What Are Elimination Disorders?

Elimination disorders occur when children relieve themselves in inappropriate places, after a certain age. Read on to learn about this condition.

January 17, 2025 · 7 min · 1491 words · Shelby Williams

Table of Contents

Table of ContentsView AllTable of ContentsWhat Are Elimination Disorders?TypesSymptomsDiagnosisCausesTreatment

Table of ContentsView All

View All

Table of Contents

What Are Elimination Disorders?

Types

Symptoms

Diagnosis

Causes

Treatment

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Elimination disorders are present in children that urinate or defecate in places other than the toilet. Children with these disorders are usually past the age where such acts are common behavior. This condition is diagnosed in children between the ages of 7 and 12.

Elimination disorders primarily fall underenuresis, where urine is passed outside the toilet.Alternately,encopresisis the passage of feces in unsuitable locations away from the toilet.In other cases, it is possible to experience both disorders at the same time.

This guide will examine the two main types of elimination disorders, common characteristics of this condition, and the factors responsible for the disorders. To help with overcoming elimination disorders, we’ll examine possible treatment methods to encourage normal waste disposal.

Types of Elimination Disorders

Elimination disorders are broadly categorized into enuresis andencopresis.

Enuresis

This disorder is more commonly known as bedwetting. Children with this condition are unable to control their urine. This usually results in frequent or irregular release on their beds or elsewhere.

In households made up of young children, especially boys—enuresis is a common occurrence. Around 20% of five-year-olds live with this condition. This number goes down to 5%-10% in seven-year-olds. Bedwetting is however more common in the latter age group.

Enuresis may occur in two forms:

Despite taking place during waking hours, diurnal enuresis is involuntary. A child may pass urine where they feel an increased urge to pee.

Other times, this urination is the result of pressure on the abdomen. When children delay urination while in public spaces, this may worsen their chances of involuntary expulsion. Unplanned urination may also take place when laughing.

Encopresis

This condition may be voluntary or involuntary, and is a common occurrence in male children.

About 4.1% of children between five to six years of age will defecate in unsuitable locations. In 11- to 12-year-olds, this number drops to 1.6%.

Encopresis usually takes place in daytime. This condition may be observed in children that have received, and those that are lacking toilet training.

The disorder is observed in two forms:

Symptoms of Elimination Disorders

There are notable characteristics of elimination disorders. In either case, the following distinguishing traits are present:

Diagnosis of Elimination Disorders

Here is how enuresis and encopresis are diagnosed.

To confirm a case of enuresis, other similar disorders should be ruled out. This includes medical conditions such as a UTI, diabetes,seizures, sickle cell, or asleep disorder.

Likewise, bedwetting could be medication-induced, and not the result of enuresis. SSRIs, antipsychotics, and diuretics may cause incontinence.

When making an encopresis diagnosis, the pediatrician may ask about the child’s history of strained bowel movements. This questioning can also require answers about toilet training and diet.

An accurate encopresis diagnosis may also require a rectal examination. The doctor could require an x-ray of the child’s abdomen in deciding a diagnosis.

To determine whether encopresis is present, conditions like spinal cord trauma/tumors, cerebral palsy, and diseases of the pelvic muscle and anal sphincter should be assessed.

Causes of Elimination Disorders

Let’s take a look a some of the causes behind these two elimination disorders.

There is no precise cause of enuresis. Different factors are however linked to bedwetting, or passing urine in inappropriate places.

For instance, constipation may increase pressure on the bladder, leading to an increased urge to urinate.Deep sleepers who are not easily aroused may also be at higher risk of enuresis.

Where the bladder suffers a delay in maturity, this can affect its capacity to hold urine. Likewise, levels of vasopressin—a hormone that promotes water retention in the kidneys—may decrease. This can impact the chances of holding urine in.

Certain risk factors also increase the chances of enuresis. These include unusual stress in children, growing up in a low socioeconomic environment, divorced parents, the addition of a sibling, or a family history of enuresis.

This condition may result from constipation. A low-fiber diet and poor hydration. Even stress over potty training can contribute to this condition.

Risk factors of encopresis include a low socioeconomic background, fear of using unhygienic toilets, living in a war-torn area, or child hospitalization for another condition. Other contributing factors are bullying and behavioral problems like depression or social anxiety. Poor performance in school could also be a factor.

