From the Guidelines
Encopresis is a recognized medical condition that refers to fecal incontinence in children, often associated with constipation and bowel dysfunction. The term "encopresis" is used to describe the involuntary passage of stool in children who are past the age of toilet training, and it is often linked to underlying issues such as constipation, bowel obstruction, or neurological disorders 1. According to the study published in the Journal of Urology, the management of encopresis typically involves a comprehensive approach that includes education, bowel management, and behavioral therapy 1.
The study highlights the importance of addressing constipation and bowel dysfunction in the treatment of encopresis, and notes that disimpaction and maintenance bowel management can be effective in resolving the condition 1. Additionally, the study suggests that behavioral therapy, such as biofeedback and pelvic floor muscle training, can be beneficial in teaching children to relax and coordinate their pelvic floor muscles, leading to improved bowel control 1.
Another study published in the Journal of the American Academy of Child and Adolescent Psychiatry notes that encopresis can be a symptom of underlying psychological or psychosocial issues, and that treatment should address these underlying factors 1. The study recommends a comprehensive approach to treatment that includes education, behavioral therapy, and family therapy, as well as medical management of underlying conditions such as constipation or bowel obstruction 1.
Key points to consider in the management of encopresis include:
- Education and awareness of bowel and bladder function
- Bowel management and disimpaction
- Behavioral therapy and biofeedback
- Addressing underlying psychological or psychosocial issues
- Medical management of underlying conditions such as constipation or bowel obstruction
- Collaboration with healthcare professionals, including pediatricians, psychologists, and gastroenterologists, to develop a comprehensive treatment plan.
Overall, the treatment of encopresis requires a comprehensive and multidisciplinary approach that addresses the underlying causes of the condition and promotes healthy bowel and bladder function.
From the Research
Definition of Encopresis
- Encopresis is a complex condition characterized by fecal soiling in clothing, often associated with functional constipation in children 2, 3.
- It is a disruptive event that can place both the child and family at risk for crisis 2.
Characteristics and Symptoms
- Encopresis is most common between the ages of 3 and 7 years 3.
- Infants and pre-school children may present with a history of constipation and withholding maneuvers, while school-age children may have constipation and fecal soiling for some time prior to detection 3.
- In some cases, encopresis is associated with enuresis and urinary tract infection 3.
Treatment Approaches
- A multi-dimensional approach to treatment may include bowel evacuation, a high-fiber diet, techniques of behavior modification, and maintenance on either contingent rectal cathartics or oral laxatives 2.
- Habit training, which involves initial disimpaction followed by attempts to defecate after a specific meal, and use of enemas contingent on failure to defecate, has been shown to be an effective treatment for encopresis secondary to chronic constipation 4.
- Enhanced toilet training (ETT) and biofeedback (BF) therapies have also been found to be beneficial in reducing soiling and improving bowel movements 5, 6.
- Family education is an essential first step in management, followed by disimpaction of stool and complete evacuation of the rectum, prevention of reaccumulation of stool, and gradual weaning of laxative regimen and instituting toilet training 3.