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Encopresis is a disorder in which a toilet-trained child has bowel movements when he or she is not on the toilet. It is usually caused by chronic constipation.
What is encopresis and how is it treated?
Although controversy remains and conflicting data have been reported, many authors advocate behavioral strategies, with or without long-term laxative therapy, to encourage bowel movements in patients with chronic encopresis.
Should we use laxatives to treat encopresis?
These risk factors may increase the chances of having encopresis: 1 Using medications that may cause constipation, such as cough suppressants. 2 Attention-deficit/hyperactivity disorder (ADHD). 3 Autism spectrum disorder. 4 Anxiety or depression.
What are the risk factors for encopresis?
No evidence suggests that dietary interventions are beneficial in the management of encopresis. Although many people advocate high-fiber diets, the authors know of no studies conducted to systematically evaluate the effectiveness of dietary therapy in childhood encopresis.
Are dietary interventions beneficial in the management of encopresis in children?
How to treat encopresis?
The first step in treating encopresis is cleaning impacted stool out of the colon. A doctor may give the child enemas, laxatives and medication to soften the stool. If the colon has expanded to make room for a large volume of hard stool, those muscles will need time to return to their normal size.
How to prevent encopresis in children?
The best way to prevent encopresis is by avoiding constipation with a high-fiber diet, and making sure the child drinks lots of water and gets plenty of exercise. When your child is ready for toilet training, make it a positive experience. Try to avoid putting pressure on the child.
How to diagnose encopresis?
How is encopresis diagnosed? To diagnose encopresis, the doctor will do a physical exam, which might include a rectal examination (the doctor inserts a gloved, lubricated finger into the rectum). The doctor will also ask about the child’s history of difficulty with bowel movements.
What is the name of the disorder where the bowels are blocked?
Hirschsprung disease, a birth defect in which nerve endings in the bowel are missing, which causes a blockage of the intestine so that stool cannot pass through. Oppositional defiant disorder, a pattern of disobedience and hostility toward authority figures (including parents)
What do doctors want to know about a child's encopresis?
The doctor will want to know about the child’s toilet-training history and diet. The doctor may ask how the child feels about the problem, and about changes that have happened in his or her life. A psychological evaluation is another possible tool for finding the cause of a child’s encopresis.
What is it called when a child is not on the toilet?
Encopresis is a disorder in which a child who has already been toilet-trained is having bowel movements when he or she is not on the toilet. Other terms for this are soiling and fecal incontinence. Encopresis is a diagnosis for children who are at least four years old and still soiling their clothes.
What is encopresis?
Encopresis is when your child leaks stool into his or her underwear. It is also called stool soiling. It is most often because of long-term (chronic) constipation. Encopresis happens to children (generally 4 or older) who have already been toilet trained.
What causes encopresis?
In most cases encopresis happens because a child has long-term (chronic) constipation.
Who is at risk for encopresis?
Any child who has long-term (chronic) constipation may develop encopresis. Risk factors for constipation include:
How is encopresis diagnosed?
Your child's healthcare provider will give your child an exam and take a health history. Imaging tests may also be done to check the intestine and rule out other health problems. These tests may include:
How is encopresis treated?
Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is.
Can encopresis be prevented?
If your child's encopresis is caused by another health problem, treating that condition may help.
Living with encopresis
Making changes in your child's diet and activity level may help prevent constipation and stool soiling. But solving encopresis may be harder for some children. If your child soils his or her underwear, don't get angry or punish your child.
Why do children have encopresis?
Encopresis is a problem that children age 4 or older can develop due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry and difficult to pass. The child may avoid using the bathroom to avoid discomfort.
Why do boys have encopresis?
For unknown reasons, boys develop encopresis six times more than girls. Family stress can be linked to constipation, there does not seem to be any association between developing encopresis and how many children are in a family, a child's birth order (for example, first, middle, or last), a child's age, or the family's income.
How do you know if you have encopresis?
