Children normally develop bladder and bowel control by the age of 5. Controlled toileting is a developmental milestone that happens step by step. Babies are born incontinent. They slowly develop control of their bowels at night and during the day, then gradually acquire daytime and night-time bladder continence. Most children can control their bladder and bowel by age 4–5, but some take longer to do so. Five years old is considered the cut-off age for diagnosing encopresis (faecal soiling) and enuresis (wetting).
Encopresis and enuresis are the primary toileting difficulties in childhood. These issues can affect the social and educational development of children, who can be isolated at school, excluded from peers, and face conflict with parents and teachers. They can lead the child to experience low self-esteem, poor academic achievement, and secondary social, emotional, or behavioural issues.
According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) children who do not achieve toilet training by age 5 and have repeated bed or clothes wetting twice per week for 3 consecutive months, meet the criteria for enuresis (307.6); specified if: 1. nocturnal only; 2. diurnal only; and 3. nocturnal and diurnal. If the child involuntarily and repeatedly passes faeces in inappropriate places (usually undergarments) the criteria for encopresis (307.7) is met; specified if: 1. with constipation and overflow incontinence; 2. without constipation and overflow incontinence.
According to the International Statistical Classification of Diseases and Related Health Problems 2010 Edition (ICD-10; WHO, 2011), children can experience involuntary rejecting of urine, day and night, which is usually not expected considering the child's mental age, and is not a result of a lack of bladder control due to neurological disorder, epilepsy, or unusual abnormality of the urinary tract. This type of toileting issue is known as nonorganic enuresis (F98.0). The child's enuresis may be present from birth or it may have developed after bladder control. The enuresis could be associated with emotional or behavioural difficulties.
The child may experience repeated, voluntary, or involuntary passing of faeces, usually of normal consistency, in places that are not deemed appropriate in the child's sociocultural setting. In the ICD-10 this is known as nonorganic encopresis (F98.1).