Toileting issues involve the inappropriate elimination of urine or feces. The repeated voiding of urine into inappropriate places is called enuresis and the repeated passage of feces in inappropriate places such as clothing or the floor is called encopresis. Generally these difficulties occur separately, but co-occurrence can occur. Most children toilet train by 5 years of age for appropriate urinating and have few difficulties with bedwetting or nighttime accidents. However, in some children, involuntary urination persists and can result in the child feeling embarrassed and ashamed while their parents may be frustrated and angry with continual need to change bed sheets and pajamas. In the majority of cases, bedwetting may be a part of normal development. The prevalence of enuresis is 5 to 10% among 5 year olds, 3 to 5% among 10 year olds and around 1% among individuals 15 years and older.
Generally, most children have toilet trained by 4 years of age for feces. After this, encopresis is distressing when the child continues to pass feces in places other than the toilet. For some children, it is involuntary, whereas for others, it can be quite intentional. Some children resist having bowel movements, causing impacted stools to collect in the colon and rectum. When a child’s colon is full of impacted stool, liquid stool leaks out of the body, staining the child’s underwear. In some cases, encopresis is a symptom of chronic constipation. Again, encopresis is fairly common and affects probably 1 to 2% of children under the age of 10. It is 6 times more common in boys than girls, with no clear reason for the gender disparity.
If you believe your child has a toileting issue, consult the child’s pediatrician first. Medical assessment is necessary to ensure that there is no physiological issue that is contributing to the diagnosis of enuresis or encopresis. If other help is needed, Silber Psychological Services offers treatment programs that help identify and treat both enuresis and encopresis. We also address any social and emotional issues and the impact the lack of toileting appropriately is having on the entire family. Our child psychologists will work with both the child and the parents to address the problematic toileting behaviors with positive behavioral strategies and lifestyle changes to overcome the toileting problems. Our clinicians at Silber Psychological Services will utilize the most effective techniques to avoid relapse and bring about a positive outcome.