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Clinical Atlas Prestige · Evidence-first

Psych VivasChild and adolescent psychiatry — elimination disorders

Psych Vivas · Child and adolescent psychiatry — elimination disorders

Elimination disorders — structured clinical viva

Fellowship viva on enuresis and encopresis: nosology, assessment, NICE/AACAP/ICCS enuresis care, ESPGHAN constipation pathway, safety.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CAMHS registrar. A GP refers a 7-year-old with lifelong night wetting and school soiling. Parents want 'the bedwetting tablet' and have been punishing wet nights. Discuss classification (DSM/ICCS), the enuresis triad, alarm versus desmopressin, retentive encopresis management, medication safety, and non-punitive care.

Interpretation

Reveal interpretation

This is a school-age child with likely primary MNE plus retentive encopresis (constipation with overflow), complicated by punitive parenting and social stigma — not a simple "naughty" behaviour problem.[1][2][6]

Classification soundbites. Enuresis age ≥5; encopresis ≥4. Primary vs secondary; nocturnal/diurnal; ICCS MNE vs NMNE. Encopresis with vs without constipation and overflow.[1][2]

Mechanism soundbite. Enuresis triad: nocturnal polyuria, reduced bladder capacity/overactivity, impaired arousal. Encopresis cycle: withholding → impaction → overflow → shame → more withholding; bowel–bladder interaction worsens wetting.[6][8]

Management soundbite. Stop punishment; clear and maintain the bowel (disimpact + PEG + toileting programme). Alarm for cure; desmopressin for short-term dryness with fluid restriction; imipramine last-line toxicity. Screen ADHD and school bullying.[3][4][5][6][7]

Safety soundbite. Desmopressin hyponatraemia; imipramine overdose/cardiac risk; organic red flags in secondary presentations.[5][7]

Key points

Alarm vs tablet

Alarm for durable cure; desmopressin for camps/sleepovers — not interchangeable goals.

Soiling is often overflow

Most encopresis is constipation with overflow; treat the bowel.

Never punish continence symptoms

Punishment worsens withholding, shame, and treatment failure.
[3] [4] [6]

References

  1. [1]Fritz G, Rockney R, et al. Practice parameter for the assessment and treatment of children and adolescents with enuresis J Am Acad Child Adolesc Psychiatry, 2004.PMID 15564822
  2. [2]Neveus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society J Urol, 2010.PMID 20006865
  3. [3]Nunes VD, O'Flynn N, Evans J, Sawyer L Management of bedwetting in children and young people: summary of NICE guidance BMJ, 2010.PMID 20980375
  4. [4]Caldwell PH, Codarini M, Stewart F, Hahn D, Sureshkumar P Alarm interventions for nocturnal enuresis in children Cochrane Database Syst Rev, 2020.PMID 32364251
  5. [5]Hahn D, et al. Desmopressin for nocturnal enuresis in children Cochrane Database Syst Rev, 2025.PMID 40728007
  6. [6]Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN J Pediatr Gastroenterol Nutr, 2014.PMID 24345831
  7. [7]Caldwell PH, Sureshkumar P, Wong WC Tricyclic and related drugs for nocturnal enuresis in children Cochrane Database Syst Rev, 2016.PMID 26789925
  8. [8]Butler RJ Childhood nocturnal enuresis: developing a conceptual framework Clin Psychol Rev, 2004.PMID 15533278