Enuresis or incontinence--lack of bladder control--is a fact
for many children with disabilities. It is often associated with particular
disabilities including spina bifida, neuromuscular diseases including muscular
dystrophy and cerebral palsy, nervous system disorders, brain damage, spinal
cord injuries and inflammation of the bladder or urethra. Children with
incontinence face both physical and emotional challenges. A pediatrician or
urologist can recommend treatment options including medications, catheterization
and surgical procedures. Psychological counseling may be advisable.
In a healthy child, enuresis usually does not indicate a physical or an
emotional problem. Causes may be due to a delay in the development of bladder
muscles, toilet training that was too early, or a response to stress. Treatment
includes behavior modification techniques, such as rewards for remaining dry at
night; limiting fluids at bedtime; waking the child periodically during the
night; and, in some cases, medication. Patience and support by family members is
essential.
Encopresis, a lack of bowel control in a child that has been
previously toilet trained, is a chronic, complex but solvable problem, found
more often in boys than girls. It can have either physical or emotional causes.
Physical causes include constipation and fecal impaction. Treatment in these
cases focuses on preventing constipation through diet (high fiber, adequate
fluids) and encouraging good bowel habits.
Emotional causes may be related to a lack of toilet training or opposition to
toilet training, stressful life events such as divorce, moves, family illness,
or fear of a painful bowel movement. Behavior modification and a reward system
encouraging proper toilet habits, and psychological counseling are used to treat
this problem.