Elimination disorders involve the inappropriate elimination of urine or feces, usually occurring in childhood or adolescence. This includes enuresis (repeated voiding of urine into inappropriate places) and encopresis (repeated passage of feces into inappropriate places), which can be voluntary or involuntary. Enuresis is characterized by repeated bedwetting or daytime accidents at least twice a week for 3 months. Causes may include environmental, developmental, genetic, and hormonal factors. Encopresis involves soiling accidents monthly for 3 months in those over age 4 that is not due to medical issues. Treatment for both disorders involves behavioral interventions like alarm devices and positive reinforcement, as well as addressing any underlying constipation in enc

1. Muhammad Musawar Ali
MPHIL, ICAP
Psychmmusawarali@gmail.com
Elimination Disorders

2. Elimination disorders
 Elimination disorders all involve the inappropriate
elimination of urine or feces. Their onset occur
usually in childhood or adolescence.
 This group of disorders includes enuresis, the
repeated voiding of urine into inappropriate
places.
 And encopresis, the repeated passage of feces
into inappropriate places.

3. Elimination disorder
 Both disorders may be voluntary or involuntary.
 Although these disorders typically occur
separately, co-occurrence may also be observed.

4. Enuresis disorder
Diagnostic features
Repeated voiding of urine during the day or
at night into bed or clothes.
Voiding is involuntary, though some times it
may be intentional.
The voiding of urine must occur at least twice
a week for at least 3 consecutive months or
must cause clinically significant distress or
impairment in social, academic ,occupational,
or other important areas of functioning
The urinary incontinence is not attributable to
any medication.

5. Etiology
 Environmental factors:
 including delayed or relax toilet training and psychosocial
stress.
 Developmental and biological factors
 A signaling mechanism matures during early childhood,
This signal may initiate dreams about water or going to
the toilet, which usually wakes them up. Some children
with primary enuresis, however, lack normal development
of this signal processing in the brain
 Genetic factors:
 Studies were conducted on twins and segregation
analysis depicts that it is heritable.
 Hormonal factors
 Deficiency of antidiuretic hormone leads to enuresis.

6. Encopresis
 Diagnostic features
 Repeated passage of feces into inappropriate places
(e.g., clothing, floor),
 It may be involuntary or intentional.
 At least one such event occurs each month for at least 3
months.
 Chronological age is at least 4 years (or equivalent
developmental level).
 The behavior is not attributable to the physiological
effects of a substance (e.g., laxatives) or another medical
condition except through a mechanism involving
constipation.
 The constipation may develop for psychological reasons
(e.g., anxiety about defecating in a particular place, a
more general pattern of anxious or oppositional behavior)

7. Etiology
 Genetic and physiological.
 Painful defecation that is, they contract rather than
relax the external sphincter when they attempt to
defecate (Campbell et al., 2009), can lead to
constipation and a cycle of withholding behaviors
that make encopresis more likely.
 Use of some medications (e.g., anticonvulsants,
cough suppressants) may increase constipation
and make encopresis more likely.

8. Treatment
 Behavioral intervention
 in Classical conditioning
principal an alarm is used
that sounds at the first
detection of urine
 Traditionally ‘bell and pad’
(a battery operated device
that produced a loud sound
as soon as a drop of urine
closed the electrical circuit)
was invented.


9. Treatment
 Modern alarms have a
simple moisture sensor that
snaps into a child’s
pajamas, with a small
speaker attached to the
shoulder to awaken the
child.
 The alarm will begin to
wake the child directly within
4 to 6 weeks, and by 12
weeks.

10. Treatment
 Operant conditioning principles,
 It involves variations of dry-bed training.
 Monitoring and intermittent reinforcement is also used.
 Dry-bed training methods combined with an alarm
(referred to today as full-spectrum home training).
 A simple incentive such as earning stars or similar
tokens for dry nights.

11. Treatment
 To get the process moving, (Encopresis) fiber,
enemas, laxatives, or lubricants may be given to
disimpact the fecal mass (Kuhl et al., 2010).

12. Thank you so much for
your attention 
Questions??