Chapter 13.Enuresis and Encopresis

Although incontinence continues to be one of the leading causes of child abuse in this country, children with urinary or fecal accidents today fare much better than children of antiquity. The methods then used to attain continence seem freakishly harsh given the benign nature of the problem. Penile binding, buttock and sacrum burning, and forced urine-soaked pajama wearing are among the many aversive treatments reported in a review of ancient approaches to incontinence (Glicklich 1951). But perhaps the question of whether incontinence was a bigger threat to health in antiquity than it is now could at least partly explain why treatments were so harsh. The health-based consequences of prolonged incontinence during that time could be severe due to the limited means for cleaning bedding, beds, and clothing coupled with ineffective methods for managing infection. Another concern may have been the unpleasant olfactory sensations resulting from close contact with soiled bedding and clothing in homes where air circulation may have been poor. Fortunately for many incontinent children (unfortunately not all), practitioners and parents have mostly abandoned physically harsh treatments for incontinence and now use methods that are much more humane from a physical perspective and much more effective from an outcomes perspective.