Elimination Disorders

Back to All Diagnosis

Overview – Elimination Disorders

Elimination disorders involve the inappropriate elimination of urine or feces. Typically, these disorders are usually first diagnosed in childhood or adolescence. They involve the repeated voiding of urine into appropriate places, or the repeated passage of feces into inappropriate places, or some variation on this theme. Sometimes the smearing of feces is the issue. There may be abdominal pain due to underlying medical conditions such as urinary tract infections or constipation. 

Elimination disorders tend to occur in children who struggle with going to the bathroom, often due to constipation and the pain of trying to pass the stool. Although it is not uncommon for children to have occasional “accidents”, when these behaviors occur for longer than three months particularly in children older than 5 years, they may have an elimination disorder.

Contributors to elimination disorders may involve genetics, psychological factors, psychosocial stressors, delayed or lax or pressured toilet training, parental neglect, and so on.

A variety of associated psychosocial symptoms may be present including:

  • Embarrassment
  • Low self-esteem
  • Loss of appetite
  • Decreased interest in physical activity 
  • Withdrawal from friends and family as children often feel ashamed 
  • Avoidance of situations that can lead to accidents (school, summer camp)  

Elimination Disorders presents information on four types of disorders, one type each day for four days. These are: 

Enuresis Disorder

Enuresis Disorder is an Elimination Disorder that may be comorbid with mood and emotional disorders, and with attention deficit hyperactivity disorder (ADHD). The high comorbidity of enuresis with ADHD is consistent with a higher incidence of development delays in children with enuresis. Enuresis Disorder is characterized by the inappropriate elimination of urine, voluntary or involuntary. It has been linked with delays in the development of normal circadian rhythms of urine production, resulting in nocturnal polyuria, and with reduced functional bladder capacities, an/or bladder hyper-reactivity. 

Enuresis Disorder can be distressing and a source of embarrassment for a child, but it is not physically harmful. In roughly one (1) percent of children with the condition, it continues into adulthood; but for most, it ends by adolescence. More girls experience daytime enuresis while more boys experience night-time enuresis, or bedwetting. In adolescence twice as many boys than girls experience enuresis. 

There are three main types of enuresis:

  • Nocturnal Enuresis Disorder is the most common form and is defined as incontinence only during nighttime sleep. Nocturnal enuresis is more common in boys. Elimination often takes place in the first one third of the night, which could be caused by behavior (inadequate elimination before bedtime), high levels of stress or anxiety, or an underlying physical issue (the bladder does not completely fill).
  • Diurnal Enuresis Disorder involves the voiding of urine only during waking hours. It may occur when a child experiences sudden urges to urinate or because they consciously postponed urination or due to a bladder infection. It is more likely to happen in the afternoon when a child is at school or with playmates, and thus can be a source of embarrassment and teasing from peers.
  • Nocturnal and Diurnal Disorder is the inappropriate elimination of urine both during the day and at night.
Encopresis Disorder

Encopresis Disorder is an Elimination Disorder that is much less common than enuresis. It is characterized by the inappropriate elimination of feces, involuntarily or voluntarily. It is essentially a repeated passage of feces into inappropriate places, such as on clothing or the floor. At times, no clear cause of encopresis disorder can be identified. Typically, however, it is the result of chronic constipation, impaction, and retention with a resultant overflow. 

Constipation may develop for psychological reasons like anxiety about defecating, a more general pattern of anxiety disorder, dehydration associated with a febrile illness, hypothyroidism, or medication side effects like anticonvulsants. Painful defecation can lead to constipation and a cycle of withholding behaviors that make encopresis more likely. Once constipation has developed, it may be complicated by an anal fissure, painful defecation, and further fecal retention.

Other Specified Elimination Disorder

Elimination disorders involving the inappropriate elimination of urine or feces and are usually first diagnosed in childhood or adolescence.

Under the age of five, inappropriate elimination of urine or feces is common as children are potty trained and learn to control voiding behavior. Urinary incontinence is considered Enuresis when a child is five years of age or older. Fecal incontinence, whether involuntary or intentional, which is not due to a medical condition (organic defect or illness) and which occurs at an age of at least 4 years, is considered Encopresis.

The diagnosis for Other Specified Elimination Disorder may be used by the clinician when symptoms of an elimination disorder cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any specific disorder such as enuresis (bed-wetting) or encopresis (fecal incontinence). It may involve enuresis, encopresis, or a combination of urinary and fecal symptoms.

Unspecified Elimination Disorder

The diagnosis for Unspecified Elimination Disorder may be used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific elimination disorder. It also includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

The unspecified elimination disorder category may also be used by a clinician when symptoms of an elimination disorder cause significant distress or impairment in social, occupational, or other important areas of functioning but the symptoms do not meet the full criteria for any specific disorder such as enuresis (bed-wetting) or encopresis (fecal incontinence). 

Elimination disorders involving the inappropriate elimination of urine or feces and are usually first diagnosed in childhood or adolescence. Under the age of five, inappropriate elimination of urine or feces is common as children are potty trained and learn to control voiding behavior. Urinary incontinence is considered Enuresis when a child is five years of age or older. 

Fecal incontinence, whether involuntary or intentional, which is not due to a medical condition (organic defect or illness) and which occurs at an age of at least 4 years, is considered Encopresis.

Who can apply for these mental health programs?

Individuals diagnosed with anxiety, PTSD, bipolar disorder, depression, or schizophrenia can apply for help. These mental health services are covered by Medicare and some healthcare insurance.

Contact us if you would like to receive more information about our mental health services.