Encopresis

Key Features

• Defined as the repeated passage of stool into inappropriate places (such as in the underpants) by child who is chronologically or developmentally older than 4 years

• Occurs each month for at least 3 months and is not attributable to the physiologic effects of a substance or another medical condition except to the mechanism involving constipation

• Prevalence at highest between 5 and 6 years of age

Clinical Findings

• Constipation is defined by two or more of the following events for 2 months

  • Fewer than three bowel movements per week

  • More than one episode of encopresis per week

  • Impaction of the rectum with stool

  • Passage of stool so large that it obstructs the toilet

  • Retentive posturing and fecal withholding

  • Pain with defecation

• Conditions associated with constipation include

  • Metabolic disorders such as hypothyroidism

  • Neurologic disorders such as cerebral palsy or tethered cord,

  • Anatomic abnormalities of the anus

  • Stress or maltreatment

Diagnosis

• A complete history and meticulous physical examination must be performed, including a rectal examination, particularly looking for abnormalities around the anus and spine

• An abdominal radiograph can be helpful in determining the degree of constipation, the appearance of the bowel, and whether there is obstruction

Treatment

• Initial intervention starts with treatment of constipation

• Subsequently, education, support, and guidance around evacuation are essential

• If there is an underlying psychiatric disorder, such as depression, the child should be treated for the mental health problem as well as constipation

• When medical management of constipation is indicated, oral medication or an enema for "bowel cleanout" followed by oral medications should be used

• Child should be encouraged to have a daily bowel movement, and the use of fiber, some laxatives, and even mineral oil can be helpful