Encopresis is an elimination disorder that involves frequently having bowel movements in improper places at the age when bowel control is expected. It is also called “soiling” or “fecal incontinence.”
Description
By four years of age, most children are trained for bowel movements to toilet. After that, if inappropriate bowel movements occur continuously for several months, a child may be suffering with encopresis. Encopresis is either intentional or unintentional. Intentional soiling is related to several psychiatric disorders. Unintentional soiling occurs due to constipation.
Causes and symptoms
The only symptom of encopresis is that a child has bowel movements in wrong places, such as in clothing or on the floor. This soiling is not the result of laxatives or other medications, and is not due to a disability or physical defect in the bowel.
Types of encopresis
There are two main types of encopresis with different causes.
Involuntary encopresis
In this condition, a patient can’t control elimination of feces from the bowel. The feces is semi-liquid to almost liquid, and it leaks into clothing without the patient will to expel it. Leakage generally occurs during day-time when the person is active, and may be continuous.
Involuntary encopresis results from constipation. Harder mass of feces develops in the colon or rectum and is not completely expelled during a routine bowel movement in the toilet. This mass stretches the large intestine out of shape, allowing liquid feces to leak out. Up to 95% of encopresis is involuntary.
Voluntary encopresis
Patient of voluntary encopresis has control over and when and where bowel movements occur and chooses to have them in inappropriate places. Constipation is not a factor in this case, and the feces is usually of normal consistency. Often feces is soiled in an apparent place, although occasionally it is hidden around the house. The APA classifies voluntary encopresis as encopresis without constipation and overflow incontinence.
In young children, voluntary encopresis may represent a power struggle between the child and the caregiver doing the toilet training. In older children, voluntary encopresis is frequently connected with oppositional defiant disorder (ODD), conduct disorder, sexual abuse, or high levels of psychological pressures.
Treatments
Involuntary encopresis is treated by eliminating the cause of constipation and establishing soft, pain-free stools. This treatment includes:
- Rising the amount of liquids in child drinks and diet
- Adding highly-fibrous foods to the diet
- Short-term use of laxatives or stool softeners
- Cleaning the colon by using an enema
- Establishing regular bowel habits
Once the problem of constipation is resolved, involuntary encopresis normally stops.
On the contrary, treatment of voluntary encopresis depends on the root cause. When it results from a power struggle between child and adult, it is treated with behavior modification. In addition to taking the steps mentioned above to ensure a soft, pain-free stool, the adult should make toileting a pleasant, pressure-free activity. Some experts advise transferring the initiative for toileting to the child instead of constantly asking them to use the toilet. Others recommend toileting at scheduled times, but without pressure to perform. If resistance to using the toilet continues, the family may be referred to a child psychiatrist or a pediatric psychologist.
With older children who hide feces, voluntary encopresis is a by- product of another more serious disorder. When children are successfully treated for the underlying disorder with psychiatric interventions, behavior modification, and education, the encopresis is often resolved.
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