From the Guidelines
Encopresis should be treated by addressing the underlying cause, often chronic constipation, and establishing regular bowel habits, with initial management including a bowel cleanout using laxatives such as polyethylene glycol (MiraLAX) or mineral oil, followed by maintenance therapy with stool softeners for several months 1.
Key Components of Treatment
- A high-fiber diet and increased fluid intake are essential components of treatment to help soften stool and promote regular bowel movements.
- Scheduled toilet sitting times, typically after meals, can help establish a routine and improve bowel habits.
- Parents should maintain a positive, non-punitive approach, as shame and punishment can worsen the condition.
- Behavioral therapy may be beneficial if psychological factors are contributing to the encopresis.
Importance of Addressing Underlying Cause
- Chronic constipation is a common cause of encopresis, and treating this underlying condition is crucial for resolving the encopresis.
- A bowel cleanout using laxatives such as polyethylene glycol (MiraLAX) or mineral oil can help clear the bowel of impacted stool and establish regular bowel habits.
- Maintenance therapy with stool softeners for several months can help prevent recurrence of constipation and encopresis.
Additional Considerations
- Biofeedback therapy and pelvic floor retraining may be considered for patients who do not respond to conservative measures, as suggested by a 2017 study on surgical interventions and device-aided therapy for fecal incontinence and defecatory disorders 1.
- However, the primary focus should be on establishing regular bowel habits and addressing any psychological factors contributing to the encopresis, rather than relying on more invasive or specialized treatments.
From the Research
Definition and Prevalence of Encopresis
- Encopresis is defined as functional faecal incontinence at 4 years of age or older and affects 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 will help to 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.
Treatment and Management
- 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.
- A symptom-oriented behavioural approach (toilet training) is most successful, with the addition of laxatives (polyethylene glycol) if constipation is present 2.
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 4.
- Biofeedback is not effective 2, while other forms of psychotherapy are indicated only in case of comorbid behavioural disorders 2.
Treatment Outcomes
- Recovery rates are 30% to 50% after 1 year and 48% to 75% after 5 years 3.
- Treatment took between 13 and 21 days in a study of children with developmental disabilities 5.
- A combined approach using medical and behavioral strategies within the context of a developmental model was successful in treating encopresis 6.