February Week 4: Enuresis & Encopresis


Enuresis. Graham and Levy. Peds in Review. 2009.

Encopresis. Har and Croffie. Peds in Review. 2010.


You are seeing a 5 year old boy in clinic for his annual well child check. His mother’s only concern at this visit is that he will often go for a week without a bowel movement, but soils his underwear daily, both at home and at school. This has been going on for several months. The patient is extremely embarassed by his problem and hides behind his mother throughout your discussion.

1. What will you tell this mother is the most likely cause of this problem? 

2. What are some organic causes which need to be ruled out?

3. What are the important features of a focused physical exam for this patient?

4. How would you treat this patient?

You are seeing a 7 year old boy in clinic for his well child check. His mother is very concerned because he continues to have problems with bedwetting at least three nights a week . She wants to know what else she can do; her son’s best friend is having a sleep-over party in a few months, but he is too embarassed to go.

1. What are some of the important initial questions to ask? 

2. What is the first line and most effective therapy for this problem? What is second line?

Your next patient has daytime wetting.

3. What are the two general categories of problems that cause daytime wetting?

4. Regardless of category, what are the initial steps in management?

Cases by Dr. Pisano