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22 - Elimination disorders: enuresis and encopresis

Published online by Cambridge University Press:  06 August 2009

Alexander Von Gontard
Affiliation:
Department of Child and Adolescent Psychiatry, University of Hamburg, Germany
Christopher Gillberg
Affiliation:
Göteborgs Universitet, Sweden
Richard Harrington
Affiliation:
University of Manchester
Hans-Christoph Steinhausen
Affiliation:
Universität Zürich
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Summary

Introduction

Enuresis and encopresis are common disorders of childhood with a high spontaneous cure rate. They are therefore often considered to be ‘developmental disorders’. They are associated with high emotional distress for children and parents, as well as with increased rates of co-morbid behavioural disorders. Especially in daytime wetting, somatic symptoms such as urinary tract infections often co-exist. Therefore, a detailed assessment of both somatic and psychological aspects is essential to ensure an optimal and specific treatment.

In addition, several distinct subtypes of elimination disorders have been identified, which differ according to their aetiology, pathophysiology and clinical features.

Enuresis

Definition and classification

The main features according to both the ICD-10 and DSM-IV classification schemes are:

  • involuntary wetting at night or during daytime

  • from the age of 5 years onwards

  • after organic causes have been ruled out.

The differences between the two classifications systems regarding:

  • the duration of the wetting, which is shorter in DSM-IV (3 months) than in ICD-10 (6 months)

  • the frequency of wetting of two or more times per week or the alternative and less stringent criteria of high emotional stress according to DSM-IV; in contrast, children under 7 years need to wet two or more times per month, and those over 7 years only once a month to be considered to have enuresis according to ICD-10.

In contrast to these two official classification schemes, voluntary wetting is often a reflection of severe psychopathology and should not be termed ‘enuresis’.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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References

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