Elimination Disorder-Enuresis & Encopresis
Treatments
Counseling and Medication
Treatment Summary: :Not all treatment requires counseling; however, a combination of medication and behavior-modification techniques would greatly enhance the treatment for enuresis. Medications used for enuresis include, anti-depressants and desmopressin (brand name DDAVP). Limiting the amount of liquids a child consumes prior to bedtime is a behavior-modification technique.
- Reference: Fletcher, Teresa B. (Jan 2000). Primary nocturnal enuresis: A structural and strategic family systems approach. Journal of Mental Health Counseling. Vol 22, Iss 1, pg 32-45
- Submitter: William Miller
Biobehavioral Treatment
Treatment Summary: Before applying the Biobehavioraltreatment to an encopretic child the therapist should get a medical evaluation. After the medical evaluation confirms the disorder, then this method of treatment can be considered. Treatment of Encopresis targets the processes that creates or makes worse the condition, including reducing colonic motility, constipation, and fecal impaction. Parents of children suffering from Encopresis are taught to demystify the elimination process. In other words parents should show no disapproval or blame the child when he or she defecates outside the toilet. Bowel evacuation(full cleansing of bowels, usually done using a combination of enemas, suppositories, or laxatives), toileting schedule, monitoring, and providing positive feedback if the child has a bowel movement in the toilet are the stages of modality for this treatment.
- Reference: Friman, P.C., Hofstadter, K.L. & Jones, K.M. (2006).A biobehavioral approach to the treatment of functional Encopresis in children. Journal of Early & Intensive Intervention, 3(3)
- Submitter: N/A
Multi-modal treatment with bio-behavioral approach
Treatment Summary: Child is given a thorough medical exam and then treated with a stool softeners, followed by a three-phase behavioral approach. This approach has a 75-80% success rate and has a significantly higher rate of success compared to either a medical or a behavioral approach alone.
- Reference: Carney, T. & Murphy, S. (2004). The classification of soiling and Encopresis and a possible treatment protocol. Child and Adolescent Mental Health, 9 (3), 125-129.
- Submitter: Rachel Dawson
Bell and Pad Alarm
Treatment Summary: A pad with a wetness sensor is placed in the child's bed, connected to a bell that sounds at the first sign of wetness. When the bell rings, the child must then get out of bed and go to the bathroom instead of continuing to wet the bed. This method is successful in part because it associates bedwetting with the unpleasantness of being awakened and inconvenienced in the middle of the night.
- Reference: Nevius, T., Eggert, P., Evans, J., Macedo, A., Rittig, S., Tekgul, S., et al. (2010). Evaluation of and treatment for monosymptomatic enuresis: A standardization document from the international children's continence society. The Journal of urology, 183 (2), 441-447.
- Submitter: Bobbi King
Treatment pathway for elimination disorder
Treatment Summary: Determine whether the encopresis is caused by constipation. If it is determined that constipation is the primary cause of encopresis then laxatives and colon irrigation may be recommended as well as adding fiber and water to child's diet. If constipation is not the primary cause then behavioral treatment may be deemed necessary such as retraining toilet skills, strengthening of anal muscles and positive reinforcement. Treatment of enuresis can be treated by a method that was made in the 1930's which includes a bell and pad; the pad is connected to a bell or buzzer that initiates an alarm to wake the child when the child begins to wet the bed. After time the child begins to recognize when their bladder is full and wakes up and uses the restroom.
- Reference: Oswalt, A., Reiss, N., Dombeck, M. (2008). Child Development and Parenting: Early Childhood. Mental Help.net Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=14320&cn=462
- Submitter: Sherone Smith
