From the Guidelines
Therapy for encopresis should involve a multi-faceted approach combining medical management, behavioral interventions, and dietary modifications, with the goal of clearing fecal impaction, preventing reaccumulation, and addressing psychological factors. The initial treatment should focus on clearing any fecal impaction using oral laxatives such as polyethylene glycol (MiraLAX, 1-1.5 g/kg/day) or mineral oil (1-3 ml/kg/day), sometimes combined with enemas in severe cases 1. After disimpaction, maintenance therapy includes daily stool softeners like MiraLAX (0.5-1 g/kg/day) for 3-6 months to prevent reaccumulation while the bowel regains normal tone and sensation.
Some key points to consider in the treatment of encopresis include:
- A structured toilet sitting schedule is essential, typically having the child sit on the toilet for 5-10 minutes after meals to take advantage of the gastrocolic reflex 1
- Dietary changes should include increased fiber (age plus 5-10 grams daily) and adequate fluid intake
- Behavioral therapy helps address any anxiety or negative associations with toileting, while positive reinforcement systems reward successful bowel movements in the toilet
- Family education about the involuntary nature of encopresis is crucial to reduce shame and blame
- Treatment typically continues for several months, with gradual medication tapering once regular bowel habits are established
It's also important to note that biofeedback therapy can be used to train patients to relax their pelvic floor muscles during straining and to correlate relaxation and pushing to achieve defecation, and has been shown to improve rectoanal coordination during defecation and symptoms of constipation despite reduced laxative use 1. Additionally, a stepwise approach should be followed for management of fecal incontinence, with conservative therapies tried first, followed by pelvic floor retraining with biofeedback therapy, and then more invasive procedures such as sacral nerve stimulation if necessary 1.
From the Research
Therapy for Encopresis
Therapy for encopresis typically involves a combination of medical and behavioral strategies. The goal of treatment is to achieve bowel control and prevent further complications.
- Medical strategies may include the use of laxatives, such as polyethylene glycol 2, or other medications to soften stool and make it easier to pass.
- Behavioral strategies may include toilet training, bowel habits training, and positive reinforcement for successful bowel movements 3, 4.
- A multidisciplinary approach, involving pediatric nurses, nurse practitioners, and pediatricians, can be effective in treating encopresis 3.
- Treatment outcomes can vary depending on the individual child and the severity of their condition, but research suggests that a combined approach can be successful in achieving bowel control 3, 4.
Treatment Options
Several treatment options are available for encopresis, including:
- Polyethylene glycol, which has been shown to be safe and effective for treating chronic constipation 5, 6, 2.
- Laxatives, such as senna or bisacodyl, which can be used to stimulate bowel movements 5, 6.
- Suppositories, which can be used to elicit continent bowel movements 4.
- Biofeedback and surgery may also be considered in some cases, although these options are typically reserved for more severe cases of encopresis 5.
Effectiveness of Treatment
Research suggests that treatment for encopresis can be effective in achieving bowel control, although outcomes can vary depending on the individual child and the severity of their condition 3, 4. A study published in the Journal of Applied Behavior Analysis found that a multidisciplinary treatment approach was effective in increasing continent bowel movements in children with developmental disabilities 4. Another study published in Pediatric Nursing found that a combined medical and behavioral approach was successful in treating encopresis in children 3.