Elimination Disorders | BH360

My child may have an elimination disorder, now what?

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Education

Kids with elimination disorders have a hard time controlling their bladder or bowel movements. They might have accidents, even after they have learned to use the bathroom, or they might have trouble with potty training to begin with. There are two types of elimination disorders:

Enuresis: kids wet themselves (either on purpose or on accident). This can happen during the day, only at night, or both.

Encopresis: kids poop in places they aren’t supposed to (either on purpose or on accident).

Elimination disorders can make kids feel worried or sad, feel badly about themselves, or even cause other problems with behaviors. It’s normal for kids (especially under age four) to have accidents sometimes, and it’s normal for many kids to occasionally have trouble wetting the bed at night when they’re older. But if they can’t seem to control their bladder or bowels, are having accidents more than once, or are unable to participate in things because of problems going to the bathroom when they should, they might have an elimination disorder.

Usually, elimination disorders aren’t caused by just one thing – there are a few factors that can make it more likely that a child will struggle with enuresis or encopresis.

Environment: kids who never learned how to listen to their body’s signals about needing to go to the bathroom might have these types of issues even after they were potty trained the first time. Kids can also have enuresis or encopresis if parents tried to potty train them before they were ready or if they have a hard time focusing on clues that tell them they need to pee or poop. It’s important for parents to teach kids to listen to their body’s signals. Kids can also have problems with elimination if they have recently experienced stress or something traumatic, so it’s good to let your provider know about any recent changes or difficulties in your child’s life.

Medical problems: there are also medical reasons why kids might have elimination disorders. Kids who struggle with encopresis (bowel movements they can’t control) often have a history of being constipated and having pain or discomfort when they poop. Kids who struggle with enuresis might have a similar history of bladder infections. When kids have had pain before when going to the bathroom, they might get scared and try to avoid peeing or pooping. But when they try to hold it for too long, the muscles in their body get tired and stretched out, and they usually end up having accidents as a result. It’s important to make sure your child feels comfortable using the bathroom. Making sure they are drinking enough water and eating healthy (especially making sure they eat enough fiber to avoid being constipated) can help avoid these types of problems.

Personality: some kids might be anxious or worried about things related to going to the bathroom. Maybe the sound of toilet flushing makes them scared, or they are worried about germs in the bathroom, or they don’t want to be separated from parents or caregivers when they use the bathroom. Ask your child if they feel nervous about being in the bathroom and see if there’s anything you can do to help them feel more relaxed.

There are a lot of things that you can do to help your child who struggles with enuresis or encopresis – and you’re already taking a big step by learning more! Many kids & parents see a lot of improvement with the right support. Here are some treatments that scientists have found to help with elimination difficulties:

EDUCATION

Understanding what causes elimination problems can help kids not feel ashamed about what’s going on, and can also help parents understand how to help them. It’s stressful and upsetting when your child has accidents, and it’s important to make sure you know what is causing this behavior in order to help fix it.

BEHAVIOR TRAINING (ENURESIS)

Therapists work with the child and their family to help them learn to control their bladder. For kids with enuresis that happens at night, this sometimes involves using an alarm like this one that wakes your child up when they start to pee at night. For kids with enuresis that happens during the day, a therapist might help the family develop a plan for them to go to the bathroom more often at scheduled times. Sometimes a reward system can help encourage kids and help them make progress with bladder control.

MEDICAL SUPPORT (ENCOPRESIS)

Kids with encopresis might need to see a doctor to make sure they’re not constipated and holding in their bowel movements. Doctors might give your child some medicine to help them poop and make sure they aren’t constipated and in pain when they try to poop. Once their treatment team is sure they are able to have a bowel movement without pain, they might work with kids and families to develop a schedule for your child to sit on the toilet and try to poop every day.

BEHAVIOR THERAPY

Therapy can be helpful for many kids with elimination disorders, both to help kids understand why they started having these problems, and to help kids deal with shame and embarrassment they might feel about not being able to control their bladder or bowels. Especially if you think your child might have an elimination disorder that was caused by stress or trauma, it’s important to have them talk to a therapist about what’s going on, make sure they are safe, and help them find ways to understand and cope with their emotions.

Elimination disorders are problems kids can have with going to the bathroom and having accidents, even after they are old enough to use the toilet. Explore the questions below to learn how to recognize the signs, understand what causes it, and discover effective treatment options.

