Also known as paradoxical diarrhea, is voluntary or involuntary fecal soiling in children who have usually already been toilet trained.
Children with encopresis often leak stool into their undergarments.
Term is usually applied to children.
The estimated prevalence in four-year-olds is between one and three percent.
It is more common in males than females, by a factor of 6 to 1.
When symptoms are present in adults, it is more commonly known as fecal leakage, fecal soiling or fecal seepage.
It is usually caused by constipation, by reflexive withholding of stool, by various physiological, psychological, or neurological disorders, or from surgery.
The colon normally removes excess water from feces, and if the feces or stool remains in the colon too long due to conditioned withholding or incidental constipation.
Subsequently, the stool becomes hard, and painful for the child to expel in an ordinary bowel movement.
The above may result in the child avoiding moving his/her bowels in order to avoid a painful toilet episode.
When deeply conditioned the rectal anal inhibitory response (RAIR) or anismus results.
Can occur even under anesthesia and when voluntary control is lost.
Eventually stool continues to build up and stretches the colon or rectum to the point where the normal sensations associated with impending bowel movements do not occur.
Eventually, softer stool leaks around the stool blockage and cannot be withheld by the anus, resulting in soiling.
The child typically has no control over these leakage accidents.
The child may not be able to feel that they have occurred or are about to occur due to the loss of sensation in the rectum and the rectal inhibitory rectal response.
Strong emotional reactions typically result and may complicate conventional treatments using stool softeners, and behavioral strategies.
The onset of encopresis is most often benign and is usually associated with toilet training.
Associated with parental demands that the child sit for long periods of time, and intense negative reactions to feces.
Shared bathrooms in schools is a major environmental trigger.
FeArguing among parents, and siblings, moving, and divorce can inhibit toileting behaviors and promote constipation.
Repeated passage of feces into inappropriate places may occur.
The approach to the treatment of encopresis associated with constipation:
cleaning out with enemas, laxatives, or both.
using stool softening agents
scheduled sitting times typically after meals.
Enemas and laxatives are used daily to keep the stools soft and allow the stretched bowel to return to its normal size.
Children must be taught to use the toilet regularly to retrain their body.
Creating a regular schedule of bathroom time allows a child to achieve a proper elimination pattern.
If this method fails, a more aggressive approach using suppositories and enemas to overcome the reflexive holding response and to allow the proper voiding reflex to take over.
Failure to establish a normal bowel habit can result in permanent stretching of the colon.
Diet recommendations in the case of constipation-caused encopresis include:
reduction in the intake of constipating foods such as dairy, peanuts, cooked carrots, and bananas.
increase in high-fiber foods such as bran, whole wheat products, fruits, and vegetable higher intake of water and liquids, such as juices.
limit drinks with caffeine, including cola drinks and tea
Eating well-balanced meals and snacks.
Limited intake of fast foods/junk foods that are high in fats and sugars.
limit whole milk to 500 mL a day for the child over 2 years of age.
Behavioral treatment can be added to increase effectiveness.