Child Enuresis

Are you worried about child enuresis? Does a child you know wet or soil herself (encopresis)?

Mary is a worried parent. Her six year old daughter, Susan, still wets and soils herself and she doesn't know what to do. Her daughter's teacher has contacted her and told her the wetting (child enuresis) and soiling is causing problems at school. Susan also complains about being hungry and she drinks a lot of liquids.

Mary took her to the doctor to get tested for diabetes but the results were negative. She recently took Susan to a new doctor to further explore her concerns about child enuresis and soiling. He requested an x-ray and did some blood work and took a urine sample, but Mary has not heard back from him.

The wetting and soiling is becoming a problem at school and at home and Mary wonders what to do?

Recommendations for Addressing Child Enuresis

Parents, like Mary, who are worried about child enuresis or encopresis, can try the following.

(1) The first step in addressing child enuresis or soiling is to contact a medical doctor, which Mary has already done. The doctor will do a number of medical tests to determine if a medical problem is contributing to the wetting (child enuresis) or the soiling problems the child exhibits. It is essential that the parent find out if a medical problem is a factor in child enuresis or ecopreisis. The treatment and solution to solving the problem depends on knowing the cause.

(2) The steps Mary will need to take to address her daughter's problems will depend on the results of the medical tests. If her daughter's concerns are the result of a medical problem then Mary will need to work with the doctor to address them.

(3) If a medical problem is ruled out then Mary needs to explore other issues that might contribute to her child's concerns. There are many causes for wetting and soiling or child enuresis and encopresis. Some may be minor and easily addressed. Other's may be more serious and benefit from the support of child psychologist or other mental health professional.

(4) If a medical problem is not a factor, it will be important for Mary to consider what she thinks is contributing to the problem? Perhaps it is a minor issue that can be easily addressed. For example, does her child get so involved and busy with playing or school work that she leaves it too late to reach the bathroom on time? Or does she simply dislike using the toilet, especially at school?

(5) What about an emotional problem or high stress levels? Children who exhibit symptoms of child enuresis may be feeling anxious or stressed or suffering from emotional distress.


To assist in exploring whether these are factors in Susan's case and getting to the root of the problem (providing a medical condition has been ruled out) it is recommended that Mary consider the following questions.These questions can help determine what direction Mary needs to take to address her daughter's concerns.

(a) How long has the problem been going on? If it began when she started school or grade 1, perhaps she is experiencing some school related stress.

(b) How often does the problem occur, how many times a day or a week, for example?

(c) Are there times when the wetting and soiling are not concerns, for example, certain times during the day or periods in the week?

(d) What is different about these times? Mary can consider whether there is something about these more positive periods that makes it easier for Susan to use the toilet? Are things better, for example, when Susan is not at school or during school holidays?

(e) Are there any family issues or specific stressors that may be contributing to stress or emotional distress in her child?

(f) Mary could talk to Susan to try and find out if something is bothering her. If she indicates that something is, Mary needs to determine what she can do to support her and address the problems that are contributing to the toileting concerns.

(g) Mary can also review what she has done to address the problem. Has anything worked? Even small steps in the right direction can make a difference. If anything has worked or shown some improvement, however small, Mary can do more of what works. Small changes can make a difference in the long term.

Mary Can Also Try the Following:

(a) Talk with her child's teacher to encourage her to remind Susan to go to the washroom regularly.

(b) Try positive reinforcement for using the toilet, like praise, hugs or a special time together, playing games or doing something Susan enjoys. Or what about incentives like stickers or an opportunity to earn credits towards a reward that will motivate her.

(c) Record Susan's progress and provide her with visible evidence of success. For example, a chart documenting the number of days in a week when she did not wet or soil herself. Provide her with a star for every time she used the toilet for a bowel movement or to urinate. Each time she posts a star Mary can praise Susan for her accomplishments. Using the chart to record Susan's progress she can offer Susan an agreed upon reward after two weeks of no accidents.

(d) To reduce Susan's reliance on external rewards Mary can say something like,"You must be proud of yourself." whenever she achieves some success.

(e) If Mary wants to explore this concern further and take more direct steps to determine what is contributing to her daughter's problems, a psychological assessment can help.

Through a psychological assessment Dr. O'Connor can work with Mary to explore what might be contributing to her daughter's concerns. Information provided by the assessment will result in specific recommendations tailored to her child's individual needs.

If a medical concern has been ruled out as the cause of child enuresis or soiling and Mary feels the problem may be symptomatic of serious mental health concerns she should consult a child psychologist or other mental health professional.

There are likely various mental health agencies in her area where she could receive some help. Perhaps her doctor or someone in her daughter's school could refer her to a qualified professional. Schools often have psychologists or social workers who assist parents and children with these kinds of concerns. Perhaps Mary could ask the school for a referral to one of these professionals or a mental health agency or professional in the community.

A licensed psychologist or mental health professional would need to do a thorough assessment to help determine what is contributing to her daughter's concerns and to recommend the most effective treatment to help her.

Contact Dr. OConnor to find how to help when child enuresis is a problem.