From the Guidelines
Encopresis should be treated by addressing the underlying cause, often chronic constipation, through disimpaction and establishment of a healthy bowel regimen, as this approach can eliminate the condition in many cases 1. When managing encopresis, it's crucial to consider the potential for mechanical pressure on the bladder due to constipation or palpable stool impaction, which can contribute to enuresis, as noted in the practice parameter for the assessment and treatment of children and adolescents with enuresis 1. The treatment approach involves:
- Disimpaction using oral laxatives or rectal enemas in severe cases
- Maintenance therapy with stool softeners and dietary changes to increase fiber and fluids
- Scheduled toilet sitting times after meals to utilize the gastrocolic reflex
- Behavioral therapy if psychological factors are contributing to the condition Key aspects of treatment include:
- A supportive, non-punitive approach by parents to avoid worsening the condition through shaming
- Recognition that chronic constipation can lead to stretching of the rectum, reducing sensation and weakening rectal muscles, making it difficult for the child to control bowel movements
- The importance of addressing any co-occurring conditions, such as enuresis, which may be related to the encopresis due to mechanical pressure on the bladder 1.
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.
- It is a complex condition presenting a treatment challenge for health care providers, and is a disruptive event, placing both the child and family at risk for crisis 3.
Etiology and Subtypes
- The two most important subtypes are encopresis with and without constipation 2.
- In preschoolers, toilet refusal syndrome can occur, and comorbid behavioural disorders and urinary incontinence are common 2.
Assessment and Treatment
- 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 4.
- Successful treatment of encopresis requires a combination of parent and child education, behavioral intervention, medical therapy, and long-term compliance with the treatment regimen 4.
- A symptom-oriented behavioural approach (toilet training) is most successful, with the addition of laxatives (polyethylene glycol) if constipation is present 2.
- Biofeedback is not effective, and 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 4.
- Combination therapy with high-fiber, laxative, and lubricant therapy is nutritionally safe and effective in reducing soiling episodes 5.
- Polyethylene glycol-electrolyte solution is a safe and effective therapeutic program for intestinal clearance in children with refractory encopresis 6.