Encopresis - Causes, Symptoms and Treatment

Most children are potty trained by the age of four. However, if your child continues to have a lot of bowel movement accidents this is called encopresis. Encopresis is one of the more frustrating disorders of middle childhood. Encopresis affects 1 to 3 percent of children, with higher rates in boys than in girls. is the passing of stools into the underwear or pajamas, far past the time of normal toilet training. Encopresis is commonly caused by constipation , various physiological , psychological, or neurological disorders, or from surgery. Ninety percent of encopresis cases are due to functional constipation - that is, constipation that has no medical cause. The stool (or BM) is hard, dry, and difficult to pass when a person is constipated. Many kids "hold" their BMs to avoid the pain of constipation, which sets the stage for having a poop accident. Chronic constipation due to irregular and incomplete evacuation results in progressive rectal distention and stretching of both the internal anal sphincter and the external anal sphincter (EAS). As the child habituates to chronic rectal distention, he or she no longer senses the normal urge to defecate. Soft or liquid stool eventually leaks around the retained fecal mass, resulting in fecal soiling. Encopresis may also be due to psychological problems, such as oppositional defiant disorder or conduct disorder . However, it is typically thought of as mainly a physical problem with a psychological component (but not cause). Most children with encopresis deny the urge to defecate associated with their soiling episodes.

Many school age children soil late in the afternoon after returning home from school. Soiling episodes occur during the daytime when the child is awake and active. Stool can be palpated throughout the distribution of the colon, most notably in the left lower. Encopresis can lead to many problems. Mega colon : When the colon gets bigger and bigger. This hurts the colon's muscles and nerves. Then they can't signal it's time for a bowel movement. When the skin around the rectum cracks and bleeds. Fissures hurt. Bladder Infection : The big colon can press on your child's bladder. It can keep the bladder from emptying. When urine stays in the bladder, it can cause an infection. It can also cause wetting accidents. In many children with encopresis, the colon has become stretched out of shape, so they may intermittently pass extremely large bowel movements. The medical assessment is usually normal, and signs of constipation are noticeably absent. Laxatives make it easier to have a bowel movement. They make the feces softer. They help your child have a regular BM. Use an enema or suppository if necessary. Your nurse will show you how to use an enema or suppository. Using an enema or suppository cleans out the colon and rectum. Biofeedback technique has been used successfully to teach some children how to best use their abdominal, pelvic and anal sphincter muscles, which they have so often used to retain stool.

Causes of Encopresis

Common causes and risk factors of Encopresis

• Constipation
• Anatomic abnormality.
• Physiological factors
• Neurological disorders.
• Surgery.

Signs and Symptoms of Encopresis

Common sign and symptoms of Encopresis

• Mega colon.
• Fissures.
• Bladder Infection.
• Soiling episodes usually occur during the day.
• Colon has become stretched out of shape.
• No urge to pass a bowel movement before they soil their underwear.

Treatment of Encopresis

Common Treatment of Encopresis

• Full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems.
• Successful interventions depend on the presence of soft, comfortable bowel movements and addressing toilet refusal behavior.
• Daily scheduled positive toilet sits are recommended.
• Incentives may be used to reinforce successful defecation during these sits.
• Use laxatives. Laxatives make it easier to have a bowel movement. They make the feces softer. They help your child have a regular BM. .
• To restore normal physiological control over bowel function; and
• Defuse conflicts and reduce concerns within the family brought on by the child's symptoms.