Understanding Elimination Disorders

Elimination disorders happen when kids are unable to control their bladder (enuresis) or are unable to control their bowel movements (encopresis). These problems can happen during the day, at night, or both. Elimination disorders often go away as kids get older, but it can make kids feel sad, ashamed, and embarrassed when they have these problems. As a parent, it’s important to think about whether your child’s accidents are unusual for their age or prevent them from participating in things. It’s also important to know if anything stressful or traumatic has happened in their life that might have caused these problems. If you’re concerned, talk to a professional to figure out what’s going on and find new ways to help your child. With the right support, most kids are able to fully recover from elimination disorders and participate in all the fun things that kids do without worrying about having an accident!

Getting support for elimination disorders starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.

There are a few ways to get diagnosed with an elimination disorder. Here is how you can get started:

Talk to your child’s pediatrician. Medical doctors can be especially helpful with elimination disorders because they can help figure out if there is a medical reason that your child is having trouble with bladder or bowel control. They might ask you some questions about how often your child is having accidents, where they are when accidents happen, and if your child is having accidents during the day, at night, or both. They might also examine your child or run some tests to make sure your child is healthy. If your child’s doctor thinks that their elimination disorder is related to stress, trauma, or other mental health concerns rather than a medical reason, they can refer you to a mental health professional to help.

Ask a mental health professional. If your child’s doctor tells you there is no medical reason for problems with elimination, it’s time to talk to a mental health professional too. A therapist can work with your child to figure out what might have caused their problems and what parents can do to help them. It’s important to find a therapist who works with young children and understands behavior therapy, because not all therapists have experience in elimination disorders.

Click here to find a provider.

Work with your child’s school. If your child is old enough to be in school and if they are having accidents when they are at school, they might need some extra help in the classroom while they are getting treatment for an elimination disorder. Talk to your child’s school to figure out what might help them – for example, the school might be able to offer them more frequent breaks or remind them to use the bathroom during the day. Sometimes kids with these types of disorders benefit from formal accommodations at school (these are usually called IEP’s or 504 plans). Whether your child’s elimination disorder is caused by medical reasons or mental health concerns, they can qualify for accommodations – don’t be afraid to ask! And if you’re not already doing so, make sure your child is prepared in case they have an accident at school – send an extra outfit or pair of underwear along in case of an accident, and make sure your child knows who they can talk to at school if they have an accident and need help cleaning up.

Click here to learn more on how to talk to your child’s school.

BEHAVIOR TRAINING

Using the bathroom is a learned behavior, and kids who are having trouble with this often do well with behavior changes. This can include things like rewards when your child is able to control their bladder or bowels (lots of parents use sticker charts for this reason when they first start to potty train their kids). Behavior training can also include the use of nighttime alarms to help your child realize when they are wetting the bed. Some providers do bladder training for enuresis, which involves having your child drink a lot of liquids and then wait to use the bathroom until their bladder is very full. Sometimes for nocturnal enuresis (wetting the bed at night), treatment can be as simple as drinking less fluids right before bed.

THOROUGH POTTY TRAINING

Sometimes kids with enuresis or encopresis were never really potty trained to begin with. That’s not necessarily your fault as a caregiver – some kids need more time or different strategies to figure this out, and some kids aren’t ready for potty training until they’re a little bit older. It can be hard to figure out how to teach kids to use the bathroom! It’s so normal for most adults, we don’t even think twice about it, but young kids have never done this before and might need a lot of support. There are some good online classes and resources about potty training that you can look at (like this one) and you can also ask your child’s doctor or therapist what they recommend. Remember, every child is different, and what works for one kid might not work as well for another.

This article helps explain the basics of potty training and how to know when your child is ready to start potty training.

COMPREHENSIVE APPROACH

It’s important to make sure you’re addressing all the things that are contributing to your child’s elimination disorder. If your child has medical concerns, make sure you have a medical doctor on your treatment team. If your child has experienced stress or trauma, make sure you have a mental health professional working with them. If treatment doesn’t seem to be working, talk to your provider and ask if there is anything else that they might be missing, and see who else could be an important part of your child’s care team.

Advocating

for Help

Getting the right support for your child who has an elimination disorder can feel overwhelming, but you don’t have to do it alone. This section guides you through how to start the conversation with professionals, understand what a thorough assessment looks like, and recognize key treatment components that make a difference. You’ll also find practical tips for working with your child’s school to secure accommodations and how to find the right providers to support your family’s unique needs. We’re here to help you confidently advocate for the care your child deserves.

