The essential feature of Encopresis is repeated passage of feces into inappropriate places (e.g., the child’s clothing or on the floor). Most often this is involuntary but occasionally it may be intentional.
When the passage of feces is involuntary rather than intentional, it is often related to constipation, impaction, and retention with subsequent overflow. The constipation may develop for psychological reasons (e.g., anxiety about defecating in a particular place or a more general pattern of anxious or oppositional behaviour) leading to avoidance of defecation. Physiological predispositions to constipation include dehydration associated with a febrile illness, hypothyroidism, or a medication side effect. Once constipation has developed, it may be complicated by an anal fissure, painful defecation, and further fecal retention. The consistency of the stool may vary. In some individuals it may be of normal or near-normal consistency. It may be liquid in other individuals who have overflow incontinence secondary to fecal retention.
- Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional.
- At least one such event a month for at least 3 months.
- Chronological age is at least 4 years (or equivalent developmental level).
- The behaviour is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.
The essential feature of Enuresis is repeated voiding of urine during the day or at night into bed or clothes. Most often this is involuntary but occasionally may be intentional.
- Repeated voiding of urine into bed or clothes (whether involuntary or intentional).
- The behaviour is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
- Chronological age is at least 5 years (or equivalent developmental level).
- The behaviour is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina-bifida, a seizure disorder).
The situation in which the Enuresis occurs may be noted by one of the following subtypes:
- Nocturnal Only: This is the most common subtype and is defined as passage of urine only during night-time sleep. The enuretic event typically occurs during the first one-third of the night. Occasionally the voiding takes place during the rapid eye movement (REM) stage of sleep and the child may recall a dream that involved the act of urinating.
- Diurnal Only: This subtype is defined as the passage of urine during waking hours. Diurnal Enuresis is more common in females than in males and is uncommon after age 9 years. The enuretic event most commonly occurs in the early afternoon on school days. Diurnal enuresis is sometimes due to a reluctance to use the toilet because of social anxiety or a preoccupation with school or play activity.
- Nocturnal and Diurnal: This subtype is defined as a combination of the two subtypes above.