1. Wetting
    1. Definitions
      1. Variations
      2. Problems
      3. Disorders
    2. Key Points
      1. Toilet training
        1. Classification
        2. Epidemiology
        3. Etiology
    3. Clinical Guides
      1. History
      2. Physical Exam
      3. Laboratory
    4. Differential Diagnosis
      1. Primary Enuresis
      2. Secondary Enuresis
    5. Management
      1. Toilet training/Toilet learning
      2. Nocturnal Enuresis
        1. Principles for all wetting treatments
        2. Dryness suggestion technique: First choice intervention
        3. Conditioning alarm: second choice intervention
        4. Pharmacotherapy: Third choice intervention.
        5. Self-hypnosis/Hypnotherapy (See Dryness Suggestion)
        6. Dietary
      3. Diurnal Enuresis
  2. Encopresis
    1. Definitions
      1. Variations
      2. Problems
      3. Disorders
    2. Key Points
      1. Toilet Training for Stool
        1. Stool_training
          1. Symptoms
          2. Physical Exam
          3. Encopresis predisposing factors
          4. Prevalence
          5. Etiology
          6. Tests
          7. Psychogenic
          8. Prognosis
    3. Differential Diagnosis
    4. Management
      1. Prevention
      2. Toilet fears
      3. Stool refusal
      4. Encopresis - retentive type
      5. Laxatives
      6. Encopresis - non-retentive type
      7. Outcome Retentive Type
  3. Citations
  4. Readings for Parents



According to the Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version (Wolraich, M. (Ed.) 1996) , the following are the definitions for Wetting variations and problems:


V65.49 Day or Nighttime Wetting Variation

Enuresis is a normal developmental variation until early school years. Daytime wetting may reflect a child's preoccupation with play, "forgetting" to go to the toilet, or fear of the toilet. Bladder capacity increases as a child gets older. Secondary transient wetting may stem from minor stress or temporary behavioral regression and is associated with birth of a sibling.

Parent text for preschool and school aged children.


V40.3 Wetting Problem

Wetting is a problem if a child is beginning to be teased by peers or starting to avoid social encounters, or the wetting causes parent-child interactional problems but the symptoms are not sufficiently intense to qualify for the diagnosis of enuresis.

Parent text for preschool and school aged children.


According to the Diagnostic and Statistical Manual of Mental Disorder-Fourth Edition (DSM-IV) (American Psychiatric Association 1994) , the following are the definitions for the Enuresis Disorders:

307.6 Enuresis (Not Due to a General Medical Condition)

  1. Repeated voiding of urine into bed or clothes (whether involuntary or intentional)
  2. The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairments in social, academic (occupational), or other important areas of functioning.
  3. Chronological age is at least 5 years (or equivalent developmental level)
  4. The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder)
Specify type:
Nocturnal Only: passage of urine only during nighttime sleep.
Diurnal Only: passage of urine during waking hours.
Nocturnal and Diurnal: a combination of the two subtypes above

Parent text for pre-school and school aged children.

Key Points

Toilet training[note]


  • Classification of enuresis may be by time of occurrence and /or age of onset both
  • Fewer than 10% of nocturnal also have diurnal; most diurnal have nocturnal


  • Nocturnal: 7% of 8-year-old males with a decrease of 1% per year; Males 1.4:1 Females

Clinical Guides

See: Clinical Guide Algorithm

Latest research on Wetting


Toilet training history if primary
In young child recently trained- what were clues of readiness before training?, Was training coercive?, ask about new siblings, recent stresses, signs of readiness, how complete training had been
Onset- determine if primary or secondary.
Trigger questions: Was he ever dry? Was there ever a stretch of 6 months when he was dry? How long ago did he start wetting?
diurnal or nocturnal, what times during the night, circumstances eg only at home vs overnights with relatives or friends
  • If diurnal, under what circumstances
    • Stress related? eg only in math class when stressed
    • Too busy? Only when playing
    • Frequency as in diabetes eg every 1 hour vs once a day
  • If nocturnal, determine pattern
    • Just before arising while still in bed-> behavioral
    • Only during first 120 minutes of sleep-> deep sleep cycle, excess evening intake
    • Only at home -> less likely to be organic if controlled by lighter sleep
eg Leak pattern eg dribbles (poor hygiene, UPJ valves, vaginal reflux) vs floods pants
Motivation/perception by child
Trigger questions: How bad is this wetting for you? Has anyone teased you about it? How would your life be different if you didn't wet? Do you want to stop wetting?
Trigger questions: How are things going for you? What has changed in your life recently? Do you feel stressed or nervous about anything?
Parent perception and management
Trigger questions: What do you make of his wetting? What have you tried to do about it? What have other people said to you about it?
Family History:
age of parents when dry, anyone else who wet to an older age History of kidney problems, UTI in the family
Voiding history:
Frequency (>6 voids/waking part of day)
Urgency, dysuria, history of UTI
Stream: intermittent, weak, split, staccato, hard to start
Posturing or squatting to start stream
Stool pattern for signs of constipation
eg hard, painful, infrequent (3 days between stools), very large, soiling (See also: Constipation PT)
Sleep pattern
snores, restless, very deep sleeper, apnea, ease of arousal, exhausted
Food allergies and relation to wetting
Signs of diabetes
polyuria, polydipsia, weight loss, fatigue, new onset bed wetting

