Elimination disorders: causes, symptoms and treatment

Psychological problems in childhood often cause suffering not only in the child, but also in the parents or in the closest family around him. This psychological discomfort during childhood can manifest itself in unusual ways, this being the case of elimination disorders.

These changes related to toilet training It is usually related to experiencing feelings of discomfort and anguish. Throughout this article we will talk about the characteristics of each of them, as well as their causes, symptoms and possible treatments

What are elimination disorders?

The term elimination disorders refers to an alteration that can appear during childhood, affecting both the psychological state and behavior of the child as generating feelings of concern and anxiety in the rest of the family. Sometimes, this alteration can become so pronounced that it ends up being a source of conflict within the family nucleus.

The nature of this disorder is related to the acquisition of sphincter control. Although there are individual differences in each of the children, this control is usually reached between 18 and 36 months of age.

Among the conducts or behaviors that are included within this category are nocturnal and diurnal fecal continence and urinary continence also nocturnal and diurnal.

In the case of elimination disorders, the child does not manage to achieve this control, which usually leads to two different events: functional enuresis or uncontrolled urination, which tends to appear time after the acquisition of urinary control, it is not usually diagnosed before the age of 5 and usually occurs during sleep.

On the other hand, we find functional encopresis, which refers to the evacuation of feces at inappropriate times and situations, both voluntarily and involuntarily. In this case, the approximate age for diagnosis is 4 years.

In most cases, both alterations appear accompanied by one another; however, this does not have to be the case. In addition, each of them is accompanied by some characteristics, causes and psychological symptoms.

Despite this, In both enuresis and encopresis, the family often feels helpless and disoriented. The reason is that there is no single cause that can cause these behaviors and also the appearance of emotional symptoms on the part of the child makes the parents' concern and frustration even higher.

functional enuresis

By functional enuresis we understand the child's inability to control urination, which leads to the expulsion of urine during the night or at inappropriate times and places. This behavior usually occurs both involuntarily and voluntarily.

In order for a correct diagnosis of functional enuresis to be made, it must appear once the evolutionary guidelines have passed; that is, at that age the child should already be able to control urination (more than 3 or 4 years). In addition, it will first be necessary to rule out possible physical or organic causes,

1. Main features

There are a number of characteristics that define functional enuresis:

• Enuresis appears with a frequency of at least two weekly episodes for three consecutive months.
• It can generate clinically significant distress and discomfort in the least. As well as affect social and school development.
• These behaviors cannot be explained by an organic cause such as a disease or the administration of a drug or diuretic substance.
• When it shows up at night, it tends to show up around 30 minutes to 3 hours after falling asleep.
• In most cases the child has not managed to achieve bladder control, which is known as primary enuresis. However, in approximately 20% of cases it is secondary enuresis due to a stressful or distressing event or situation.

2. Possible causes

If physical problems related to the size of the bladder or muscle weakness, as well as hereditary causes or sleep cycles, can be ruled out. The medical professional or psychologist should then carry out a psychological evaluation that reveals possible psychological factors or causes..

Sometimes functional enuresis is accompanied by emotional symptoms and behavioral. However, it has not yet been possible to determine whether this is the cause or, on the contrary, the effect of the disorder itself.

Regarding the psychological origin of functional enuresis, the case studies point to the idea that experiencing periods of stress and anxiety, as well as experiencing traumas and psycho-social crises such as the birth of a sibling, can be some of the causes of this trouble.

3. Behavioral and physical symptoms

Functional enuresis may be associated with the following psychological and physical symptoms:

• Feelings of embarrassment, aggressiveness and anger
• Refuse to sleep away from home
• feeling of shame
• Low self-esteem
• Irritation in intimate areas

4. Treatment

Regarding the approach to the problem by parents and teachers, they must remain attentive to when bedwetting occurs and, under no circumstances, reprimand or punish the child for doing it

The most effective option is to go to a specialist in psychology. Which, in addition to carrying out an evaluation and psychological intervention, will teach the minor training techniques for sphincter control or techniques and alarm devices.

functional encopresis

In the case of functional encopresis, the elimination disorder is manifested by the evacuation, voluntary or involuntary, of feces also at inappropriate times. In this case, the diagnosis dictates that the problem must remain present for at least three months, with the child being over four years of age.

1. Main features

As in enuresis, functional encopresis has a series of characteristics that distinguish it:

• It happens more during the day than in the hours of sleep
• In 50% of cases it is due to poor learning of sphincter control (primary encopresis) while in the other 50% it consists of a regression response to a distressing event or situation (from 8 years of age).
• The behavior cannot be explained by a medical illness or by the use of medication or laxative substances.

2. Possible causes

Eliminating possible physical causes of encopresis, such as constipation and impaction fecal, you can find certain psychological factors that cause this type of disorder of elimination.

Poor learning and training in hygiene matters, training too early or the appearance of an emotional condition such as oppositional defiant disorder or a behavioral disorder, are usually the main causes of this alteration.

3. Physical and psychological symptoms

In addition to the problem behavior itself, functional encopresis presents a series of physical and psychological symptoms:

• Feelings of upset and shame
• Neurodevelopmental symptoms such as attention problems, hyperactivity, impulsivity, low tolerance for frustration and lack of coordination.
• Gastric and stomach disorders such as stomach pain and constipation.
• In girls, urinary tract infections may appear.

4. Treatment

As in bedwetting, neither parents nor teachers should reprimand the child when an unpleasant situation occurs, but rather it is necessary to speak with him in a language according to his age, not as if he were a newborn.

As for the medical and psychological approach, these will try to prevent constipation, as well as stimulate the development of correct defecation habits.

Through psychotherapy, the child can be helped to control and manage the emotional symptoms of this elimination disorder.