Symptoms may include: Loose, watery stools. Involuntary stooling, or needing to have a bowel movement with little or no warning, which may soil underwear when a child cannot get to the bathroom in time.
What is barium enema?
Barium enema. A test that checks the intestine for obstruction (blockage), strictures (narrow areas), and other abnormalities. A fluid that shows up well on X-ray, called barium, is given as an enema, and then the intestine is examined with an X-ray.
How to help a child with constipation?
Serve breakfast early so your child does not have to rush off to school and miss the opportunity to have a bowel movement. Increase exercise . Increasing the amount of exercise your child gets can also help with constipation.
Can encopresis cause emotional upset?
Children with encopresis can certainly feel emotionally upset by the "accidents" they have when they soil their clothes. They usually do not have control of this leakage of stool. Their self-esteem and interactions with other people can be affected. Children are often ashamed or embarrassed.
Can a child with constipation develop encopresis?
Any child with chronic constipation may develop encopresis. Some of the situations that lead to constipation include the following: Eating a high-fat, high-sugar, "junk-food" diet. Drinking mainly soft drinks and sugared drinks, and not drinking enough water and fruit juices. Lack of exercise.
Definition
Encopresis is the repeated passage of feces by a child age 4 or more in inappropriate places such as clothing. It is often the result of chronic constipation, which over time results in fecal impaction and a resultant leakage of liquid stool accumulated above the impacted feces.
Causes
Usually, encopresis is a physical disorder associated with chronic constipation and the development of abnormal patterns of external sphincter muscle practices whereby the muscle is contracted rather than relaxed when a bowel movement is attempted.
Treatments
The optimal treatment regimen of encopresis involves both a medical and behavioral approach. The treatment goals will likely be multifold:
Overview
Encopresis (en-ko-PREE-sis), sometimes called fecal incontinence or soiling, is the repeated passing of stool (usually involuntarily) into clothing. Typically it happens when impacted stool collects in the colon and rectum: The colon becomes too full and liquid stool leaks around the retained stool, staining underwear.
Causes
There are several causes of encopresis, including constipation and emotional issues.
Risk factors
Encopresis is more common in boys than in girls. These risk factors may increase the chances of having encopresis:
Complications
A child who has encopresis may experience a range of emotions, including embarrassment, frustration, shame and anger. If your child is teased by friends or criticized or punished by adults, he or she may feel depressed or have low self-esteem.
Prevention
Below are some strategies that can help prevent encopresis and its complications.
Treatment
Generally, the earlier that treatment begins for encopresis, the better. The first step involves clearing the colon of retained, impacted stool. After that, treatment focuses on encouraging healthy bowel movements. In some cases, psychotherapy may be a helpful addition to treatment.
Lifestyle and home remedies
Avoid using enemas or laxatives — including herbal or homeopathic products — without first talking to your child's doctor.
What is the treatment for encopresis?
Treatment, which should be administered by a physician, may include measures such as providing laxatives, enemas, or stool softeners and introducing a high-fiber diet. If necessary, a pediatric gastroenterologist may employ additional techniques to help overcome encopresis.
How to diagnose encopresis?
For a diagnosis of encopresis, according to the DSM-5: 1 A child passes feces—involuntarily or on purpose—into clothing, on the floor, or in other inappropriate places 2 This occurs at least once a month for three months 3 The child is at least 4 years old (or at an equivalent level of development) 4 This behavior must not be attributable to a substance's physiological effects or another medical condition, except through a mechanism involving constipation
Why do children with encopresis feel embarrassed?
It is often the result of chronic constipation, which over time results in the leakage of stool. Typically, this behavior is involuntary. Children with encopresis often feel ashamed and may seek to avoid entering situations where they could feel embarrassed.
How long does encopresis last?
A maintenance phase that involves scheduled toilet times and regular laxative use may last a couple of months or longer , according to the American Academy of Pediatrics. A psychotherapist may help a child with encopresis cope with its negative psychological effects, such as shame or decreased self-esteem.
