychological causes of soiling are attributed to poor toilet training or fear of the toilet. Additionally, strict toilet regimes in childhood can lead to encopresis in children. Encopresis leads to a great amount of shame in children. Staining clothes often leads to embarrassment in public places, and peers often bully child who faces this. Children who display this behavior often have psychological problems such as conduct disorder or oppositional defiance disorder.


The severity of the symptoms, outcomes, and prognosis of elimination disorder varies from child to child. Additionally, if the causes are psychological, elimination disorders are self-limiting. As children enter late childhood and early adolescence, they learn to control enuresis or encopresis. Physiological causes are difficult to treat if the child has difficulty controlling the bowel muscles or relaxing the sphincter muscles.

Treatment Methods

Various behavioral interventions using the principles of classical and operant conditioning are used to enforce healthy elimination behaviors. Therapists widely use behavior therapy to treat children, and here are some commonly used methods for treating elimination disorders.

  • Behavior modification: There are several behavior modification methods.

    • Alarm method: An alarm-enabled sleeping pad is the most common method to train children with elimination disorders. In this system, the alarm rings as soon as the pad becomes wet, waking up the child facing nighttime elimination problems.

    • Dry-bed method: Positive reinforcement is given to children whenever the bed is dry. This reinforcement is intermittent and is often combined with the alarm method and psychotherapy.

    • Scheduling method: This involves taking care of the diet and sleep schedules of the child. Fluid intake is controlled before bedtime. In case of encopresis, if fiber-rich food is given to children with incontinence, flow and fluid intake are increased for children having constipation. Additionally, a child is awake for a few days to urinate. This should be practiced carefully as frequently waking up the child can cause sleep problems.

  • Psychotherapy is provided to children who feel ashamed due to frequent soiling of pants or bed wetting. Stress-related enuresis or encopresis are treated using stress-relief measures in counseling.

  • Pharmacological interventions are used to treat children with constipation. For instance, lubricants are given to children with problems pushing down the fecal matter.


Elimination disorders are very common in children—this greatly alarms parents and caregivers. In addition to this, these disorders cause discomfort and embarrassment to both caregivers as well as children. There are several physiological and psychological causes behind these disorders. The need of the hour is to understand them and provide effective treatment to children at the right time. If the treatment is delayed, it can lead to feelings of shame which eventually causes low self-esteem among children. Voluntary enuresis also needs to be looked into as signs of conduct disorder and oppositional defiance disorder in children. Involuntary enuresis and encopresis can be effectively treated with suitable routines or treatments. Consideration should be given to expert advice to ensure that kids are getting the care they need.


Simply Easy Learning

Updated on: 13-Oct-2022


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