Treatment of Elimination Disorders

Here are the ways in which these two elimination disorders may be treated:

Enuresis Treatment

There are non-pharmaceutical and pharmaceutical measures available for managing this condition.

Non-Pharmaceutical Management of Enuresis

Pharmaceutical Management of Enuresis

Children may be given anti-diuretic hormones (ADH) like desmopressin to manage urine production. Other options include imipramine—a tricyclic antidepressant that helps to relax the bladder, preventing enuretic episodes.

It should be noted that pharmaceutical measures produce higher relapse rates compared to the bell and pad method.

Encopresis Treatment

To manage this condition, a pediatrician may give the affected child a laxative, an enema, or medication to soften the stool.

To avoid constipation, parents can encourage a healthy diet high in fiber. Children should also drink more water to alleviate constipation.

A Word From Verywell

Elimination disorders are a common occurrence in children. But that doesn’t prevent them from being a worry to caregivers and wards alike. With the right habits or interventions, enuresis and encopresis can be properly managed in children. To ensure children are receiving appropriate care, expert opinion should be considered.

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Law S, Malady M, Buqo T, Williams L.Elimination Disorders.Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings. 2018:193-201. doi:10.1007/978-3-319-70539-2_17Wilson M, Gupta V.Enuresis. [Updated 2021 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Yilanli M, Gokarakonda SB.Encopresis. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Von Gontard A, Hollmann E.Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations.J Urol. 2004;171(6 Pt 2):2644-2647. doi:10.1097/01.ju.0000113228.80583.83Kuhn, B.Treatment Guidelines for Primary Nonretentive encropesis and stool toileting refusal. American Family Physician. April 15 1999.Cleveland Clinic.Bedwetting.Cleveland Clinic.Encopresis (soiling).National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms of Constipation in Children. Last reviewed May 2018Cleveland Clinic.Constipation.

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Law S, Malady M, Buqo T, Williams L.Elimination Disorders.Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings. 2018:193-201. doi:10.1007/978-3-319-70539-2_17Wilson M, Gupta V.Enuresis. [Updated 2021 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Yilanli M, Gokarakonda SB.Encopresis. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Von Gontard A, Hollmann E.Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations.J Urol. 2004;171(6 Pt 2):2644-2647. doi:10.1097/01.ju.0000113228.80583.83Kuhn, B.Treatment Guidelines for Primary Nonretentive encropesis and stool toileting refusal. American Family Physician. April 15 1999.Cleveland Clinic.Bedwetting.Cleveland Clinic.Encopresis (soiling).National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms of Constipation in Children. Last reviewed May 2018Cleveland Clinic.Constipation.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Law S, Malady M, Buqo T, Williams L.Elimination Disorders.Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings. 2018:193-201. doi:10.1007/978-3-319-70539-2_17Wilson M, Gupta V.Enuresis. [Updated 2021 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Yilanli M, Gokarakonda SB.Encopresis. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.Von Gontard A, Hollmann E.Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations.J Urol. 2004;171(6 Pt 2):2644-2647. doi:10.1097/01.ju.0000113228.80583.83Kuhn, B.Treatment Guidelines for Primary Nonretentive encropesis and stool toileting refusal. American Family Physician. April 15 1999.Cleveland Clinic.Bedwetting.Cleveland Clinic.Encopresis (soiling).National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms of Constipation in Children. Last reviewed May 2018Cleveland Clinic.Constipation.

Law S, Malady M, Buqo T, Williams L.Elimination Disorders.Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings. 2018:193-201. doi:10.1007/978-3-319-70539-2_17

Wilson M, Gupta V.Enuresis. [Updated 2021 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Yilanli M, Gokarakonda SB.Encopresis. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Von Gontard A, Hollmann E.Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations.J Urol. 2004;171(6 Pt 2):2644-2647. doi:10.1097/01.ju.0000113228.80583.83

Kuhn, B.Treatment Guidelines for Primary Nonretentive encropesis and stool toileting refusal. American Family Physician. April 15 1999.

Cleveland Clinic.Bedwetting.

Cleveland Clinic.Encopresis (soiling).

National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms of Constipation in Children. Last reviewed May 2018

Cleveland Clinic.Constipation.

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