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Diagnostic Criteria PsychNetBack.gif (1523 bytes)

Refer to conditions of use

Encopresis

The voluntary or involuntary passage of stools causing soiling of clothes by a child over 4 years of age.  Encopresis can be divided into two groups. The first in which there is a physiologic basis for the encopresis, the second in which there seems to be an emotional basis.

* Encopresis frequently is associated with constipation and fecal impaction.

* Other causes may be related to a lack of toilet training or training at too early an age or an emotional
   disturbance such as Oppositional Defiant Disorder or a Conduct Disorder.

Accidentally or on purpose, the patient repeatedly passes feces into inappropriate places (clothing,
     the floor).

  For at least 3 months, this has happened at least once per month.

The patient is at least 4 years old (or the developmental equivalent).

This behavior is not caused solely by substance use (such as laxatives) or by a general medical
      condition (except through some mechanism that involves constipation).*

Code by specific type:

787.6 Encopresis With Constipation and Overflow Incontinence

307.7 Encopresis Without Constipation and Overflow Incontinence

 

Associated Features

Medical condition, bowel infection
Oppositional Defiant Disorder
Conduct Disorder


Differential Diagnosis 


Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Constipation
Fecal impaction


Treatment:

The goal of treatment is to prevent constipation and encourage good bowel habits. Here counseling and dietary advice is essential.

Counseling and Psychotherapy [ See Counselling Section ]:

Parental support and refrain from criticism or discouragement is important. Education of the parents and child, and biofeedback for the child is often used. Psychotherapy can help the child deal with associated shame, guilt, or loss of self-esteem. As an example, The child may suffer from low self-esteem and peer disapproval related to this problem. If routine bowel habits are not developed, the child may suffer from chronic constipation.


Medical & Other:

A diet high in fiber, including fruits, vegetables, and whole grain products and adequate fluid intake will promote the passage of softer stools and minimize the discomfort associated with bowel movements.  Consultations with Pediatric Gastroenterologists to treat the more difficult cases.  

Coding Note

* Mechanisms that involve constipation could include hypothyroidism, side effects of medication and a febrile illness that causes dehydration.

See Also Our Behaviour Disorders Links Page