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Bedwetting & Soiling: enuresis & encopresis
Young children do not yet have the words, or the means of thought, that adults rely on to make sense of what troubles them. What they cannot yet think or say, they often express through the body: the mind's distress finds its voice in physical symptoms. Difficulties with bladder and bowel control are a common example, when a child still wets the bed, or soils their underwear, at an age when they would be expected to be clean and dry, usually by around three and a half.
These symptoms are never simply a matter of toilet training. Each carries a meaning of its own, unique to the child, and that meaning deserves to be heard.
Enuresis: a symptom, not an illness
Enuresis refers to involuntary wetting that persists, or returns, beyond the age at which a child would normally have gained mastery of this function, most often during sleep. It is common, and among the most frequent reasons parents seek advice about their child.
Bladder control is not simply acquired as the body matures. It also depends on how the child invests these functions emotionally, as a source of pleasure and mastery but also of anxiety, and on the relationship with the parents. Bedwetting therefore has no single meaning: it speaks to a difficulty that belongs to each child.
What is perfectly ordinary in a toddler only becomes a symptom with time. To reduce it to a single explanation would be to lose sight of the child behind it.
Encopresis: a matter of holding on
Encopresis refers to the repeated passing of stools in inappropriate places, usually in the underwear, beyond the age at which a child would normally have gained mastery of this function. It is less common than enuresis and occurs more often in boys.
Contrary to a widespread assumption, children with encopresis are rarely unable to hold on. More often, it is precisely the holding back of stools that lies at the heart of the difficulty. For a young child, the choice between letting go and holding on is one of the very first ways of asserting oneself in relation to others. Toilet training is the moment when the child discovers that they can comply or refuse, and say "no". Gaining control of one's body in this way is also how a child discovers that their body is their own.
This stage can turn into a genuine battle of wills between parents and child.
Encopresis is still surrounded by a great deal of shame. Families often keep it hidden, which can leave both the child and those around them in considerable distress.
FAQ
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Children play out, act out or show through the body what they are not yet able to think or put into words. The symptom may reflect unhappiness, anger, defiance, sadness or difficulty with separation.
It sometimes reappears in a child who had already been clean and dry, in the wake of an event such as the birth of a sibling, a move, a parental separation or a bereavement. Returning to an earlier way of being can then become a means of reclaiming a place, a closeness or a sense of security that seemed to have slipped away.
Paradoxically, the symptom can also be a way of staying connected with others, even if it means provoking their anger.
There is no single meaning to be found. Only by listening to the child and the family can we begin to understand what the symptom is saying.
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Every child gains bladder and bowel control at their own pace. A symptom that lingers beyond the usual age deserves attention, as does its return in a child who had previously been clean and dry. It is never too early to seek advice: the sooner support is offered, the less likely the symptoms are to become entrenched or to worsen.
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Yes. Any organic cause, whether sphincteric or neurological, needs to be ruled out first, along with possible constipation. The most helpful assessment considers the child from both a medical and a psychological perspective. When no organic cause is found, paediatricians and family doctors often refer the child to a psychologist.
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A consultation is called for when the symptom persists over time, when the child begins to think poorly of themselves, when relationships become more strained, or when night-time wetting is joined by daytime accidents, or even soiling: the symptoms then multiply and intensify.
Family life may also come to revolve around the symptom, with attempts at control, broken nights, exhaustion and growing tension between parents and child. The child feels guilty and may begin to see themselves as a "bad child".
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Keep a sense of proportion and steer clear of punishment, bargaining and pressure, which only fuel the battle around the symptom without making it go away.
Try not to let family life organise itself around the symptom: constant checking, monitoring and waking the child at night rarely help, and may even keep it going.
Put simple, truthful words to what the child is going through, to help them make sense of their feelings.
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A first meeting with the parents, usually without the child, allows us to assess the situation and consider whether therapy is indicated.
Psychotherapy offers the child a space in which to speak and think freely, where what was expressed through the body can gradually be put into words.
The parents’ involvement is essential: a child’s symptom is always part of a family story, and progress is often made together with them. Parallel support for the parents may also be offered.
References: G. Schmit and M. Soulé, « L'énurésie infantile », and M. Soulé, K. Lauzanne and B. Colin, « Les troubles de la défécation », in Nouveau traité de psychiatrie de l'enfant et de l'adolescent, PUF, 2004; S. Muths, « L'analité de la honte », Cahiers de l'enfance et de l'adolescence, 2019; M. Guittonneau-Bertholet, « L'encoprésie, une lutte à corps perdu », Cliniques méditerranéennes, 2021; M. Ferrazzi, « Le transfert dans la cure de garçons présentant une énurésie primaire », Analyse Freudienne Presse, 2012.