Middle Childhood Intervention: Module Two – Special Needs & Conditions

Elimination Disorders

An elimination disorders means a child has trouble with bowel or bladder control. The child may have trouble controlling his or her bladder at night (enuresis) and/or his or her bowel functioning (encropesis). Enuresis involves urine and encropesis involves stool.


Enuresis, also known as bed-wetting, means losing control over one’s bladder during the night. The child wakes up with wet sheets and pajamas. Enuresis is not a cause for concern in children who are under six or seven years of age. It could become a problem if the child wets the bed after he or she turns six or seven years old. Some of the warning signs of enuresis are:

  • Wetting the bed after a period of no bed-wetting (that is, the child is completely toilet trained, wakes up dry after a long night’s sleep, then suddenly starts wetting the bed);
  • Experiencing pain while urinating;
  • Being thirsty all the time.

Nobody really knows why a child may have enuresis. There are a few theories regarding the cause of this disorder. They are:

  • Having an unusually small bladder (that is, a bladder that can only hold a small amount of urine);
  • Not being able to tell that one’s bladder is full (most of us know when our bladder is full, even at night, and go to the bathroom. Some children seem unable to recognize that their bladder is full.);
  • Stress: sometimes children start wetting the bed because they are experiencing a stressful event in their lives;
  • Having a medical condition that could cause enuresis. Such conditions include hormonal imbalances and diabetes.

Some children overcome enuresis on their own, and others do not. For those who do not, some medications that make the body produce less urine at night could be prescribed.

For more information about enuresis, please visit the birth to six section of this course.


Encropesis, also called “stool holding,” involves voluntarily refusing to have a bowel movement. The child holds the stool inside until it fills up parts of his or her body. When that happens, liquid stool could leak from the child’s anus, causing staining on the child’s underwear. Encropesis happens in children who have already developed bowel control and who are usually over four years of age. It can be caused by emotional difficulties and/or stress. Some of the symptoms of encropesis are:

  • Having very hard stool;
  • Having stool that is so large it clogs the toilet;
  • Avoiding having a bowel movement;
  • Going for up to a week without having a bowel movement;
  • Having abdominal pain.

Because the causes of encropesis can be either physiological or psychological, treatments vary, and can include:

  • Using stool softeners, enemas and/or suppositories (that is, medical tools that can help the child have a bowel movement);
  • Psychotherapy, if the cause is emotional and/or a stress condition.

Unlike enuresis, encropesis can be quite visible at school. A child who holds his or her stool cannot control the fact that the stool could leak out occasionally. The child may end up smelling bad or wearing stained pants, which can be embarrassing. If that happens, the teacher will need to be very understanding and patient with the child. It is also recommended that the child always have a change of clothing at school, in case he or she soils his or her pants.

For more information about encropesis, please visit the birth to six section of this course.

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