2. INTRODUCTION
Enuresis
Derived from a Greek word enourein –to void
Enuresis is defined as involuntary (or even intentional)wetting in children 5 years
of age or even older after organic causes have been ruled out.
A form of elimination disorder in childhood.
A source of emotional and physical distress in patients and parents.
3. INCIDENCE
Worldwide ,the prevalence of enuresis among 6-12 years of children is reported as
1.4 to 28%.
It is now generally accepted that 15-20% of children have some degree of night time
wetting at 5 years of age , with a spontaneous resolution rate of approximately 50%
per year .
4. ETIOLOGY
Enuresis is symptom with multiple possible etiologic factors including
Developmental delays that interfere with toilet training
Psychological distress
Genetic factors
Small bladder capacity
Persistent Urinary tract infection
Chronic renal failure
Constipation
5. CLINICAL FEATURES OF ENURESIS
Repeated bed wetting
Wetting in the clothes
Wetting at least twice a week for approximately three months.,
Cloudy or pinkish urine or blood stain urine
Frequency, urgency or burning on urination
Constipation
6. COMPLICATIONS
Low self esteem in response to criticism from caregivers and embarrassment
if peers are aware of the problem.
Poor academic performance
Many children becomes Isolated
7. ENCOPRESIS
INTRODUCTION
Encopresis is the involuntary passage of stools into inappropriate places in
children over the age of 4 years who has already learned to use a toilet .it
represents severe psychological distress on children and their parents .
Occurs at least per month for at least 3 months .
Exact incidence is unknown but it is not uncommon and is more typical in boys
than in girls by ratio about 6:1
8. Etiology of Encopresis
A child has long term (chronic) constipation.(main)
May be related to developmental delay of sphincter control
Disruption in mother child relationship.
Delay toilet training .
Psychological causes .
Emotional issues.
9. SIGN AND SYMPTOMS
Passing stools any where other than toilet .
Passage of stool happens at least once a month for at least 3 months.
Constipation with dry hard stool.
Long period of time between bowel.
Lack of appetite .
Abdominal pain
Repeated bladder infection typically in girls.
10. COMPLICATIONS OF ENCOPRESIS
A child who has encopresis may experience a range of emotions ,including
Embarrassment
Frustration
Shame and anger
Depressed
Low self esteem
11. MANAGEMENT
The first step is to consult with the child pediatricians.
Psychological counseling may be effective in cases incase child has had a traumatic events
and low self-esteem.
The doctor may recommend enema or scheduling blockage .(encopresis)
Maintain a diet that limits the constipation such as eating high fiber diet increasing liquids
.(encopresis)
behavioral interventions (scheduling a child to sit on the toilet for 5-10 minutes after every
meal.
Creating a routine in which everyone in the house uses the bathroom before heading out.
Psycho education interventions (like teaching child how their body works ,explaining how
their bodies passes the bowel)
Limiting fluid before bed time (enuresis)
Going to bathroom before bed time .
12. NURSING MANAGEMENT
provide support to the parents and child .
Parents should also be taught to observe for side effects of any medications
used.
Re assure them that the bed wetting and encopresis is not a manifestation of
emotional disturbance and willful misbehavior .
Punishment such as scolding shaming and threatening is contraindicated
because of their negative emotional impact and limited success in reducing
the behavior .
Encourage parents to be patience and understanding and to communicate
love and support to the child.
13. NURSING DIAGNOSIS
ENURESIS
Situational low self esteem related to bed wetting or urinary incontinence .
Impaired social interaction related to bed wetting or urinary incontinence.
Risk for impaired skin integrity related to prolonged contact with urine.
ENCOPRESIS
Bowel incontinence related to fecal impaction.
Risk for constipation insufficient fiber intake
Self esteem disturbances related to bowel diversion
14.
15. REFERENCE
1. Sreevani R.,A guide to mental health and psychiatric nursing 4th edition
JAYPEE page no. 266-268.
2. Ahuja N.,A Short text book of psychiatric 6th edition JAYPEE page no:152-
1554.
3. http://www.mayoclinic.org/childhood disorders
4. https://cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet
_EnuresisEncopresisInChildren_Feb2019.pdf
5. https://psycnet.apa.org/record/2006-03571-078
