From the Guidelines
Encopresis should be treated with disimpaction and establishment of a healthy bowel regimen, as this approach often eliminates the condition, especially when it is associated with constipation or palpable stool impaction 1. When treating encopresis, it is crucial to address the underlying cause, which is often chronic constipation leading to impaction. The initial step involves disimpaction, which can be achieved using oral laxatives such as polyethylene glycol (PEG 3350) or enemas in severe cases. Following disimpaction, maintenance therapy with stool softeners and laxatives is essential to prevent reaccumulation of hard stool. Key aspects of treatment include:
- Disimpaction using oral laxatives like PEG 3350
- Maintenance therapy with stool softeners and laxatives
- Dietary changes, including increased fiber and adequate fluid intake
- Regular physical activity
- Behavioral interventions like scheduled toilet sitting times The goal of treatment is to establish regular bowel habits and prevent future episodes of encopresis. By addressing the underlying cause and implementing a comprehensive treatment plan, most children can improve significantly, although complete resolution may take several months 1.
From the Research
Definition and Prevalence of Encopresis
- Encopresis is a condition where a child has a bowel movement in inappropriate places, such as in their underwear, at an age where they should be able to control their bowel movements 2.
- It is estimated that up to 3% of the pediatric population suffers from encopresis 2.
Treatment of Encopresis
- Treatments for encopresis often employ behavioral strategies, medications such as suppositories, laxatives, or enemas, and in some cases, a combination of these approaches 3.
- A multidisciplinary treatment approach, including medical and behavioral strategies, has been shown to be effective in treating encopresis in children with developmental disabilities 3, 2.
- Over-the-counter laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are commonly used to treat constipation, which is often a contributing factor to encopresis 4, 5.
Efficacy of Different Treatments
- Osmotic laxatives, such as PEG 3350, have been shown to be effective and safe for the treatment of pediatric constipation 4, 5.
- Stimulant laxatives, such as senna, have also been found to be effective in treating constipation, although they may have more side effects than osmotic laxatives 4, 5.
- The efficacy of different bowel preparation protocols, including high-volume polyethylene glycol, low-volume polyethylene glycol plus laxative, and sennosides, has been compared in children, with no significant differences found among the groups 6.