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Encopresis
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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.

1. Encopresis frequently is associated with constipation and fecal impaction.

2. 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).

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.

 


DSM Code

307.6 Encopresis

F98.1 Encopresis

Disorder Sheets

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Recommended Book

Childhood Encopresis and Enuresis: Causes and Therapy - Click Here to View

 

Encopresis

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