From the Guidelines
Encopresis should be treated by addressing the underlying cause, often chronic constipation, through disimpaction and establishment of regular bowel habits, as well as addressing any psychological factors, with the goal of improving morbidity, mortality, and quality of life. The treatment approach for encopresis typically involves a combination of medical and behavioral interventions.
- Disimpaction using oral laxatives like polyethylene glycol (PEG 3350) or enemas in severe cases is often the initial step, as suggested by 1.
- Maintenance therapy with stool softeners, dietary changes (increased fiber and fluids), and scheduled toilet sitting times after meals to take advantage of the gastrocolic reflex are also crucial, as these measures help in establishing regular bowel habits and preventing future impactions.
- Behavioral therapy may be necessary if psychological factors contribute to the problem, emphasizing the importance of a supportive, non-punitive approach by parents, as shame and punishment can worsen the condition 1.
- It's also important to consider the stepwise approach for managing fecal incontinence and defecatory disorders, which includes conservative therapies, pelvic floor retraining with biofeedback therapy, and other interventions as needed, as outlined in 1.
- The primary goal of treatment is to improve the child's quality of life by reducing the frequency of encopresis episodes, promoting regular bowel movements, and addressing any underlying psychological issues, which aligns with the principles of managing morbidity, mortality, and quality of life in clinical practice.
- Given the potential for significant improvement with proper treatment, a comprehensive and supportive approach is essential for managing encopresis effectively, as indicated by the most recent and highest quality evidence available 1.
From the Research
Definition and Diagnosis of Encopresis
- Encopresis is a condition where a child has fecal incontinence, which can be caused by various factors, including constipation or anatomic/organic disease 2.
- A careful history and physical examination are necessary to differentiate between encopresis with or without constipation and fecal incontinence caused by anatomic or organic disease 2.
Treatment of Encopresis
- Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen 2.
- 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 2.
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are effective and safe therapies for both long and short-term treatment of pediatric functional constipation 3.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories can be used as adjunct therapies in specific clinical scenarios 3.
Treatment Outcomes and Recovery Rates
- Almost every patient will experience dramatic improvement in encopresis, with recovery rates of 30% to 50% after 1 year and 48% to 75% after 5 years 2.
- A multidisciplinary treatment approach, including behavioral strategies and medications, can be effective in treating encopresis in children with developmental disabilities 4.
- Treatment can be successful when a combined approach using medical and behavioral strategies within the context of a developmental model is used 5.
Safety and Efficacy of Over-the-Counter Therapies
- Over-the-counter therapies, such as polyethylene glycol (PEG) and senna, have good evidence for efficacy and safety in treating chronic constipation 6.
- Other therapies, such as psyllium, magnesium salts, and stimulants, have moderate evidence for efficacy, while some therapies have insufficient evidence 6.
- Common adverse events associated with over-the-counter therapies include diarrhea, nausea, bloating, and abdominal pain, but no serious adverse events have been reported 6.