Physical Exam

Physical exam usually normal. Check abdomen for masses, genitals for abnormalities, hymen integrity for abuse/sexual activity, perineal sensation/anal wink, lower spine for dimple or skin abnormality, ankle reflexes. Watch child void if story of abnormal stream.


Urinalysis for UTI, DM, renal disease
Culture in girls or if abnormal UA
If indicated by history: sickle prep, urine concentrating ability eg first am void specific gravity
Renal workup of Ultrasound, VCUG (including spine film) in: adolescents; neurologically abnormal; current or past UTI; severe daytime frequency; persistent daytime enuresis associated with poor stream; encopresis with very infrequent daytime urination
Urological evaluation in: vesicoureteral reflux; hydronephrosis; thickened unstable bladder; posterior urethral valves

Differential Diagnosis

Primary Enuresis

Lack of readiness in young child
Mental retardation
Structural GU abnormality
Posterior urethral valves
Ectopic ureter
Functional renal disorder
Sickle cell disease
Concentrating defect
Metabolic disorder
Diabetes mellitus
Diabetes insipidus
Neurological abnormality
Spina bifida (not occulta)
Tethered cord
Spinal cord tumor
Degenerative neurological disorder
Seizure disorder
Medications increasing urine output eg diuretics, caffeine, theophylline
Sexual abuse

Secondary Enuresis

Stress reaction
Sexual abuse
Metabolic disorder
Diabetes mellitus
Diabetes insipidus
Psychogenic over drinking
Functional renal disorder
Sickle cell disease
Concentrating defect


Toilet training/Toilet learning

  • Toilet training can be frustrating and confusing[note] (See also: Normal Toilet Training pt.)
    • Bring up toilet training early enough in health supervision to head off starting too early e.g. discuss it at 12 months
    • Caregivers and relatives put pressure on themselves and the child. Find out "Who has something to say about toilet training your child?" and get them in for a visit if necessary
    • Set backs, accidents, and relapses are the norm. Compulsive or neat caregivers may have special trouble with this. Ask "What is it like for you when s/he has an accident?" and "How would you like to react in this situation?"
  • Strategies for toilet training[note] (See also: Is My Child Ready? pt)
    • Wait for readiness. Short version- signals before voids in diaper. Long version- dry for 3 hours and across naps, follows two step commands, walks, climbs on toilet, pulls pants up and down, is generally cooperative, no other recent or expected stresses such as new sibling
    • Accustom to potty chair in clothes
    • Accustom to potty chair naked
    • Demonstrate use of toilet by adult. Take contents of diaper, dump in potty, then dump into toilet
    • Sit on potty after meals
    • Celebrate anything done in potty
    • Avoid shaming accidents
    • Avoid use of pants until clean and dry for at least one week
  • Toddlers who resist toilet training[note] (See also: Toileting Resistance pt)
    • The most common reason for resisting toilet training is general oppositionality.
    • For all struggles over toilet training start by stopping all efforts and placing child back in diapers. Advise all caregivers and siblings to stop talking about toilet training.
    • If due to normal age/stage- postpone until more cooperative. Have caregivers act surprised if the child shows an interest.
    • If due to specific parent-child conflict- see Social Development DTW
    • If child has short attention span- sort out if there are significant symptoms for ADHD (See ADHD DTW) or temperamental tendency (See Temperament DTW) . Have caregivers make steps to toileting very brief, e.g. sit for 5 seconds accompanied then reward.
    • If child is too interested and busy to be bothered but doesn't resist - take to toilet every 1.5 hours and reward 1 candy for sitting, 2 for peeing, 3 for pooping.
  • Fear of the toilet[note] (See also: Toileting Fears pt)
    • Related to cognitive awareness of body differences but lack of understanding that body parts can't be lost. Explain that "(penis or vagina) is theirs forever, no one can take it away. When you get big like Daddy (or Mommy) you will have a big (penis/vagina) too!"
    • Place child back in diapers as first step regardless of age. Parents will need reassurance that this is necessary! Tell child "You are just not ready yet." Get all caregivers and sibs to cease talk about the toilet.
    • Most often related to painful stools in the past that generalize but may also cause constipation. Assure soft stools at least twice a day before starting to train or intervene. (See Constipation PT).
    • May relate to trauma with toilet e.g. fell in, slammed lid. Have child play with toy or real potties and slam lids playfully or have dolls "fall in", act scared and get out saying "I'm OK." Make toilet scrapbook, take toilet tours while caregivers sings, gives treats or helps child relax in other ways.
    • Restart child sitting after meals when fear is gone.
    • When child is no longer afraid of toilet but still won't sit and void, try 1 candy for sitting, 2 for peeing, and 3 for pooping. (See Tolieting Resistance pt).
    • Consider sexual abuse as reason if there are other signs such as sleep problems, aggression or withdrawal, refusal of daycare or sexual behaviors. Investigate or report as needed.