How old is a child when they have encopresis?
The child is at least 4 years old (or at an equivalent level of development) This behavior must not be attributable to a substance's physiological effects or another medical condition, except through a mechanism involving constipation. Encopresis can be further classified according to two subtypes:
Is there evidence of constipation?
Without constipation and overflow incontinence: There is no evidence of constipation; soiling is intermittent; feces may be left in a prominent place; may coincide with the presence of oppositional defiant disorder or conduct disorder. article continues after advertisement.
What is the treatment for encopresis?
Pharmacologic Therapy. Because most children with encopresis have retentive encopresis as a consequence of chronic constipation with resulting overflow incontinence, medical therapy is initially focused on disimpaction of the distal colon, [ 22] which is followed by prolonged use of laxatives to ensure that the child passes soft stools frequently ...
How many soft stools can you get from a laxative?
Virtually any laxative can be used, provide that it is administered in sufficient quantity to produce 1-2 soft stools daily. No evidence suggests that dietary interventions are beneficial in the management of encopresis.
Is biofeedback invasive?
[ 25] Both manometric and electromyographic (EMG) biofeedback have been used to treat encopresis, but manometric biofeedback is more invasive than EMG biofeedback.
Is encopresis a randomized trial?
Despite the frequency with which childhood encopresis occurs, no large, randomized, controlled therapeutic trials have been conducted. [ 16] As a result, treatment remains largely experiential rather than evidence based. Conventional medical therapy is commonly the first therapy attempted, generally consisting of the following:
Is disimpaction effective in the oral route?
In clinical trials, disimpaction is reported to be equally effective whether done via the oral route or via the rectal route. [ 23, 24] Most enema preparations contain osmotically active agents that are not substantially absorbed in the colon (see Medication).
What is the purpose of enemas and suppositories?
Enemas (liquids) and suppositories (solids) are introduced rectally to stimulate an almost immediate reflex for bowel movements. Suppositories, usually made up of glycerin, provide bulk, lubrication, and moisture retention to stimulate bowel movements, and are very safe and non-irritating. Dulcolax is a common brand.
How do laxatives work?
Laxatives. Oral laxatives work by irritating the gastrointestinal tract, which then causes pushing contractions. They can also cause changes in the bowel over extended periods of time. These agents include Bisacodyl and Senna (a vegetable laxative). Senna can be dosed by squares in a divided chocolate bar.
How long does it take for a child to eliminate a gastrointestinal engine?
Starting the gastrointestinal engine with oral solutions is much more unpredictable in terms of timing (6-12 hours) before a child feels the need to eliminate. However, cultural sensitivities make the use of oral laxatives feel more acceptable than bottom up methods such as enemas and suppositories.
Is Bisacodyl a liquid suppository?
Bisacodyl, branded as “The Magic Bullet” can also be used as a suppository and is a more powerful, water-based agent. Liquid glycerin is much more stimulative and is also sold as a “liquid suppository” for infants (Pedia lax) and adults.
Can children resist enemas?
It is a very powerful and immediate stimulus leading to a bowel movement. Few children can successfully resist an enema. However, simply repeating enemas day after day is not a rational long-term approach. Soiling Solutions® is carefully designed to lead the child to becoming self-sufficient and independent.
Is Miralax hard to swallow?
It comes in a gel cap, which may be hard to swallow for children, and the taste is not palatable. Osmotic or Hypermolar Agents (e.g., MOM, Miralax) Made of mostly salts or carbohydrates, these oral supplements promote the transport of bodily fluids into the colon by the process of osmosis.
Is miralax good for encopresis?
Encouraging a child to drink lots of water or sports drinks is advisable with these agents to prevent dehydration or altered electrolyte levels. Miralax ( Polyethylene Glycol or PEG) has become dominant with the current practice of a top down treatment for encopresis.