Progress

Over Time

Once your child has been diagnosed and is getting treatment, there are still more ways you can support them – and yourself. Here are some next steps to consider:

Read helpful books. There are some excellent, practical reads written for parents like you.

“Encopresis – you can beat it! Game changing solutions for toilet anxiety, soiling, and constipation in children” by Dr. Baruch Kushnir

“The M.O.P. Book: The Proven Way to STOP Bedwetting, Daytime Enuresis, Encopresis, and Chronic Constipation in Toddlers Through Teens” by Steve Hodges, M.D.

“Emma and the E Club: An Epic Episode About Eliminating Enuresis and Encopresis” by Suzanne Schlosberg
“Encopresis Workbook: Family Therapy Techniques for Overcoming Encopresis, Soiling, and Constipation in Children” by Julio Matti

Avoid shaming & blaming. It’s frustrating when your child has accidents, and it’s easy to get upset or angry – especially when you feel like they should be old enough to use the bathroom by now! However, we know that feeling shame or embarrassment won’t help kids with enuresis or encopresis get better, and it might even make their behaviors worse. Do your best to avoid getting upset with your child and respond as calmly as you can when they have an accident. Remember – most kids are able to get better and stop having accidents, it just takes some time. Praise the small victories – maybe your child went half a day without having an accident, or was on their way to the potty when they wet their pants. Even if it’s not perfect, offer praise for any good things that happen!

Make cleanup easier. Even after they start treatment, your child is probably going to have some accidents and it might be a bit before they use the bathroom every time they need to. Do what you can to make cleanup easier when they do have an accident – if your child wets the bed at night, make sure you have a waterproof mattress protector or towel underneath them to make things easier on yourself. If your child has accidents during the day, consider getting them thicker underwear for a period of time until they learn to control their bladder or bowels a bit better. Pack extra clothes and wet wipes when you’re out of the house. Figure out what’s realistic for your family to manage the mess.

It’s hard to see your child struggling, especially when it feels like things are getting more intense, not better. You’re not alone—and there are steps you can take to get support and stabilize things.

Start with your child’s provider. Let them know what’s changed. Sometimes therapy needs to be more frequent or focused differently, or something needs to be changed in your child’s routines or environment. Be specific about what you’re seeing: more aggression, bigger meltdowns, school issues, more frequent outbursts, etc. This will help your provider to identify areas of change that might help your child.

Make sure you’ve ruled out medical reasons. Ask your child’s provider if there are any possible medical explanations that they could have missed. Your child won’t be able to change their behaviors if there is something wrong inside their body that is making it impossible for them to use the bathroom and control their bladder or bowels.

Look at the behavior patterns. Figuring out when and where accidents are happening can tell us a lot about what’s going on. If your child is only having accidents at school, maybe there is something specific about their school day that needs to be addressed. If your child only has accidents at night, treatment will look different from another child who can’t control their bladder during the day. Work with your child’s providers to see if there are any patterns that might give you more information about what’s going on.

Your child spends a big part of their day at school—so it’s important that their learning environment supports their needs. You don’t have to be an expert in education law to advocate for your child. Here’s how to get started:

Request a meeting with the school. If your child already has a 504 Plan or IEP, you can call a meeting anytime – not just during annual reviews. Share your concerns, ask for updates, and discuss if changes need to be made. If your child doesn’t have a plan yet, you can formally request an evaluation to see what supports they qualify for.

Bring data and observations. Schools respond best to clear examples. Keep track of patterns—like missed assignments, behavior changes, or stress around certain subjects. You can also ask your provider to write a summary of concerns or diagnoses to share.

Learn about your rights. Resources like Wrightslaw explain special education laws in parent-friendly language. Knowing your rights helps you feel more confident in meetings and ensures your child gets what they’re entitled to.

Explore tools from other parents. Understood.org and wapave.org is a great website full of free tools, templates, and stories from families navigating similar school challenges. It can help you figure out what to ask for and how to phrase it.

Consider getting extra help. A behavioral health consultant or educational advocate can go to meetings with you, help interpret school evaluations, and suggest goals that actually match your child’s needs. This kind of support can make a big difference—especially if meetings feel overwhelming or you’re not sure what to ask for.

his section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.