Nocturnal Enuresis

Principles for all wetting treatments

  • Treat constipation first.
  • Talk with child alone to assess motivation.
  • Don't begin treatment unless states some motivation.
  • If motivated - suggest that s/he can sleep lighter and wake up to go to toilet and return to "nice, dry bed"
  • May combine with rewards for dry nights (See Also: Night Training pt)

Dryness suggestion technique: First choice intervention

  • Type of self-hypnosis.
  • Assess child understanding of wetting and child motivation to be dry.
  • If not motivated - reappoint in a few weeks.
  • If motivated, speak with child alone about being able to sleep lighter so he can feel it when he needs to get up to pee, then void and "return to your nice, dry bed"
  • Can also try this self suggestion/hypnosis every night before going to bed. May combine with holding quarter out at arms length while thinking about waking to pee and returning to dry bed, feeling it getting warmer and heavier until it drops. Demonstrate this in the office. Provide the child this "magic quarter" and have him practice this every night (See Also: Night Training pt)

Conditioning alarm: second choice intervention

(See Also:Night Training pt)

  • 66% rate (1 year success rate 51%) (Houts, AC 1994)
  • Operant conditioning where the alarm is aversive and the conditioned stimuli is the pelvic floor or sphincter contractions.
  • Takes 3-5 months, inexpensive[note]
  • If less than 10 years old or deep sleeper may not hear alarm, so parent should wake them up leaving alarm sounding and take to bathroom, clean up, cover bed with towel, and return to bed.
  • After 14 dry nights in a row, "Overconditioning"[note]
    • The overconditionsing reduces the relapse rate from around 40% to 10-15% (if daytime symptoms, may overlearn to 60 cc water) (Morgan, RT 1978)
    • Less likely to work if stressed, behavior problems, or child is being punished for wetting

Pharmacotherapy: Third choice intervention.

  • Should not be first intervention (education, lighter sleep come first). Save medication for special occasions e.g. overnights, camp; pressure from parents you can't defuse; or child who is very upset about wetting and has failed alarm.


  • Decreases urine production overnight
  • Reduces wet nights, complete dryness in 25% (Moffatt, ME 1993)
  • Blow nose first then instill 10-40 micrograms at bedtime intranasal or 1-2 mg oral
  • Symptomatic relief, not curative. Good for special sleep overs
  • Very expensive
  • Side effects: headache, nasal stuffiness, abdominal pain. Should not be used in metabolic or neurologic disorders because of risk for water intoxication (rare)


  • Mechanism: lighten sleep enough to allow bladder filling to be detected (Blackwell, B 2004)
  • Imipramine 1-1.5 mg/kg within 1 hour before bedtime
  • Side effects: insomnia, behavior/mood changes, fatal cardiac arrhythmia if overdose
  • Symptomatic, not curative. Relapse when drug stopped.
  • Use for special occasions or in recalcitrant frequent wetters chronically
  • If response to drug, continue for 6 months, taper (may work for 43%: (Houts, AC 1994)


