Enuresis is a disorder of wetting the bed or clothing. As with many developmental disorders, it is not unusual to find enuresis coexisting with Asperger’s Disorder. Primary enuresis is found in children who have never been dry for longer than six months. Secondary enuresis occurs in children who have achieved dryness for at least six months and then begin to wet themselves. Nocturnal enuresis is more commonly known as bedwetting, while diurnal enuresis occurs during the waking hours. Encopresis involves bowel movements outside the toilet in children age four or older. This is far less common in all children, including those with Asperger’s Disorder.
Children and teens understandably do not like to admit to toileting problems, and therefore we do not know the number of children and teens with enuresis and encopresis. Studies estimate that at age five years enuresis affects 5–10 percent of all children, with the majority being boys. The incidence drops significantly with age. By age ten, it affects 3 percent of boys and 2 percent of girls. About 1 percent of adolescents still experience enuresis. Encopresis is present in only 1 percent of five-year-olds and, as with enuresis, is more common in boys. Enuresis has very strong family ties, with 75 percent of those affected having a first-degree biological relative who also had the disorder.
Children eventually outgrow enuresis and encopresis even without treatment. However, years of frustration between parent and child can have a very negative effect on the relationship and the child’s self esteem. Having enuresis or encopresis is associated with a higher incidence of coexisting behavioral symptoms. Many children who bedwet avoid sleepovers and overnight camps due to fear of being discovered by their peers as a bedwetter, which typically results in devastating ridicule and humiliation that is difficult to overcome even after the problem no longer exists.
The emotional consequences of enuresis and encopresis make treatment necessary. However, no psychotherapy should be started until medical clearance is obtained by a pediatric urologist and/or gastroenterologist who can ensure there are no physical causes to the wetting or soiling. If physical causes are ruled out, emotional causes need to be considered. Anxiety, changes in the family, and emotional trauma are commonly seen in children with secondary enuresis and encopresis.