Elimination disorders — structured clinical viva

This is a school-age child with likely primary MNE plus retentive encopresis (constipation with overflow), complicated by punitive parenting and social stigma — not a simple "naughty" behaviour problem.^[1][2][6]

Classification soundbites. Enuresis age ≥5; encopresis ≥4. Primary vs secondary; nocturnal/diurnal; ICCS MNE vs NMNE. Encopresis with vs without constipation and overflow.^[1][2]

Mechanism soundbite. Enuresis triad: nocturnal polyuria, reduced bladder capacity/overactivity, impaired arousal. Encopresis cycle: withholding → impaction → overflow → shame → more withholding; bowel–bladder interaction worsens wetting.^[6][8]

Management soundbite. Stop punishment; clear and maintain the bowel (disimpact + PEG + toileting programme). Alarm for cure; desmopressin for short-term dryness with fluid restriction; imipramine last-line toxicity. Screen ADHD and school bullying.^{[3][4][5][6][7]}

Safety soundbite. Desmopressin hyponatraemia; imipramine overdose/cardiac risk; organic red flags in secondary presentations.^[5][7]