  • Weak evidence (milk, chocolate, citrus allergy, elimination) (Egger, J 1992)

Diurnal Enuresis

IF: Dribbles in pants, doesn't flood pants
If male, watch stream for pressure, split stream, hesitancy and refer GU if positive. If normal stream, review shaking off penis after voids.
If female: Consider vaginal reflux, esp if obese. Have child sit facing tank of toilet, wipe and rise, then sit and wipe again
IF: Floods pants
Principles for all wetting treatments: Support, Demystification, Education[note]
  • Treat daytime first and associated constipation if present
  • If waits too long then rushes to toilet: Consider presence of ADHD and treat that first
  • If lacks interest after showing ability:
    • Take to toilet every 1 1/2 hours. Reward if dry and cooperates in sitting. If wet or resists coming and sitting: grounded for the next 1.5 hours. (See Also: Day Wetting pt)
    • Give candy e.g 1 M&M for sitting when asked, 2 for urinating, 3 for being dry after 1.5 hours.
  • If normal imaging, then could be either:
  • If US or VCUG abnormal - urology referral
    • Then, treat nighttime enuresis with conditioning or pharmacotherapy after initial improvement of bladder capacity.



According to the Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version (Wolraich, M. (Ed.) 1996) , the following are the definitions for Soiling variations and problems:


V65.49 Soiling variation

The occasional passage of a small amount of feces inappropriately such that it soils the child's clothing or bedding. This situation usually will be associated with some circumstance such as not having access to toilet facilities.

Parent text preschool

Parent text school age


V40.3 Soiling Problem

This symptom is a problem if it increases in frequency or causes disruption in parent-child or peer interactions but is not sufficiently intense to qualify for the diagnosis of encopresis.

Parent text preschool

Parent text school age


According to the Diagnostic and Statistical Manual of Mental Disorder-Fourth Edition (DSM-IV) (American Psychiatric Association 1994) , the following are the definitions for the Enuresis Disorders:

Encopresis general

  1. Repeated passage of feces into inappropriate places (e.g. clothing or floor) whether involuntary or intentional.
  2. At least one such event a month occurs for at least 3 months.
  3. Chronological age is at least 4 years (or equivalent developmental level).
  4. The behavior is not due exclusively to the direct physiological effects of a substance (e.g. laxatives) or a general medical condition except through a mechanism involving constipation.

Key Points

Toilet Training for Stool



(See Also: Normal stools pt)

Physical Exam

  • Examine for stool masses in abdomen, rectal trauma or patulence or scars, stool mass in rectum, genital tears, anal wink, displaced anus (normal anus is more than 1/3 length from coccyx to posterior forchette in girls; normal is one-half way between scrotum and coccyx in boys), sacral dimple or defects, ankle DTRs and sensation in feet, gait, signs of endocrinopathy, signs of ADHD, anxiety, parent-child relationship (overcontrol Vs over indulged)

Encopresis predisposing factors[note]

  • Encopresis is usually the result of chronic functional constipation (90-95% of cases).
  • Sudden onset and excessive fear of toilet suggest sexual abuse.
  • Some homes and schools have adverse toileting situations[note] (See Also: Bathroom situation pt)
  • Nonretentive type (passing whole stools) is mostly found in severely oppositional children who require intense psychological treatment.
  • Primary encopretics had more developmental delay and enuresis.
  • Secondary encopretics had more stressors and conduct disorder.
  • Encopresis frequently occurs during physical activities such as gym class or during the walk home from school.
  • Development of chronic constipation with encopresis can be due to the pain-retention-pain cycle.
  • Low-fiber diets lead to relatively dry, small stools that are harder to pass.
  • A child's schedule may require him to ignore the urge to defecate[note]
  • Family stresses may also trigger constipation.
  • Predisposing factors[note]

Constipation(See Also: Constipation pt)

Newborn: anorectal malformations (anteriorly displaced anus, anal stenosis, imperforate anus), abnormal GI innervation (Hirschprung disease), spinal cord abnormalities (myelomeningocoele, spina bifida occulta), metabolic disorders (hypothyroidism, hypercalcemia), cystic fibrosis, and sepsis.

