Enuresis and Encopresis are two conditions that truly plague those who suffer from them. Children are subject to confusion, embarrassment, and frustration, and their parents are oftentimes overwhelmed and simply stumped about how to help or resolve these conditions.

Good information available for parents regarding enuresis and encopresis treatment can be hard to come by. Even then, it’s often difficult to interpret and personalize the information for each child’s specific circumstances.

Comorbidities make each case unique, and add to the complexity of finding the right treatments for the right patients at the right time.

By the end of today’s blog you’ll know the most common treatment guidelines as well as the next steps you can take to learn more.

Encopresis: What Is It and What are the Most Common Treatment Options?

Encopresis is a condition in which a child over the age of 4 has bowel movements that are unintentionally passed in inappropriate places, such as in their underwear or clothing. When episodes occur at least once a month for 6 months or more, this constitutes encopresis.

Common treatment approaches to encopresis include:

  • Addressing underlying constipation: Encopresis is often caused by chronic constipation. Therefore, the first step in treatment is usually to address the constipation, either through medication, changes in diet, and bowel habits.
  • Medications: Various medications can be used to help treat encopresis, including laxatives, stool softeners, and enemas. One popular enema regimen is called the Modified O’Reagan Protocol (M.O.P.) developed by Dr. Steve Hodges. Medications can help relieve constipation and make bowel movements easier and more regular.
  • Pelvic Floor Therapy: This may include postural training, abdominal muscle coordination, pelvic floor muscle intervention, biofeedback, and more.
  • Behavioral therapies: Behavioral therapies, such as positive reinforcement, toilet training, and scheduled toilet sitting, are often used in conjunction with other therapies to help treat encopresis. These approaches can help children to establish regular bowel movements and improve toilet habits.
  • Psychological therapies: In some cases, psychological therapies such as cognitive-behavioral therapy (CBT) or family therapy may be recommended to help address any emotional or psychological factors that may be contributing to the condition.
  • Education and support: Education and support for the child and their family can be a key component of treatment. This may include information on proper toilet habits, diet and nutrition, and coping strategies for managing the condition. Additionally, support groups can provide emotional support and a sense of community for families dealing with encopresis.

It’s important to stay up-to-date with the most recent evidence. What we know about treating encopresis points to success with using some combination of the above treatments. Not everyone responds in the same way, which is why it’s important to tailor treatment to each individual patient.

Enuresis: What Is It and What are the Most Common Treatment Options?

Enuresis is a medical condition that involves involuntary urination after the age when a child is expected to have bladder control (usually around the age of 5). Some causes of enuresis include an overactive bladder, hormone imbalances, genetics, and emotional factors such as stress or anxiety.

There are two types of enuresis: primary enuresis, which occurs when a child has never achieved nighttime dryness, and secondary enuresis, which occurs when a child has achieved nighttime dryness for at least six months but then begins to wet the bed again.

Common treatment approaches to enuresis include:

  • Behavior Modification: ensuring children are emptying their bladders frequently enough is important in the management of enuresis.
  • Constipation Management: due to the proximity of the bladder to the rectum, constipation management can greatly reduce enuresis. The M.O.P. is a wonderful place to start with constipation management if it’s indicated for the child.
  • Dietary Changes: It’s important to ensure that a child suffering from enuresis has adequate water and fiber intake, and the timing of their fluid intake must be taken into consideration as well.
  • Medication: medications can help a child achieve dryness and may be used short term or long term, depending on the child’s condition.
  • Behavioral therapies: motivational therapy and bedwetting alarms are two options for behavioral treatment of enuresis. Studies have shown success in some portions of the population with these interventions.
  • Education and support: It’s important for children with enuresis to receive support and understanding from their parents, caregivers, and healthcare providers. Encouragement and positive reinforcement can help children feel more confident and motivated to achieve dryness, while criticism or punishment will likely be counterproductive and damaging to self-esteem and psychological wellbeing.

In most cases, some combination of the above treatments will yield the best success.

Why Treatment for Enuresis and Encopresis is Important

These diagnoses come with their fair share of psychological impact on children. Pediatricians of the past often took a “wait and see” approach, encouraging parents that their children would eventually “grow out of it”. While this is true for a small portion of the population, many children do not simply “grow out of” these conditions.

Ignoring the psychological impact of enuresis and encopresis can have serious consequences for children, such as:

  • Low self-esteem: Children with enuresis or encopresis may feel embarrassed, ashamed, and isolated, which can lead to low self-esteem and feelings of worthlessness.
  • Social isolation: Children with enuresis or encopresis may avoid social situations or activities due to fear of being embarrassed or stigmatized, which can lead to social isolation and loneliness.
  • Behavioral problems: These children may exhibit behavioral problems such as aggression, defiance, or withdrawal, which can be a manifestation of their underlying emotional distress.
  • Academic difficulties: They may have difficulty concentrating in school due to anxiety and stress, which can lead to academic difficulties and poor performance.
  • Delayed treatment: Ignoring the psychological impact of enuresis and encopresis can lead to delayed treatment, which can worsen the child’s condition and make it more difficult to achieve successful outcomes once treatment is commenced.

