Psych · Child and adolescent psychiatry — elimination disorders
Elimination disorders: enuresis and encopresis
Also known as Nocturnal enuresis · Bedwetting · Diurnal enuresis · Encopresis · Faecal soiling · Fecal incontinence children · Monosymptomatic nocturnal enuresis · Functional constipation with overflow
Exam-exhaustive fellowship reference on childhood elimination disorders — DSM-5-TR and ICCS classification, enuresis pathophysiology triad, alarm versus desmopressin strategy, encopresis with constipation management (disimpaction and PEG), comorbidity and non-punitive care. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Secondary enuresis or encopresis with polyuria, polydipsia, weight loss, or glycosuria — exclude diabetes and other medical disease urgently
- Continuous daytime wetting (especially girls) — consider ectopic ureter or structural anomaly; specialist urology
- Neurological signs, spinal stigmata, gait change, or lower-limb weakness — investigate neurogenic bladder/bowel
- Desmopressin with unrestricted free water — hyponatraemia and seizures; enforce evening fluid restriction
- Imipramine overdose risk and cardiotoxicity — last-line only; safe storage; ECG considerations
- Coercive or punitive toileting, forced enemas as punishment, or other safeguarding concerns — protect the child first
Meet the patient
A 7-year-old boy wets the bed five nights a week. His mother is exhausted, the sheets are on their third wash of the day, and she tells you — within his earshot — that he is "lazy" and "doing it on purpose". His teacher says he has started refusing the school camp.[1][13]
Two questions are live on that ward round. Is this primary monosymptomatic enuresis, or is something medical hiding behind it? And what will this family do to this child if nobody reframes it? The wrong sentence here — "he'll grow out of it, come back next year" — is how wet nights quietly become a teenager who never goes on camp.[1][4][13]
References14ShowHide
- [1]Fritz G, Rockney R, et al. Practice parameter for the assessment and treatment of children and adolescents with enuresis J Am Acad Child Adolesc Psychiatry, 2004.PMID 15564822
- [2]Neveus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society J Urol, 2010.PMID 20006865
- [3]Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society J Urol, 2006.PMID 16753432
- [4]Nunes VD, O'Flynn N, Evans J, Sawyer L Management of bedwetting in children and young people: summary of NICE guidance BMJ, 2010.PMID 20980375
- [5]Caldwell PH, Codarini M, Stewart F, Hahn D, Sureshkumar P Alarm interventions for nocturnal enuresis in children Cochrane Database Syst Rev, 2020.PMID 32364251
- [6]Hahn D, et al. Desmopressin for nocturnal enuresis in children Cochrane Database Syst Rev, 2025.PMID 40728007
- [7]Caldwell PH, Sureshkumar P, Wong WC Tricyclic and related drugs for nocturnal enuresis in children Cochrane Database Syst Rev, 2016.PMID 26789925
- [8]Peng CC, Yang SS, Austin PF, Chang SJ Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis Sci Rep, 2018.PMID 30425276
- [9]Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN J Pediatr Gastroenterol Nutr, 2014.PMID 24345831
- [10]Brazzelli M, Griffiths PV, Cody JD, Tappin D Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children Cochrane Database Syst Rev, 2011.PMID 22161370
- [11]Loening-Baucke V Functional fecal retention with encopresis in childhood J Pediatr Gastroenterol Nutr, 2004.PMID 14676600
- [12]Pashankar DS, Bishop WP, Loening-Baucke V Long-term efficacy of polyethylene glycol 3350 for the treatment of chronic constipation in children with and without encopresis Clin Pediatr (Phila), 2003.PMID 14686553
- [13]Butler RJ Childhood nocturnal enuresis: developing a conceptual framework Clin Psychol Rev, 2004.PMID 15533278
- [14]Chin X, et al. Desmopressin therapy in children and adults: pharmacological considerations and clinical implications Eur J Clin Pharmacol, 2022.PMID 35199198