Enuresis and encopresis: Ten years of progress

Objective: To review the progress made over the past decade with regard to the treatment of enuresis and encopresis, as well as advances in the unders tanding of etiological mechanisms. Method: Separate computerized literature (English language only) searches of Medline and PsycINFO databases were co nducted under the parameter of enuresis and children-adolescents, as well a s encopresis and children-adolescents. Results: There has been a substantia l decrease in published research concerning the use of imipramine to treat enuresis compared with the prior two decades, accompanied by a correspondin g increase in the number of papers concerning desmopressin acetate (DDAVP), which has become the primary pharmacological treatment. Genetic studies of large pedigrees have further confirmed the importance of heritable factors . With regard to encopresis, the research has focused primarily on pathophy siological factors related to the colon and anal sphincter. Conclusions: Th e widespread use of DDAVP has been the primary addition to treatment strate gies over the past decade. The bell-and-pad method of conditioning, the onl y major treatment that has enduring benefit after being withdrawn, is the m ost cost-effective and appears to be underutilized. Research into etiologic al mechanisms has focused primarily on the mechanism of action of DDAVP and advances in the understanding of genetic factors. Advances in the treatmen t and etiological understanding of encopresis have been less impressive.