Encopresis

General Illness Information

Medical Term:
ENCOPRESIS

Common Name: None Specified

Description:

Lack of bowel control in a child , older than 4 years of age, and who does not have an organic defect or illness. A child cannot be expected to have complete bowel control until at least 2-1/2 years of age.

Occurs in about 1% of 4 year olds.

Causes: Most of these accidental bowel movements result from resistance to toilet training. However, they are sometimes caused by chronic constipation, which stretches the bowel wall and reduces the child’s awareness of a full bowel and impairs muscle control.

However, there are other causes of encopresis and they are as follows:

  • Physical or emotional crisis in the child’s life, such as birth of a sibling or recent illness with diarrhea;
  • Less frequently, might be due to impairment in the child’s nervous system;
  • Painful bowel movements;
  • Resistance to using toilet facilities at school, on camping trips, or outdoor toilets;
  • Dietary problems that cause constipation (such as lack of fiber, excessive protein or milk intake, inadequate water intake).
  • There may be organic causes for constipation and encopresis and must be ruled out.

Prevention:

  • Avoid undue emphasis on toilet-training. Approach it calmly with realistic expectations. Don’t shame or blame the child for accidents.
  • Avoid constipation by maintaining good diet and nutrition for your child .Treat constipation promptly by using dark Karo syrup and fiber for hard stools.
  • Seek medical attention promptly for painful defecation.
  • Look for signs of relapse which include large caliber stools, decrease in frequency of defecation and soiling.

Signs & Symptoms

  • Soiling of underwear.
  • Constipation usually accompanies encopresis ( there is a subgroup of children who do not have constipation).
  • Large amount of fecal material on abdominal, pelvic or rectal exam.
  • Fecal or foul odor surrounds the child.
  • Often intermittent abdominal pain around the umbilicus.
  • Occasional passage of a voluminous stool.
  • History of painful bowel movements.
  • Some have had recurrent urinary tract infections.
  • Some children are shy and withdrawn and other show aggressive behavior.

Risk Factors

  • Stress.
  • Recent illness that brought the child increased attention
  • Child abuse.
  • Boys are more often affected.
  • Difficulty with bowel training.
  • Unresolved fecal retention and impaction.

Diagnosis & Treatment

Diagnosis is suspected when there is history of soiling of undergarments.

Impaction must be eliminated before starting a maintenance program Also, must look for underlying treatable causes of constipation.

General Measures:

  • Encourage your child to sit on the toilet at consistent times twice daily for 10 minutes each time. This should be preferably after meals.
  • Praise your child for having bowel movements in the toilet. The child deserves positive reinforcement for success. Other family members may also praise the child.
  • Provide a prearranged reward if the child stays clean all day. The favorite reward of many children is 30 minutes of free time with either parent, doing whatever the child chooses. Incentives build motivation to succeed.
  • Respond gently to accidents. When the child is soiled, he should clean himself and change into clean underwear. For younger children (under 5), the parent will probably do this.
  • Don’t blame, criticize, restrict or punish the child for accidents. This may cause him to give up , as well as lead to secondary emotional problems.
  • Don’t allow siblings or others to tease the child.
  • Never put the child back in diapers.
  • Ask for the school’s cooperation. The child needs quick access to the bathroom at school, especially if he is shy or new at school. Remind him that there should be nothing embarrassing about leaving the classroom to go to the bathroom.
  • Identify stresses in the child’s life and make every effort to ease them.

Medications:

  • Stool softeners and bulk producers may be helpful. Mineral oil 15 to 30 ml daily for a few months may help, but should not be given to infants or to debilitated patients.
  • Enemas or suppositories may be necessary if there is an impaction.
  • Prune juice may help with hard stools.

Activity:

No restrictions.

Diet:

  • Avoid excessive milk, bananas, apples and gelatin.
  • Increase fiber.

Possible Complications :

  • Anal fissure.
  • Skin rash in rectal area
  • Stool impaction.
  • Excessive enemas and suppositories may cause colitis (inflammation of the large bowel).

Prognosis

Usually curable, unless there is a serious underlying physical problem. Relapses may occur.

Other

‘Nothing Specified’.