From the Guidelines
Encopresis should be treated with a multi-step approach, starting with clearing the bowel of impacted stool using polyethylene glycol laxatives like MiraLAX at 1-1.5g/kg/day for 3-7 days, followed by maintaining regular bowel movements with stool softeners and laxatives, and incorporating dietary changes and behavioral therapy as needed. This condition typically occurs in children over age 4 and is often caused by chronic constipation leading to impacted stool and overflow soiling 1. The treatment approach should prioritize clearing the bowel of impacted stool, as this is a common underlying cause of encopresis, and then focus on maintaining regular bowel movements to prevent future episodes 1.
Key Components of Treatment
- Clearing the bowel of impacted stool using polyethylene glycol laxatives like MiraLAX at 1-1.5g/kg/day for 3-7 days
- Maintaining regular bowel movements with stool softeners and laxatives, such as continued MiraLAX at lower maintenance doses of 0.5-1g/kg/day for several months
- Dietary changes, including increased fiber (20-30g daily), adequate fluid intake (at least 6-8 cups daily), and regular physical activity
- Establishing a consistent toilet routine, with scheduled sitting times after meals for 5-10 minutes
- Behavioral therapy to address any psychological factors, with positive reinforcement rather than punishment
Physiological Basis
The rectum stretching from retained stool reduces sensation and control, making it difficult for the child to recognize when they need to defecate 1. This highlights the importance of addressing constipation and impacted stool in the treatment of encopresis.
Additional Considerations
In some cases, encopresis may be related to underlying conditions such as fecal incontinence or defecatory disorders, and treatment may need to be tailored accordingly 1. However, the primary approach to treatment should focus on addressing constipation and impacted stool, and incorporating dietary changes and behavioral therapy as needed.
From the Research
Definition and Incidence of Encopresis
- Encopresis is defined as functional faecal incontinence at 4 years of age or older, affecting 1-3% of all school children 2.
- The two most important subtypes are encopresis with and without constipation 2.
Diagnosis and Assessment
- A careful history and physical examination can help differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease 3.
- Most children with encopresis with or without functional constipation require no or minimal laboratory workup 3.
- A multi-dimensional encopretic evaluation and management model can address encopresis at developmental, behavioral, and physiological levels 4.
Treatment Approaches
- Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen 3.
- The conventional treatment approach consists of behavior modification and laxative for children with encopresis with constipation, and behavior modification alone for the few children with encopresis without constipation 3.
- A symptom-oriented behavioral approach (toilet training) is most successful, with the addition of laxatives (polyethylene glycol) if constipation is present 2.
- Polyethylene glycol without electrolytes is an alternative for long-term management of children with constipation and encopresis 5.
Treatment Outcomes
- Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years 3.
- Almost every patient will experience dramatic improvement in encopresis 3.
- Combination therapy with high-fiber, laxative, and lubricant therapy is nutritionally safe and can help children with encopresis remain free of soiling or reduce soiling episodes 6.