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.
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.
