Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Introduction

• Encopresis refers to the repeated passage of solid feces in inappropriate places in children over the age of 4.
• Morecommon in boys than in girls, with a male-to-female ratio of approximately 5:1.
• Two main types: voluntary and non-voluntary.
• Cause is usually constipation. It may be a response to emotional or psychological stressors, e.g. sexual abuse.

Types of Encopresis

• Retentive Encopresis: Commonest accounting for about 80% of cases. It typically occurs due to constipation and bowel overflow, where the child withholds stool, leading to leakage.
• Non-Retentive Encopresis: Not associated with constipation and can be a response to emotional or behavioral factors, including anxiety, depression, or past trauma. Often related to a child’s emotional disorder.

Causes of Encopresis

The primary cause of encopresis is chronic constipation, which leads to fecal retention and overflow. However, in some cases, non-retentive encopresis may occur as a result of:

• Sexual abuse: Encopresis may be a behavioral response to trauma.
• Emotional and behavioral issues: Non-retentive encopresis may suggest stress, anxiety, or depression.
• Environmental factors: Poorly organized family environments or a lack of emotional expressiveness can contribute to the development of encopresis.

Clinical Features

• Recurrent soiling or passage of feces in inappropriate places (e.g., clothing, floor).
• Children may experience constipation, discomfort, or painful bowel movements prior to episodes of soiling.
• The behavior is typically involuntary, especially in cases of retentive encopresis.

Diagnosis of Encopresis is based on the child’s history, clinical examination

• A history of chronic constipation or withholding stool.
• Episodes of faecal leakage in the absence of any underlying medical condition.
• Psychosocial factors that may contribute to the behavior, such as family dynamics or emotional stress.

Management and Treatment

• Management of encopresis involves addressing both the physical and emotional components of the condition.
• Treatment strategies are tailored to the underlying cause and type of encopresis:
• For Retentive Encopresis (80% of cases):
  • Enemas: Used to clear impacted stool and relieve constipation.
  • Dietary changes: Increased fiber intake can help prevent constipation and promote regular bowel movements.
  • Stool softeners: Medications like polyethylene glycol (PEG) can help soften the stool and encourage normal bowel function.
  • Toilet training: Encourage regular toilet use, ideally 15-30 minutes after meals, to establish a healthy bowel routine.
• For Non-Retentive Encopresis
  • Behavioral therapy: Therapy techniques such as differential attention, contingency management, and contracting can help modify behavior.
  • Referral to a specialist: A child and adolescent psychiatrist can assess and manage emotional and behavioral factors that may be contributing to the condition.
  • Psychological support: Emotional issues such as anxiety or depression should be addressed to reduce any triggers for non-retentive encopresis.

Family and Emotional Support

Encopresis can be a source of significant distress for both the child and their family. Therefore, it is crucial to adopt a holistic approach that considers the family context. This condition is often associated with feelings of shame, anger, and ridicule. Family members should be encouraged to discuss their feelings and concerns openly. Additionally, understanding that encopresis can sometimes be related to anxiety, depression, attention difficulties, and social problems will help parents and caregivers provide the necessary support.

What to Tell Parents

• Reassure parents: Most children will eventually grow out of encopresis, and it is usually not a permanent issue.
• Encourage understanding: It is essential to avoid punishment or shame, as this can exacerbate emotional stress and prolong the issue.
• Highlight the benign nature: Stress that encopresis is generally a temporary condition, particularly in cases related to constipation, and that treatment can lead to significant improvement.

Conclusion

Encopresis is a common condition in children, often caused by chronic constipation, emotional stress, or a combination of both. With appropriate treatment, including dietary adjustments, behavioral therapy, and emotional support, most children can overcome the condition. It is important to approach encopresis with empathy and understanding, ensuring that the child and their family receive the necessary support to manage the condition effectively.