Infants/Toddlers: functional constipation, anal fissures, anterior displaced anus, pelvic mass, dehydration, neuromuscular disorders (cerebral palsy, hypotonia, infantile botulism, neurofibromatosis), hypothyroidism, hypercalemia, hypokalemia, cystic fibrosis, diabetes, gluten enteropathy, multiple endocrine neoplasia type 2a, anorectal malformations, Hirschprung disease, cystic fibrosis, spinal cord abnormalities (tethered cord syndrome), lead poisoning, excess milk intake

Preschoolers: functional constipation, spinal cord abnormalities (tethered cord, spinal cord tumor/trauma), Hirschprung disease, excess milk intake, low fiber diet, dehydration, malnutrition, abnormal abdominal musculature (Down, prune belly, gastroschisis)

School-aged/Adolescents: functional constipation, diabetes mellitus, depression, anorexia nervosa, irritable bowel syndrome, polyposis syndromes, abdominal or pelvic tumors, collagen-vascular diseases, hypothyroidism, sexual abuse, ADHD, tethered cord, static encephalopathy, visceral myopathies, visceral neuropathies, intestinal neuronal dysplasia, scleroderma, SLE, Ehlers-Danlos, drugs



  • 1.5% of 7-8 year olds, males: females 3:1.
  • No relation to SES, birth order or family size.


  • Stool withholding or retention result in large painful stools, loss of sensation of fullness because of bowel distension and then either overflow of liquid stool or chunks of stool working their way out of the distended rectum.
  • Parental ambivalence about the stress of toilet training can result in withholding (Spock-Bergen syndrome).



  • Psychosocial factors may produce constipation, e.g., marital conflict and traumatic experiences. A few children have psychogenic encopresis.[note]


  • 78% successfully treated with a combined clean out and behavior change approach. All improve by 16 years

Latest research on Encopresis

Differential Diagnosis


Central nervous system


Infectious diarrhea

Medications exacerbating constipation

Comorbid Conditions

See: Clinical Guide Algorithm



Toilet fears

Encopresis - retentive type


Laxatives (adapted from Schmitt BD, Mauro RO: Twenty common errors in treating encopresis. Contemp Peds May, 47-65, 1992).

Medication Dosage Comments
Miralax 1/2-1 cap q HS Mix in any liquid and let rest 15 min. Tasteless. Prescription only.
Bisacodyl 1-3 5 mg tablets/dose, 0.5-1 suppository if >2 1 q HS if >5 years; 2 if>12, up to 4 5 mg tablet or 10 mg suppository
Fletcher's castoria <5: 1-2 tsp, >5: 2-3 tsp, max 2 Tbsp 0.3 - .6 mg/kg/dose -usually 3x/day
Senekot <5: 1-2 tsp ; >5: 2-3 tsp 1 tsp= 8.8mg/5cc=3cc granules=1 tablet
Milk of Magnesium 1cc/kg/dose bid, adolescents 60cc 1/2 tsp=1 tablet
Mg citrate 1-3 cc/kg/day < 6t, 110-160 cc/day 6-12, 150-300cc/day >12, qd-bid 16.17% Mg liquid. Infants can develop Mg poisoning.
Stool softeners
Mineral oil 1-2 cc/kg/dose bid, adol. 60cc/dose, max 8 oz/day Not in GER or nonwalkers
Lactulose 0.5-1.0 cc/kg/dose bid, adol. 15 cc bid, max. 3 oz/day Prescription only. Can cause gas, cramps
Sorbitol 1-3 cc/kg/day 70% solution. Less cost than lactulose, same side effects.
Barley malt extract 2-10 cc/240 cc milk or juice Bad odor. Infants can tolerate in bottle.
Rectal suppositories
Glycerin No side effects
Dulcolax 10 mg >2: 1 pr bid
Mineral oil 1-2 oz/20 lb of weight, adol 4 oz. Maintenance: 1-3 cc/kg/day Squeeze bottle is 4.5 oz. Not < 1yr
Sodium phosphate (Fleet) 1 oz/20 lb., adol. 4 oz., max. 8 oz. Squeeze bottle: 2.25 oz children's,. 4.5 oz adult. Avoid < 2 yr
Polyethylene glycol - electrolyte solution Disimpact with: 25cc/kg/hr (1000 max) per ng until clear or 20 cc/kg/hr for 4 hr/day Maintain: 5-10 cc/kg/day Difficult to take. Nausea, bloating, cramps, vomiting, anal irritation, aspiration, pulmonary edema
Cisapride 0.2 mg/kg/dose tid or qid 1 mg/cc, 5,10, 20 mg tablets. May cause headache, abdominal pain, diarrhea, urinary frequency, cardiac arrythmias (with P450 3A4 (77) meds)

