Two disorders should come to mind when toilet training does not occur in the pre-school period or when it starts over again after it has occurred. The first of these is enuresis (involuntary, recurrent, daytime and/or nighttime urinary incontinence in children after at least five years of age) and the other is encopresis (involuntary or purposeful, recurring defecation in inappropriate places).
Bed-wetting. (Enuresis): Although it is predicted that it may be caused by many reasons (such as incorrect and unsuccessful toilet training, genetic predisposition, developmental disorders, environmental stress factors), in some cases it may occur without a cause. Enuresis requires evaluation and treatment because it has negative social and emotional consequences for the child and parent. It is necessary to consult a family doctor, pediatrician and child psychiatrist for medical evaluation. Treatment includes education, behavioral interventions and, if necessary, medication. Education contributes to increasing awareness of enuresis in the family and child and to the success of treatment. The most success in behavioral interventions is working with alarm devices. Its use is limited in Turkey. Desmopressin and imipramine are used in drug treatment. Drug treatment is the last treatment that should be considered due to reasons such as the risk of side effects and the high probability of the old symptoms appearing again when the drug is stopped after a certain period of use.
Poo Incontinence (Encopresis): It is more difficult to treat than enuresis and It is a disorder that is more devastating to parents. It is necessary to consult a pediatrician and child psychiatrist in the treatment of organic problems and psychological problems that cause encopresis.
Constipation is observed in the majority of cases with encopresis. This attitude of the child, who associates defecation with the negative situations he has experienced, may cause him to have problems with defecation and frequent constipation. Environmental stress factors and psychological disorders may be observed in a very small number of children with encopresis. Children with encopresis may not be able to sense their own odor, although they can sense the odor of those around them, due to sensory fatigue. In addition, in children with frequent constipation, the rectum and anal sphincter (the part where the stool is removed) er) Due to prolonged pressure, the child may not be aware that he or she is leaking stool. For this reason, it would be correct not to blame the child. In addition to constipation, encopresis can also be caused by other organic diseases, although rare. Therefore, a detailed evaluation by the pediatrician is required.
Encopresis causes psychological problems in the child and his family. This is why the child becomes depressed, shy and introverted. The family reduces the social activities they can do with their children because they will feel embarrassed. This situation causes other psychological disorders to occur in both the child and family members. The longer the time before starting encopresis treatment, the less successful the treatment will be and the longer the treatment duration. Drug therapies and behavioral methods can be used in treatment.
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