Overall, it’s important to address both the physical and psychological aspects of enuresis and encopresis in order to promote healthy development and well-being in children.

As a medical professional, you understand the importance of providing effective treatment to patients with enuresis and encopresis. However, you may feel unsure or lack confidence about your ability to treat these conditions effectively. If this sounds like you, we have an excellent opportunity for you to improve your knowledge and skills in this area.

Why Treating Enuresis and Encopresis Presents a Challenge for Medical Professionals

Medical professionals may face several challenges when treating enuresis and encopresis, including:

  • Stigma and shame: Children and adults with enuresis and encopresis may feel embarrassed or ashamed of their condition, which can make it difficult to seek help and follow through with treatment. Delayed treatment is not uncommon in this population, which can make successful treatment even more of an uphill battle.
  • Comorbid conditions: Enuresis and encopresis may be associated with other medical conditions, such as urinary tract infections or constipation, which can complicate treatment and require a multidisciplinary approach. Other comorbidities, such as neuropsychiatric conditions and upper airway obstruction can make finding the appropriate treatments more challenging.
  • Noncompliance: Treatment for enuresis and encopresis may be lengthy and require significant effort from patients and their families, which can lead to noncompliance and lower treatment success rates.
  • Lack of evidence-based guidelines: There is still much to be learned about the most effective treatments for enuresis and encopresis, which can make it challenging for medical professionals to develop treatment plans based on evidence-based guidelines. Even literature published as recently as 2022 providing guidelines for constipation management speaks nothing of pelvic floor therapies. Standardization and education are needed.
  • Impact on quality of life: Enuresis and encopresis can have a significant impact on a patient’s quality of life, affecting their social, academic, and emotional well-being. Addressing these challenges requires a holistic approach that takes into account the patient’s physical and psychological needs.

Overall, treating enuresis and encopresis requires a patient-centered approach that addresses the unique challenges faced by each individual, and meets them where they’re at in terms of treatment approaches.

By recognizing these challenges and working collaboratively with patients and their families, as well as staying up-to-date on the most recent guidelines, medical professionals can develop effective treatment plans that improve patient outcomes and quality of life.

How Can You Learn The Most Up-To-Date Treatment Methods for Enuresis and Encopresis?

Maybe you’re already a pediatric therapist. Or maybe you’re a pelvic floor therapist getting referrals for pediatric patients. Whether you’re currently treating pediatric patients or not, you can improve your skill set and get all the tools you need to start confidently treating children with bowel and bladder problems today. Yes, today!

My online course, Peds Level 1 — Treatment of Bowel and Bladder Disorders: Evaluation and Treatment of Dysfunctional Voiding, Bedwetting, and Constipation is self-paced and enrollment is open year round!

You’ll walk away from the lectures understanding the causes and treatments for the most common pediatric bowel and bladder issues. You have the ability to ask me questions directly throughout the course as well.

You’ll want to get into this course ASAP, because there is an exciting opportunity for you to dive even further into the world of peds pelvic floor therapy, available for a limited time only.

Enrollment is now open to sign up for an upcoming continuing education course — Level 2: Advanced Treatment of Enuresis and Encopresis With M.O.P., taught by Dr. Hodges himself on April 22, 2023. After April 22nd, the replay is available through the link below.

Don’t worry if you missed Dr. Hodges’ Level 1 — this course is perfect for trained pediatric pelvic floor therapists, and any other health professionals interested in learning the most recent evidence and updates to the M.O.P. This live 5-hour Zoom course will cover the latest research, treatment options, and best practices for managing enuresis and encopresis in both children and adults.

You will have the opportunity to ask questions and participate in discussions with other healthcare professionals, as well as learn from experienced clinicians, including myself, Dawn Sandalcidi, PT, RCMT, BCB-PMD as well as Dr. Amanda Arthur-Stanley, PhD and Licensed Psychologist. Our team of experts is excited to share our wealth of knowledge and expertise in this field with you!

By participating in this course, you will gain the confidence and skills you need to provide effective treatment to patients with enuresis and encopresis. You will also be able to network with other professionals in your field and stay up-to-date on the latest developments and best practices in the field.

Don’t miss out on this valuable opportunity to enhance your professional skills and improve patient outcomes. Sign up for this continuing education course on enuresis and encopresis today!