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

These sphincter control disorders are often related to experiencing feelings of discomfort and distress. Throughout this article we will discuss the characteristics of each of them, as well as their causes, symptoms and possible treatments

What are elimination disorders?

The concept of elimination disorders refers to an alteration that can appear during childhood, affecting both the psychological state and behaviour of the child and generating feelings of concern and anxiety in the rest of the family. Sometimes, this alteration can be 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 child, this control is usually achieved between 18 and 36 months of age.

Among the behaviours or performances that fall into this category are nocturnal and daytime faecal continence and nocturnal and daytime urinary continence.

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

On the other hand, we find functional encopresis, which refers to the evacuation of stool 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 are accompanied by one another; however, this does not have to be the case. Moreover, each of them is accompanied by some characteristic psychological features, causes and symptoms.

In spite of this, in both enuresis and encopresis, the family often feels powerless and disoriented . The reason is that there is no single cause that can provoke these behaviours and in addition the appearance of emotional symptoms on the part of the child makes the parents’ concern and frustration even greater.

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 inconvenient times and places. This behaviour usually occurs both involuntarily and voluntarily.

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

1. Main characteristics

There are a number of characteristics that define functional enuresis:

  • Enuresis occurs at a frequency of at least two weekly episodes over three months in a row.
  • It can generate clinically significant distress and discomfort at the very least. As well as affecting social and school development.
  • These behaviors cannot be explained by an organic cause such as illness or the administration of a drug or diuretic substance.
  • When it appears during the night, it tends to do so about 30 minutes to 3 hours after falling asleep.
  • In most cases the child has failed 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 bladder size or muscle weakness, as well as hereditary or sleep cycle causes, 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 and behavioral symptoms. However, it has not yet been possible to determine whether this is the cause or, on the contrary, the effect of the disorder itself.

As for the psychological origin of functional enuresis, case studies point to the idea that experiencing periods of stress and anxiety, as well as experiencing trauma and psycho-social crises such as the birth of a sibling, may be some of the causes of this problem.

3. Behavioral and physical symptoms

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

  • Feelings of distress, aggression and anger
  • Refusing to sleep over
  • Shame
  • Low self-esteem
  • Irritation in intimate areas

4. Treatment

As for the approach of the parents and teachers to the problem, they should remain attentive to the moments when enuresis occurs and, under no circumstances, reprimand or punish the child for doing so.

The most effective option is to go to a specialist in psychology. He will not only perform a psychological evaluation and intervention, but will also teach the child learning techniques of sphincter control or alarm techniques and devices.

Functional encopresis

In the case of functional encopresis, the elimination disorder manifests itself through the voluntary or involuntary evacuation of faeces 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 characteristics

As with enuresis, functional encopresis has a number of distinguishing features:

  • Occurs more during the day than during sleep
  • In 50% of the 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 stressful event or situation (from age 8).
  • The behavior cannot be explained either by a medical illness or by the use of medications or laxative substances.

2. Possible causes

By eliminating the possible physical causes of encopresis, such as constipation and fecal impaction, certain psychological factors can be found to cause this type of elimination disorder.

Poor learning and training in hygiene, training too early, or the onset of an emotional condition such as oppositional defiant disorder or conduct disorder are often the main causes of this disorder.

3. Physical and psychological symptoms

In addition to the problematic behaviour itself, functional encopresis presents a series of both physical and psychological symptoms:

  • Feelings of disturbance and shame
  • Neuro-evolutionary symptoms such as attention problems, hyperactivity, impulsivity, low frustration tolerance and lack of coordination.
  • Gastric and stomach alterations such as stomach pain and constipation
  • Urinary tract infections can occur in girls.

4. Treatment

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

As for the medical and psychological approach, they will try to achieve the prevention of constipation, as well as stimulate the development of correct habits in defecation.

Psychotherapy can help the child control and manage the emotional symptoms of this elimination disorder.