What presentations are included?

• Intermittent daytime urinary accidents in a child older than expected for bladder control but without persistence required for enuresis diagnosis.
• Occasional soiling episodes that do not meet frequency/duration for encopresis but cause social or caregiver concern.
• Toileting refusal, selective withholding, regressive daytime wetting after trauma/illness, or atypical patterns linked to developmental disorders.

Assessment priorities

1. Clarify timeline, frequency, and context (day/night, school vs home), and any precipitating events (illness, toilet training change, family stress, abuse).
2. Basic medical review: urinary symptoms (dysuria, frequency), bowel habits (constipation, stool consistency), fluid intake, medications, and growth/development milestones.
3. Red flags: pain on passing urine, haematuria, failure to thrive, neurologic signs, or signs of sexual abuse — investigate promptly.
4. Consider neurodevelopmental screen for autism spectrum disorder, ADHD or intellectual disability when patterns suggest sensory or behavioural contributors.

Initial investigations (targeted)

• Urinalysis and urine culture if urinary symptoms present; pregnancy test in post‑menarcheal adolescents where relevant.
• Abdominal examination for faecal loading; consider abdominal X‑ray if constipation suspected and history unclear.
• Further testing (urodynamics, renal ultrasound, neurologic imaging) reserved for recurrent problems, suspected organic pathology, or abnormal exam findings.

Treatment principles

• Address reversible medical contributors first (UTI, constipation, pain) and optimise bowel habits with dietary advice and laxatives if indicated.
• Use behavioural toilet training techniques adapted to the child’s cognitive and sensory profile: scheduled sits, positive reinforcement, stepwise desensitisation for toileting refusal.
• Collaborate with caregivers and schools to create consistent, low‑pressure toileting routines and avoid punishment or shaming.
• For children with neurodevelopmental differences, adapt interventions (visual schedules, social stories, sensory supports) and involve occupational therapy where needed.
• Consider short courses of bladder‑training exercises, timed voiding, biofeedback or referral to paediatric continence services for persistent cases.

Behavioural strategies — practical tips

1. Scheduled toileting: encourage voiding every 2–3 hours in younger children, after meals, and before leaving the house.
2. Positive reinforcement: sticker charts, immediate praise, and small rewards for successful toileting.
3. Desensitisation for toileting refusal: start with brief tolerated steps (sitting fully clothed, then with clothes down, then attempting voiding) and gradually progress.
4. School liaison: provide discreet plans, ensure access to toilets, and educate staff on non‑punitive support strategies.

When to refer

• Alarm features or abnormal examination (see assessment) — urgent paediatric/urology referral.
• Persistent problems despite 3–6 months of structured intervention, significant psychosocial impact, suspect developmental disorder — refer to paediatric continence, child psychiatry, or developmental paediatrics.
• Consider multidisciplinary input (physio/urology/OT/psychology) for complex cases.

Key takeaways

• Other Specified Elimination Disorder covers toileting problems that are clinically important but atypical in frequency/pattern; assessment targets reversible causes and contextual triggers.
• Start with medical review (UTI, constipation), implement low‑pressure behavioural strategies, and liaise with caregivers and schools.
• Refer when alarm features present, when problems persist despite structured intervention, or when developmental concerns exist.