Encopresis is accidental loss of control of the bowels. This usually results in stool staining the underwear. In order to be considered encopresis, there is no other physical problem or illness that could be responsible for the loss of stool. Encopresis occurs in children four and older.
Causes
Causes include:
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Chronic constipation (about 80%) – When a large amount of hard, dry stool is filling the rectum, over time the child becomes unable to recognize the sensation of fullness and the need to defecate. Liquid stool may leak around the hard mass of stool, causing staining of the underwear.
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Poor toilet training or refusal to use the toilet for bowel movement
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Emotional problems
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A variety of very rare physical problems that may present with constipation (with or without associated encopresis)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
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Sex: Male
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Passage of firm stool that causes a painful tear or “fissure” of the opening of the anus
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Children with emotional problems, such as:
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Children who have suffered sexual abuse (according to some researchers)
Symptoms
Symptoms include:
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Accidental passage of stool, usually into the underwear
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Low self-esteem
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Feelings of embarrassment, shame, or guilt
Diagnosis
The doctor will ask about symptoms and medical history, and perform a physical exam. Most children with encopresis have no physical problem. While parents are often unaware that their child is constipated, they may see their child forcibly holding stool when he or she experiences the urge to defecate. The description of stool holding is quite important for making the diagnosis of constipation. The exam may include a rectal exam, which may reveal the presence of a large quantity of hard dry stool in the rectum. An x-ray of the abdomen may also show stool in the rectum.
Treatment
The doctor will explain to the parents and the child why encopresis is occurring. The parents should be encouraged not to shame the child.
Bowel Clean-Out
If constipation is a problem, enemas and mineral oil or other laxatives may be used to clean out the bowel. Under supervision from your doctor, regular laxatives are used and often continued for as long as 4-6 months.
If symptoms are not improving rapidly or if your child is passing blood with stools, then further testing may be needed to exclude other very rare disorders that may have different treatments.
Dietary Changes
To help prevent the return of constipation, the child should:
Behavioral Therapy
Help your child learn when to use the toilet. Give rewards for success in keeping the clothes clean and passing a bowel movement into the toilet.
Counseling
This may be needed if:
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There were severe problems with toilet training.
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The child has emotional problems.
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There are family problems contributing to the child's encopresis.
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The child is experiencing shame, guilt, or low self-esteem due to encopresis.
Prevention
Following reasonable guidelines for toilet training may help prevent encopresis. A healthy, high fiber diet and adequate liquid intake may also help prevent encopresis.
RESOURCES:
American Academy of Family Physicians
http://www.aafp.org
References:
Nelson Textbook of Pediatrics. 16th ed. W.B. Saunders Company; 2000.
Kuhn BR, Marcus BA, Pitner SL. Treatment guidelines for primary nonretentive encopresis and stool toileting refusal.Am Fam Physician. April 15, 1999;59(8). Available at: http://www.aafp.org/afp/990415ap/2171.html.
