Childhood Elimination Disorders

Toilet training is an essential step in a child’s psychosocial development, allowing the child to progress toward greater independence and a sense of self-control. However, difficulties in controlling urination and defecation are quite common and can lead to social problems and a sense of shame or frustration in the child and the family. Screening for elimination disorders in primary care settings or in children being evaluated for other psychiatric conditions can be useful, as families sometimes do not bring up their concerns due to embarrassment. Elimination disorders are highly comorbid with other psychiatric conditions in children. In order to address an elimination disorder, a thorough history is needed to understand the nature of the problem. It is also necessary to consider potential medical etiologies of voiding issues. Once an accurate diagnosis is reached, behavioral approaches tend to be the mainstay of treatment for enuresis and encopresis, though medications can also play a role in many cases. This chapter will give an overview of what is currently understood in physiology, pathophysiology, and treatment of enuresis and encopresis.