Enuresis and Encopresis

Abstract

Abstract:In this chapter, we describe the assessment and treatment of enuresis and encopresis. We first review literature on the symptoms, causes, and evidence-based treatments of each condition separately. We also incorporate a discussion of the mechanisms of change underlying effective intervention. Then, using Ryle's (1949) distinction between "knowing how" and "knowing that" as a framework, we discuss the basic competencies one should possess to address these clinical issues. A major reason for distinguishing between the "knowing how" and "knowing that" skill sets is that some clinicians teach and others practice. Based on this framework, we argue that demonstration of basic competency entails the clinician having the skills to conduct effective assessment and treatment of enuresis and/or encopresis, or the skills necessary to tell others (e.g., supervisees) how to do so. These skills include a thorough knowledge of the physiology of urination and defecation, potential pathophysiology of elimination disorders, the ability to effectively interface with medical providers regarding their treatment, and a strong working knowledge of evidence based treatments and their mechanisms of change. In our discussion of expert competency, we use no such distinction between "knowing how" and "knowing that", as an expert should be skilled in both. Further, expert competency in enuresis and encopresis entails the verbal and performance knowledge base to make scholarly contributions to the field, either by conducting one's own research or serving as a consultant to other research programs. Thus, an expert in this area is well poised to contribute to the field of elimination disorders as a master clinician, a specialty supervisor, and/or as a contributing researcher. OverviewChild clinical and pediatric psychologists confront a diverse set of problems that challenge children and their families. Often overlooked, but critically important, is the ability to successfully evaluate and intervene the challenges that may, at first glance, seem either medically based or within the realm of "typical" child behavioral problems. Among the most common, persistent, and stressful presenting complaints in primary medical care for children are two disorders involving developmentally inappropriate elimination of waste -enuresis (urine) and encopresis (feces). Evidence of their commonality and persistence is found in prevalence and age-range estimates. Prevalence estimates range as high 2% of 5-year-old children for encopresis and 25% of 6-year-old children for enuresis and, although both are much less prevalent by the teenage years, they are not rare. For example, as many as 8% of boys and 4% of girls are still enuretic at the age