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Elimination Disorders in Children and Adolescents

:	Edward R Christophersen, Patrick C Friman
:	Elimination Disorders in Children and Adolescents
:	Hogrefe Publishing
:	9781616763343
:	1
:	CHF 19.80
:

:	Angewandte Psychologie
:	English

:	96
:	Wasserzeichen/DRM
:	PC/MAC/eReader/Tablet
:	PDF

A compact, 'how-to' manual on effective, evidence-based treatments for enuresis and encopresis. The aim of this book is to provide readers with a practical overview of the definitions, characteristics, theories and models, diagnostic and treatment recommendations, and relevant aspects and methods of evidence-based psychosocial treatments for encopresis and enuresis, primarily in children. Although treatments and research for elimination disorders are reviewed in general, particular attention is directed at constipation and encopresis, toileting refusal, and diurnal and nocturnal enuresis due to the high incidence of these conditions in children. Case vignettes, websites, and suggestions for further reading are provided for the interested reader.

In addition to suffering from constipation, children with encopresis may have a diminished sensation in their rectum are thus less likely to perceive the “call to stool” needed for appropriate elimination (Christophersen& Mortweet, 2001). For example, Meunier, Mollard, and Marechal (1976) used anal manometry to determine the rectum sensitivity of children with and without normal bowel histories. They established a laboratory procedure in which a small tube was inserted into the patient’s rectum. One or more portions of the tube could then be inflated until the patients subjectively reported feeling as though they were about to have a bowel movement. The amount of pressure necessary to create that feeling was duly noted. This procedure allowed the researchers to simulate the increased pressure in the rectum that an individual normally feels prior to having a bowel movement. In the Meunier et al. study, most of the children with normal bowel histories required only a small amount of pressure in the rectum, whereas most of the children with encopresis required 2–4 times as much pressure before they felt the “call to stool.” The data presented here lend support to the comment often heard from children with encopresis that they “couldn’t feel the bowel movement coming.”

Further support for the role of biological factors in encopresis was provided by Ingebo and Heyman (1988), who conducted a study to determine whether children with encopresis retained more stool in their rectum than did children without encopresis. They conducted a clinical trial using an oral solution, GoLytely (polyethylene-glycol-electrolyte), with 24 children, ages 9 months to 17 years, with severe constipation (Christophersen& Mortweet, 2001). Approximately 50% of the children were being treated for encopresis, while the other half were being prepared for colonoscopy. The children with encopresis required almost 3 times as much medication, administered over 3 times as long a period of time, in order to clean out the colon. These results support the notion that children with encopresis retain more stool and require more medication over a longer period of time than do children not presenting with encopresis. The author reported no clinically important changes in the laboratory values measured before and after the intestinal cleanout in either group of children, suggesting that the use of enemas to “clean out” the colon is not detrimental to children.

2.2.2 Psychiatric Factors

For many years, encopresis was viewed as a psychiatric disorder or symptom of emotional disturbance. A number of studies specifically examined the notion that children with encopresis have emotional or behavioral problems.

The use of child-behavior rating scales, such as the Achenbach Child Behavior Checklist (Achenbach, 1991), revealed no systematic differences between children with encopresis and normal children of the same age and gender (Christophersen& Mortweet, 2001). Rating scales also showed that children with encopresis tend to be more well adjusted than same-age, same-sex samples of children with “behavior problems” (Gabel et al., 1986; LoeningBaucke et al., 1987). Friman et al. (1988) reported that children referred for management of encopresis did not differ significantly from the standardization sample for the Eyberg Child Behavior Inventory (Rob

	Table of Contents	6
	1 General Introduction	8
	2 Constipation and Encopresis	10
	2.1 Description	10
	2.1.1 Terminology and Definition	10
	2.1.2 Epidemiology	11
	2.1.3 Etiology	12
	2.1.4 Course and Prognosis	13
	2.1.5 Differential Diagnosis	14
	2.1.6 Comorbidities	15
	2.1.7 Diagnostic Procedures and Documentation	16
	2.2 Theories and Models of Constipation andEncopresis	19
	2.2.1 Physiological Factors	19
	2.2.2 Psychiatric Factors	20
	2.3 Treatment for Constipation and Encopresis	21
	2.3.1 Providing Education	21
	2.3.2 Methods of Treatment	25
	2.3.3 Problems Carrying Out the Treatments	29
	2.3.4 Variations of Methods and other Stategies	30
	2.4 Case Vignette: Encopresis	32
	2.5 Encopresis Without Constipation	34
	2.6 Toileting Refusal	35
	2.6.1 Description	35
	2.6.2 Diagnostic Procedures and Documentation	36
	2.6.3 Treatment for Toileting Refusal	36
	2.6.4 Case Vignette: Toileting Refusal	38
	2.7 Adherence and Follow-Up	40
	2.7.1 Strategies for Maximizing Treatment Adherence	40
	2.7.2 Follow-up	41
	2.8 Summary and Conclusions	42
	3 Nocturnal Enuresis	44
	3.1 Description	44
	3.1.1 Terminology and Definition	44
	3.1.2 Epidemiology	45
	3.1.3 Course and Prognosis	45
	3.1.4 Differential Diagnosis	46
	3.1.5 Comorbidities	46
	3.1.6 Diagnostic Procedures and Documentation	47
	3.2 Theories and Models of Enuresis	49
	3.2.1 Historical	49
	3.2.2 Psychopathological	50
	3.2.3 Biobehavioral	50
	3.3 Treatment for Enuresis	54
	3.3.1 Methods of Treatment	54
	3.3.2 Mechanisms of Action	57
	3.3.3 Efficacy	58
	3.3.5 Empirically Supported Components of Conventional Programs	59
	3.3.6 Additional Components with Less Empirical Support	62
	3.3.7 Medication	63
	3.3.8 Problems in Carrying Out the Treatments	64
	3.4 Case Vignette: Nocturnal Enuresis	65
	4 Diurnal Enuresis	68
	4.1 Description	68
	4.1.1 Terminology and Definition	68
	4.1.2 Epidemiology	68
	4.1.3 Course and Prognosis	69
	4.1.4 Differential Diagnosis	69
	4.1.5 Comorbidities	71
	4.1.6 Diagnostic Procedures and Documentation	72
	4.2 Theories and Models of Diurnal Enuresis	73
	4.3 Treatment for Diurnal Enuresis	73
	4.3.1 Methods of Treatment, Mechanisms of Action, and Efficacy	73
	4.3.3 Problems in Carrying Out the Treatments	78
	4.4 Case Vignette: Diurnal Enuresis	78
	4.5 Summary and Conclusions	80
	5 General Conclusion	82
	6 Further Reading	83
	7 References	84
	8 Appendices: Tools and Resources	92
	Appendix 1: Dietary Fiber Content of Foods	93
	Appendix 2: Bowel Symptom Rating Sheet	94
	Appendix 3: Representative Child and Parent Handout for Alarm Treatment	95
	Appendix 4: Websites	96