Encopresis - non-retentive type

Outcome Retentive Type

  • With an approach combining education, catharsis, prolonged laxatives and toilet sitting 78% success (Levine, MD 1976) .
  • Group therapy can enhance results in medical failures (Stark, LJ 1990)
  • Laxatives plus behavior modification is better than behavior modification alone.
  • Biofeedback training resulted in 77% normal defecation dynamics at 7 months Vs 13% in conventional treatment and 50% clinical improvement vs 16% (Loening-Baucke, V 1995) but no difference at 4 yrs.


  1. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
  2. Bakwin, H (1973). Bladder control and enuresis.
  3. Banerjee, S, Srivastav, A, Palan, BM (1993). Hypnosis and self-hypnosis in the management of nocturnal enuresis: a comparative study with imipramine therapy. .
  4. Blackwell, B, Currah, J (2004). Bladder control and enuresis.
  5. Blum, NJ, Taubman, B, Osborne, ML (1997). Behavioral characteristics of children with stool toileting refusal. .
  6. Blum, NJ, Taubman, B, Nemeth, N (20037). Relationship Between Age at Initiation of Toilet Training and Duration of Training: A Prospective Study. .
  7. Djurhuus, JC, Norgaard, JP, Rittig, S (1992). Monosymptomatic bedwetting. .
  8. Egger, J, Carter, CH, Soothill, JF, Wilson, J (1992). Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. .
  9. Eiberg, H, Berendt, I, Mohr, J (1995). Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q. .
  10. Feehan, M, McGee, R, Stanton, W, Silva, PA (1990). A 6 year follow-up of childhood enuresis: prevalence in adolescence and consequences for mental health. .
  11. Hallgren B (1956). Enuresis: a clinical and genetic study. .
  12. Houts, AC, Berman, JS, Abramson, H (1994). Effectiveness of psychological and pharmacological treatments for nocturnal enuresis. .
  13. Kaffman, M, Elizur, E (1977). Infants who become enuretics: a longitudinal study of 161 kibbutz children.
  14. Kass, EJ, Diokno, AC, Montealegre, A (1979). Enuresis: principles of management and result of treatment. .
  15. Koff, SA (1983). Estimating bladder capacity in children. .
  16. Kuhn, BR, Marcus, B, Pitner, SL (1999). Treatment Guidelines for Primary Nonretentive Encopresis and Stool Toileting Refusal. .
  17. Levine, MD, Bakow, H (1976). Children with encopresis: a study of treatment outcome. .
  18. Loening-Baucke, V (1995). Biofeedback treatment for chronic constipation and encopresis in childhood: long-term outcome. .
  19. Moffatt, ME, Harlos, S, Kirshen, AJ, Burd, L (1993). Desmopressin acetate and nocturnal enuresis: how much do we know?. .
  20. Morgan, RT (1978). Relapse and therapeutic response in the conditioning treatment of enuresis: a review of recent findings on intermittent reinforcement, overlearning and stimulus intensity. .
  21. Nolan, T, Oberklaid, F (1993). New concepts in the management of encopresis. .
  22. O'Regan, S, Yazbeck, S, Hamberger, B, Schick, E (1986). Constipation a commonly unrecognized cause of enuresis. .
  23. Stadtler, AC, Gorski, PA, Brazelton, TB, Toilet Training Methods, Clinical Interventions, and Recommendations (1999). . .
  24. Stark, LJ, Owens-Stively, J, Spirito, A, Lewis, A, Guevremont, D (1990). Group behavioral treatment of retentive encopresis. .
  25. Wille, S (1994). Nocturnal enuresis: sleep disturbance and behavioural patterns. .
  26. Wolraich, M. (Ed.) (1996). Diagnostic and Statistical Manual for Primary Care (DSM-PC): Child and Adolescent Version.
  27. Zaleski, A, Gerrard, JW, Shokeir, MHK (2004). Bladder control and enuresis.

Readings for Parents

Toilet Training in Less Than A Day, by Nathan H. Azrin and Richard M. Foxx, Pocket Books, 1989

Edutainment video for children: It's Potty Time, Learning Through Entertainment Inc., 1-800-23POTTY


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