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Enuresis and encopresis. Those are the medical terms for bed wetting and soiling. (Sounds a lot nicer in medical jargon, doesn’t it?)
These are extremely common problems. And they are extremely frustrating for parents, who often don’t understand how or why their child is bed wetting or soiling.
Why are they? Well, that takes some detective work…
Enuresis (bed wetting or otherwise involuntarily urinating) affects around 15% of 5-year old children. After 5 years of age approximately 10-20% of bed-wetters will spontaneously get better with each passing year. That still leaves a LOT of children who are wetting the bed at 6, 7 and 8 years of age. (Parents should note that while it is annoying, bed wetting at night in a child under 5 years of age is still considered normal.)
What is the cause of bedwetting? Science doesn’t seem to have a complete answer. Genetics seem to play a role – a family history of bed wetting significantly increases the chance of a child having enuresis as well. Psychological factors like stress at school or home are sometimes involved (though most kids with enuresis are psychologically normal). Caffeine, medications and developmental or congenital abnormalities are the underlying cause for a subset of kids. Some children may be constipated or have underlying food allergies. I have seen some children whose enuresis worsened with exposure to environmental antigens or toxicants, others who improved with adrenal-supportive treatments. Diseases like diabetes mellitus or insipidus, urinary tract infections, and sickle cell anemia are all less common, but concerning causes.
Encopresis (soiling with stool) affects 1-3% of school-aged children (but is significantly more common in children with brain abnormalities). Most kids (>90%) who soil themselves either never learned to control bowel function or have some type of functional constipation. Congenital problems like Hirschprung disease or other conditions like Crohn disease, cystic fibrosis, hypothyroidism or disorders of muscular function can all contribute to the problem. Thyroid dysfunction, medication use, pain on defecation, and emotional stressors may all play a role. As with enuresis, functional problems like food allergies or environmental sensitivities are also relatively common in my professional opinion.
It takes a skilled physician to weed through the possibilities that may be contributing to bed wetting. Often patients come to me after their primary care physician has ruled out any major medical cause. Parents are frustrated and kids are embarrassed. But there is help!
The first step toward “cure” is to uncover the underlying cause. Once the major medical causes have been ruled out we can begin the detective work to uncover other more subtle causes. I often send my patients home with a diet diary so we can evaluate the nutritional needs of the child and determine any food allergies or sensitivities. We assess the child’s environment, psychological health, toileting “skills,” medication or supplement use (including over-the counter medications), lifestyle factors, and any other symptoms that may be associated (or incidental). Getting all of this information helps to put together a picture of the child’s overall health – because we want to treat the whole child, not just one symptom.
In my opinion, it is always the individualized, “whole-person” treatment approach that is the ultimate solution for these kids.
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