Functional encopresis is defined as repeated involuntary fecal soiling in the . For patients who have both encopresis and daytime enuresis, it is important to .. Actividad enzimática del contenido duodenal en niños con desnutrición de tercer . del desarrollo y del comportamiento de los niños y los adolescentes. la enuresis (orinarse en la cama) y la encopresis (incontinencia de. Trastornos de la eliminación: Enuresis y encopresis.

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Children are considered as enuretic if they; fail to develop control over urination by an age at which it is usually acquired by most children or. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. Collect Leads new Upload Login. Loading SlideShow in 5 Seconds.

Enuresis and Encopresis PowerPoint Presentation.

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Email Presentation to Friend. By eileen Follow User. Description Statistics Report Eliminative Disorders: Download Presentation Eliminative Disorders: Enuresis and Eniresis James H. Enuresis Children are considered as enuretic if they; fail to develop control over urination by an age at which it is usually acquired by most children or if they revert to wetting the bed or clothing after initially for at least 6 months developing control over micturition.

Daytime control is typically accomplished by the age of 3 or 4. Nighttime control is typically present by four of five years. Some Statistics on Enuresis An estimated 5 million to 7 million children in the United States have primary nocturnal enuresis wetting at night. About 80 percent of children eenuresis enuresis wet the bed only at night. The behavior is manifested by; a frequency of twice a week for 3 consecutive months nils frequency can be less given the presence of clinically significant distress or impairment in social, academic occupationalor other important areas of functioning.

Chronological age is at least 5 years.

Full text of “West Virginia Medical Journal”

The behavior is not due to the direct effect of a substance or a general medical condition. Some Definitions The disorder may be of either the primary or secondary type.

Primary enuresis refers to cases where the child has never developed control. Secondary enuresis refers to instances where the child has, at some time, developed control over wetting for at least 6 months but has subsequently resumed wetting. The higher incidence of enuresis in children whose parents were enuretic has also highlighted possible genetic factors. In families where both parents have a history of enuresis, 77 percent of children will have enuresis.

In families where one parent has had enuresis, 44 percent of children will be affected; Only about 15 percent of children will have enuresis if neither parent was enuretic.

Genetics Heredity as a causative factor of primary nocturnal enuresis has also been strongly suggested by the identification of a genetic marker associated with the disorder. In one study, Danish researchers evaluated 11 families with primary nocturnal enuresis.

The trait showed nearly complete penetrance in these families. This seems to suggest the existence of a major dominant gene for primary nocturnal enuresis. While this gene appears to be located on chromosome 13, no specific locus dncopresis this chromosome euresis yet been identified.

This would make it more difficult for them to awaken to cues associated with a full bladder while asleep. Most other studies have not supported this finding and demonstrate no consistent correlation between abnormal sleep patterns, enuresia stage of sleep and bed-wetting.

Some have documented more difficulty in waking. Enuresis and Upper Airway Obstruction Nocturnal enuresis has, in some cases, also been associated with upper airway necopresis in children.

In these instances, surgical relief of the obstruction by tonsillectomy, adenoidectomy or both has nkos reported to diminish nocturnal enuresis in up to 76 percent of patients who display this condition.

Immaturity in motor and language development has also been implicated although the specific encopresia have not been determined. Enuresis and Anatomic Factors In cases of primary niow, anatomic abnormalities are not usually found. Findings from some studies, however, have suggested that functional bladder capacity may be reduced in patients with nocturnal enuresis.


These findings have been disputed by other research which have not found abnormalities in bladder function or size when only nocturnal enuresis cases were considered.

While some parents report a small bladder capacity in children with enuresis, this condition usually is accompanied by daytime symptoms. Secretion of Antidiuretic Hormone It has been found that humans show both diurnal and nocturnal variations in the secretion of antidiuretic hormone, when assessed over a hour period. Normal increases in the secretion of antidiuretic hormone are typically found in response to extended periods of sleep.

During this period, the bladder nuos not empty. Secretion of Antidiuretic Hormone In normal children who sleep between 8 – 12 hours per night, the increase in the secretion of anti-diuretic hormone ADH concentrates and reduces the volume of urine produced by the kidneys, thus decreasing the amount of urine stored by the bladder. There is wn evidence that children with nocturnal enuresis may have a deficiency in ADH and thus excrete significantly higher volumes of urine during sleep than children without enuresis.

This suggests that abnormal e. Other Possible Etiological Factors: Dynamic and Behavioral Factors Dynamically oriented clinicians have argued that enuresis results from underlying psychological conflict. Encopreesis available evidence would, however, seem to suggest that the majority of enuretic children show no signs of significant emotional problems When psychological problems nnios present these may often be secondary to the enuresis rather than causal.

Behavioral regression due to stress envopresis, abuse, school trauma, hospitalization does seem to be involved in many cases of secondary enuresis. Neglect can also contribute to primary enuresis. Etiology Behaviorally oriented psychologists have emphasized faulty learning experiences perhaps compounded by stressful approaches to toilet training in the development of enuresis.

