Elimination disorders are among the most common mental and psychological disorders in young children. In the field of psychiatry, these elimination disorders are classified into two types. One is enuresis (the child’s persistent loss of bladder control), and the other is encopresis (the child’s persistent loss of bowel control).
When parents notice that their child has a toilet training problem, they should go directly to a doctor. The doctor will first conduct an examination to determine whether the problem is physiological or psychological. If the problem is psychological, the doctor will refer the child to a psychiatrist who specializes in this field. Once a correct diagnosis has been made using the appropriate techniques and treatment methods, it is possible to treat elimination disorders.
Urinary Incontinence (Enuresis)
Urinary incontinence is one of the types of voiding disorders. Urinary incontinence is the loss of bladder control. Children under the age of 3 generally cannot control their bladders. This is a very normal situation. Children can only begin to control their bladders as they grow older. If, after children have reached the age when they should be able to control their bladders—that is, when they know when they need to use the bathroom—they still experience involuntary wetting, this is called enuresis, or bedwetting.
While many children can control their bladder during the day by age 4, they can usually control it at night by age 6. Enuresis can occur at night (bedwetting) or during the day (diurnal enuresis). There is no single cause of daytime or nighttime bedwetting, but doctors believe that certain factors, such as bladder capacity and genetics, may play a role. All children can experience daytime bedwetting, but statistically, it is more common in girls than in boys.
What Are the Causes of Enuresis (Bedwetting)?
There is no single cause of bedwetting in children. It may stem from bladder capacity, or it may be linked to certain genetic factors. However, there are other causes as well. These causes can be listed as follows:
- Çocuklarda mesane kapasitesi
- Uykularından uyanmada zorluk yaşamaları veya uyku bozukluğu yaşamaları
- Bazı çocuklar hiperaktivite gibi çok hareketli olabilir ve mesanesini tamamen boşaltmayabilir veya mesanesinin dolu olduğunun farkında olamayacağı kadar dalgın olabilir.
- Genetik yatkınlık
- İdrar durumunu düzenlemeye yardımcı olan hormonların düzgün çalışıp çalışmadığı ile ilgili bir sorun
- Çocuğun idrar tutma yeteneğinin gelişememesi veya geç gelişmesi durumu
- Bağırsaktaki yedek dışkı olarak bilinen kabızlık, mesaneye doğru baskı uygulayabilir ve istemsiz bir şekilde idrara çıkmaya neden olabilir.
How Is Enuresis Diagnosed?
If you suspect your child has a bowel movement disorder, you should first seek help from a specialist. You should also have your child examined to determine whether this is a physiological issue. Your doctor will ask you questions to learn about your child’s medical history. Based on these questions, your doctor may perform a physical examination if your child is experiencing any of the following issues:
- Ailede başka bireylerde enürezis rahatsızlığı varsa
- Çocuğunuz gün içerisinde hangi sıklıkla idrara çıkıyor?
- Çocuğunuz günlük ne kadar sıvı alımı yapıyor?
- Çocuğunuz kabızlık sorunu yaşıyorsa
- Çocuğunuz stresli günler geçiriyorsa
- İdrarını yaparken ağrı veya yanma problemleri yaşıyorsa
- İdrardan kan geliyorsa veya koyu ya da bulanık renkteyse
If your child is experiencing any of these symptoms—or more than one—your doctor may perform a physical exam. In addition, your doctor may also need to order tests such as urine or blood tests. These tests are performed specifically to screen for risks such as infection or diabetes in your child.
What Is Fecal Incontinence (Encopresis)?
Encopresis, or fecal incontinence, is a disorder in which children, despite being old enough to control their bowel movements as they grow, repeatedly defecate in various places, either consciously or unconsciously. This typically occurs in children aged 4 and older. It is more common in boys than in girls.
Children with encopresis may experience psychological trauma related to their friendships and social circle as a result of this condition, which can make their daily lives difficult or cause them to face challenges at school. Children may experience this condition when they have attention-deficit/hyperactivity disorder (ADHD) or when they become so absorbed in a particular activity that they forget to control their bowel movements.
Children with encopresis may, over time, become shy, withdrawn, or quiet. In such cases, they dislike crowds and try to withdraw from all social situations. At the same time, they may experience intense feelings of personality disorder, low self-esteem, or a sense of being excluded by their peers and left alone.
What Are the Causes of Encopresis (Fecal Incontinence)?
There is no single cause of encopresis, or fecal incontinence, in children. There are both physiological and psychological causes. Some of these causes can be listed as follows:
- Genellikle kabızlık yaşandığında olur
- Midede ve bağırsaklarda görülen enfeksiyonlar
- Çocuğun hazır olup olmadığı anlaşılmadan verilmeye çalışılan tuvalet eğitimi
- Ailede yaşanılan sıkıntılar nedeniyle yaşanan travmalar
- Ebeveyn ilişkilerindeki geçimsiz ilişkilerin çocuğa yansıması
- Çocukta herhangi bir nedenden dolayı tuvalet korkusu oluşması
- Okulda ve arkadaşları tarafından dışlandığını ve kendini yalnız hissetmesi
- Bir rahatsızlık ve utanma korkusu çocukta bağırsaklarını hareket ettirememeye yol açabilir
- Ağrılı dışkı atımına neden olan çatlaklar ve yaralar
- Anne ve babanın boşanması, aile içinde gelişen çocuğu etkileyecek farklı psikolojik durumlar bunları yaşamalarına neden olabilen faktörlerdir.
How Is Encopresis Diagnosed?
Most parents do not initially view this as a medical condition, assuming it is simply due to the child’s laziness. However, they may also attribute it to stomachaches, constipation, or diarrhea. If the issue stems from any of the causes mentioned above, it is essential to consult a specialist. There is no specific test for diagnosing encopresis.
This condition can vary from child to child. The doctor may ask the family questions about the child’s medical history in order to make a diagnosis. A detailed interview is conducted to identify behaviors or causes that may trigger this condition. In the initial stage, the doctor will examine how often the child has bowel movements, their eating habits, and whether they are experiencing any psychological issues that could be causing this condition.
They then undergo a physical examination. Since constipation is a common issue, an abdominal examination is performed and an abdominal X-ray is taken. This allows the amount of stool in the intestines to be determined, and a treatment plan is developed based on whether there is an underlying physical problem.
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