Elimination disorders

Last updated: January 23, 2023

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Elimination disorders manifest in childhood or adolescence as repeated voiding of urine (enuresis) or defecation (encopresis) that is inappropriate for the developmental age. Patients may have a history of other psychiatric disorders or of psychosocial stressors. The diagnosis is established based on enuresis occurring 2 times per week for at least 3 consecutive months and encopresis occurring once per month for at least 3 consecutive months. Management of enuresis consists of psychoeducation, behavioral training, and pharmacologic treatment with desmopressin or imipramine. Management of encopresis involves behavioral training and treatment of underlying constipation, if present. Both conditions have a good prognosis with high rates of spontaneous remission.

Treatment of enuresis is not indicated before 5 years of age, and the condition usually resolves spontaneously.

Enuresis alarm and desmopressin are considered the first-line treatment if behavioral measures are unsuccessful and both are effective for monosymptomatic enuresis.

References:[3]

  1. Baird DC, Seehusen DA, Bode DV. Enuresis in children: a case based approach. Am Fam Physician. 2014; 90 (8): p.560-8.
  2. Ramakrishnan K. Evaluation and treatment of enuresis.. Am Fam Physician. 2008; 78 (4): p.489-96.
  3. Boles RE, Roberts MC, Vernberg EM. Treating non-retentive encopresis with rewarded scheduled toilet visits. Behav Anal Pract. 2008; 1 (2): p.68-72. doi: 10.1007/BF03391730 . | Open in Read by QxMD

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