While behavioral approaches to treatment have been shown to be quite effective, behavioral causes of enuresis have not been well documented. Despite research related to a range of possible etiological factors, findings have often been conflicting and have failed to provide clear information regarding the specific causes of enuresis.

Treatment of Enuresis The most widely used treatment methods involve the use of drugs, conditioning approaches, and psychodynamic psychotherapy. Historically, the drug most commonly used with enuretics has been Tofranil Imipramine which is a tricyclic antidepressant. Biological Treatments Another drug, desmopressin DDAVPwhich is a synthetic antidiuretic hormone – administered in the form of a nasal spray – is being increasingly used to treat enuresis.

In many clinical settings it seems to have become the pharmacological treatment of choice. While becoming increasingly popular, available research suggest effects not unlike Tofranil. Despite the high probability of relapse, it has been suggested that desmopression is fast acting and may have fewer side effects than Tofranil.

It may be a useful treatment for older children who do not respond well to other treatments or who simply wish to decrease the probability of wetting the bed while sleeping away from home for the night. Conditioning Treatments The most common behavioral treatment is the bell and pad approach. The rationale for this approach is that if the bell, which results in the child waking up, can be paired over time with the sensations associated with a distended bladder, the child due to classical conditioning will come to awaken and inhibit urination in response to these sensations.

Bell and Pad Treatment The bell and pad method has been found to be quite effective in dealing with bed wetting, with success rates of from 70 to 90 percent being reported. Here, the child is reinforced for inhibiting urination for longer and longer periods of time.

Although there is research suggesting that this approach is less effective than the bell and pad with bed wetting, it may be useful with daytime enuresis Doleys, Sometimes use in combination with the Bell and Pad — Case Example.


This is an intense training program that includes a number of elements; nighttime awakening, positive practice in appropriate toileting e. Other Behavioral Approaches These procedures are combined in an intensive treatment package, carried out in one evening, with maintenance procedures being employed until the child has 14 dry nights. This, along with some findings that treatment is sometimes not successful without the simultaneous use of an alarm apparatus, has led some to question whether this approach is indeed preferable to the bell and pad.

Modeling — A case example. Effectiveness of Traditional Psychotherapy Some attempts have been made to assess the effectiveness of traditional psychotherapy in enuresis.

Improvement rates of Such results clearly question the effectiveness of psychotherapy in treating most cases of enuresis. Encopresis Encopresis involves soiling, which occurs past the age where control over defecation is expected.

Enuresis y encopresis en adolescente de 12 años.

The conditions occurs in somewhere between 1. Boys are 6 times more likely to have this condition than girls Brown, et al. At least one event a month for at least 3 months.

Chronological age is at least 4 years. The behavior is not due exclusively to the direct physiological effects of a substance or a general medical condition except through a mechanism involving constipation. Forms of Encopresis As with enuresis, encopresis can take various forms. The most common distinctions in addition to those in DSM IVare Between the continuous enn analogous to primary enuresis where the child has never become toilet trained, and The discontinuous type analogous to secondary enuresis where the child has initially been toilet trained and has subsequently become incontinent.

Historically, it has been suggested that continuous encopresis is associated with a lax approach to toilet training. The assumption here, is that the overly casual approach to toileting may result in the child failing to learn appropriate toileting skills as well as having little motivation to be trained. Contributors to Encopresis The discontinuous type has been seen as more likely a result of rigid and stress inducing approaches to training.

It has been suggested that coercive approaches may result in the child developing excessive anxiety over toileting, fears of the toilet, and conflicts with parents over toileting. It is noteworthy that such harsh approaches may result in a child attempting to withhold feces to avoid punishmentwhich might lead to constipation which often precedes the development of encopresis.

The Role of Constipation Encopresis is sn problem that children can develop due to chronic constipation. With constipation, children have fewer bowel movements, and the bowel movements they do encopresos are often hard, dry, difficult to pass and painful.

Soiling may occur as the anal sphincter the muscle at the end of the digestive tract loses its strength and feces usually in liquid form leaks around the impacted stool and is gradually expelled without the child’s awareness.

Such factors may contribute to encopresis without any other physiological disorder to account for soiling. Assessment for Encopresis In all cases it is necessary for the child to have a thorough physical work up to rule out physical factors.

Assessment The assessment may involve not only a physical examination but also lab tests. Abdominal x-rays to evaluate the amount of stool in the large intestine Barium enemas to test for intestinal obstruction, strictures narrow areas of the intestineand other abnormalities. Treatment of Encopresis In the case of children with impaction, the initial stage of treatment involves attempts to remove the impacted stool. This is usually accomplished through the use of enemas, prescribed by the physician.

This is to prevent a recurrence of the impaction. The physician may also make recommendations regarding diet e. Treatment of Encopresis — Cont. While a variety of treatment approaches have been employed with encopresis, behavioral methods appear to have the greatest success.