You’re doing great work. Just by showing up and staying engaged, you’re already well on the journey of supporting your child. This path isn’t always easy—it can feel like a long hike with ups, downs, and unexpected turns—but you’re not walking it alone. This section offers a few extra tools to carry with you as you go: ideas for building on the care your child is already receiving, support for when things feel like they’re getting harder, and guidance for working with your child’s school. Whether you're exploring advanced behavior strategies, needing help during a rough patch, or advocating for better support at school, these resources are here to help you keep moving forward. Every step counts—and you’re already making meaningful progress.

Progress Over Time

Advocating For Help

Parent Toolkit

Caregiver Tool Kit

This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.

Reduce feelings of shame

While most kids eventually learn to manage their bladder and bowels, kids who struggle with elimination disorders might take longer to manage feelings of shame and low self-esteem that started because of these problems. As a parent, it’s always important to look for what your child is doing well, especially when they’re struggling in a certain area. Continuing to tell them that you are proud of them, that you see how hard they are working, and that they are loved by you and by others is so important and can help them focus on all the great things about them, even when they’re struggling. Spend some extra time with them if you can and respond as calmly as possible when they have an accident. They’ll learn that you’re there for them, no matter what.

Model healthy habits

Because elimination disorders are related to things that happen in our bodies, it’s extra important to focus on healthy habits and making sure your child’s body is working as well as it can be. Eating healthy foods (with fiber: like fruits, vegetables, and whole grains) as a family can help your child avoid being constipated. Drinking lots of water helps your child learn when their bladder is full and helps their bowel movements too. Exercising helps their body work smoothly and can also help with pooping. If you do these things, your child is likely to follow in your footsteps and start these healthy habits early! You can also model listening to your body and using the bathroom. For example, you could say to your child “I feel like I might have to pee – I’m going to go sit on the potty and try now!” This helps your child understand how other people listen to their bodies, and eventually learn to do the same.

Teach kids about their bodies

Sometimes kids are scared of things they don’t understand. If they understand why their body poops and pees and how important those things are to helping their body work properly, they might be more willing to use the bathroom regularly on their own. You could find a funny, educational video to show them about their digestive system and how their body works, or you could have them color a picture of their body and show them what parts of the body help process the things they eat and drink.

Parenting a child with an elimination disorder is a big (and sometimes messy!) job. It’s okay to ask for help, and it’s good for your child to learn that they can also ask others for help when they need it!

Blame the behaviors. Your child may have a lot of accidents, and this can be frustrating and difficult for parents. Take a minute and remind yourself that this is a struggle for your child too, and that they are still learning to control their body. You and your child are a team fighting these symptoms together.

Be realistic about what you can do and prepare for the worst. If your child continues to wet the bed every night, make sure you have clean bedding handy and put something under them when they sleep to protect their mattress. If they have accidents at school, send an extra outfit or two along to keep in their classroom or in the nurse’s office. Be as prepared as you can be so that accidents don’t catch you off guard and stress you out any more than is necessary!

Clean up together. Depending on your child’s age, involve them in the cleanup process after an accident so they can understand the consequences of these behaviors. Make sure you’re not doing this in a mean or punishing way, but calmly asking them to grab another pair of underwear or put a new blanket on their bed can involve them in the process and remove some of the effort from you.

Reward yourself when things go well. If you choose to use rewards to reinforce your child’s behavior, add things that are fun for you too. When your child makes it through the day without an accident, maybe you both go out for a special treat together, spend some time at your favorite park, or enjoy a movie together. You’re in this together, and a win for them is a win for you too!

Supporting a child with an elimination disorder takes patience, creativity, and a strong set of tools. This section offers practical strategies you can use at home—like building routines, improving communication, and finding your child’s strengths. You’ll also find tips for coaching your child as they build new skills, promoting healthy habits, and taking care of yourself along the way. You don’t have to do it perfectly—you just have to keep showing up. This toolkit is here to help make the journey a little easier, one step at a time.

What will I notice in my child?

What causes elimination disorders?

Treatments that work for elimination disorders?

How to get help

If my child has an elimination disorder, what treatment components should I ask my provider about?

My child has a diagnosis, now what?

My child is getting worse, what can I do?

Talking with my child’s school

Daily Habits That Help

Caregiver Self-Care

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