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EPIDEMIOLOGY
95% (+) Bowel Control by 4 y/o
99% (+) Bowel Control by 5 y/o
Absent ≥ 16 y/o
Incidence: M 6x > F
ENCOPRESIS
ETIOLOGY
Chronic Constipation
1) Painful Defecation Phobia to Pain
2) Chronic Rectal Distention Loss
Rectal Tone & Desensitization to Pressure
Overflow Encopresis
ENCOPRESIS
ETIOLOGY
Maternal Hostility
Harsh & Punitive Parent
(+) Sexual Abuse
(+) Disruptive Life Event Regressive Bvr
ENCOPRESIS
DIAGNOSIS
w/ or w/o Constipation & Overflow
Incontinence
@ least 4 Y/O
Involuntary / Intentional Defecating into
Inappropriate Places
1x/ month x 3
R/O Substance, Medical Condition
ENCOPRESIS
DIFFERENTIAL DX
Aganglionic Megacolon- Hirschsprung’s D
Faulty Nutrition, Structural Dis of Anus,
Rectum & Colon, Medicinal Adverse
Effects, Endoc, Neuro Dis
Sexual / Physical Abuse
ENCOPRESIS
TREATMENT
Medical & Psych Evaln
Medical Tx for Constipation- Lax
Psych Tx, Beh Mod, Regular Timed
Toilet Trng, Relax Tech
Supportive PsychTx, Family Educ
ENURESIS: Epidemiology
Prevalence Rates
% Age ( yrs)
82 <3
49 3
26 4
7 5
3 10
1.5 14
1 Adult
ENURESIS
ETIOLOGY
ETIOLOGY
Hinman’Syndrome – Overactive
Detrussor MM in Bladder + Habitual
Voluntary Tighten Ext Sphincter Urge to
Urinate Urge to Urinate Dim &
Bladder doesn’t Empty Enuresis @
Night
ENURESIS
DIAGNOSIS
@ least 5 y/o
Involuntary or Intentional Voiding Urine
into Clothes/ Bed
2x/ wk x 3 consecutive mos or
Cause Distress or Impairment in Funct
R/O Substance, Medical Condition
Nocturnal/ Diurnal/ Both
ENURESIS
DIFFERENTIAL DX
ENURESIS
DIAGNOSIS
ENURESIS
TREATMENT
Rx if Enuresis Impaired Social,
Family, School Funct, Bvr, Diet, Fluid
Restrict not Effective
Imipramine, Desmopressin, Reboxetine
Psychotx