Chapter 19 - Enuresis/Encopresis

Abstract

This chapter explains enuresis and encopresis. It can be conceptualized as the result of genetic predisposition, learned patterns of toileting, and maladaptive environmental contingencies. Enuresis is clearly a treatable disorder; however, rates of relapse or failure to respond to treatment can be significant. Etiological theories of the disorder fall into three general categories: learning, emotional, and biological. Treatment strategies are closely tied to the etiological conceptualization. Additionally, encopresis may develop in combination with stressors such as a poor diet and emotional factors. Encopresis occurs during the day more often than at night and is often accompanied by a strong odor; thus, encopresis is markedly more socially evident and stigmatizing than enuresis. The distress experienced by children and their parents as a result of encopresis is evident in terms of both self-esteem and behavior. Comprehensive behavioral treatment programs which include medical interventions for the clean-out phase and psychotherapeutic techniques to address comorbid emotional features have been shown to be safe and highly effective. There is a dearth of research related to clarifying subtypes of encopresis and dismantling strategies to isolate which aspects of treatment are most effective, when, and for whom. Such research will be crucial in the attempt to increase treatment effectiveness, reduce relapse, and decrease length of treatment.