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Continence difficulties

Many children experience difficulties with continence such that they are not fully in control of their wee (daytime or night-time enuresis) or poo (constipation, encopresis or faecal incontinence/soiling). A high percentage of children with these continence difficulties also show emotional or behavioural problems. Many children with continence difficulties experience a sense of distress and failure. Studies show that continence difficulties negatively affect children’s self esteem and confidence and their social situation. There is also a correlation between some continence difficulties and significant behaviour problems.


Continence problems are also stressful for parents and adversely affect the parent-child relationship. As children become older parents may become less tolerant and more frustrated leading to increased levels of stress. Studies show that successful treatment of the continence problem will improve the child’s self esteem and emotional development, but the catch is that the best predictor of good adherence to treatment is positive self-esteem and low levels of stress.


As a psychologist who works with continence difficulties I try to find the best motivators for the child, enlist their strengths and build their self-esteem and confidence to overcome the problem. It is also important to guide parents to be positive coaches for the child and reduce tension in the child and family. Changing family dynamics and using a narrative approach to externalise the continence problem (directing the focus away from the child as the problem, which can create blame and shame that tend to be immobilising, and onto the child-problem relationship) can be very helpful. A well-coordinated approach involving close work with paediatricians, physiotherapists and parents is vital in dealing with continence difficulties.

To see a powerpoint I delivered at the Childhood Continence Conference please click the pdf below. 

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